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HIV+/AIDS and Diet

It is estimated that 312,000 people in the US currently have AIDS compared to 76,000 in 1990. Increasing proportions of persons with AIDS are women, people of color, injection drug users (IDUs) and heterosexuals. The data suggests that HIV incidence has not declined since the early 1990s and declines in AIDS incidence and deaths since 1995 were caused by slower progression of HIV-associated disease due to the new highly active antiretroviral therapy (HAART) [1], [2]

The dietary recommendations to a HIV+ patient are very dependent on the patient's specific symptoms and stage of the disease. The American Dietetics Society and the Canadian Dietetics Society have published some dietary guidelines [3], [4]. The following issues often need to be addressed:

1. Weight loss of greater than 10% from pre-HIV status still accounts for approximately 30% of deaths from HIV+ [5]. Intense nutritional counseling has been reported to increase body weight even in those whose Body Mass Index (BMI) has dropped below 20 [6]. Such counseling has concentrated on increased intake of high quality food which is high in protein and antioxidants.

2. Diarrhea is still prevalent and may now be due to both the disease and to the medications. A high fiber diet has been reported to be useful in improving control of number and severity of bouts of diarrhea.

3. Development of hyperlipidemias is now being reported in HIV+ patients which has caused a re-evaluation of recommendations for a high fat intake to guard against weight loss. Current recommendations include use of protein foods that are lower in saturated fat and cholesterol to decrease serum cholesterol levels and increased intake of n-3 fatty acids to lower serum triglycerides. These are the recommendations for persons with hyperlipidemia who do not have HIV+. There is little data on the response of HIV+ patients to these standard diet approaches but since these are diets that are known to improve general good health they are advisable while data are being accumulated on nutritional approaches for HIV+ patients. Medications to lower serum lipids are to be used if dietary approaches are not useful since this population is already taking a large battery of medications, many of which are known to cause liver problems. Statins also carry this risk and therefore are added with caution and extra testing for status of liver function. It is generally agreed that protease inhibitors are an independent contributor to dyslipidemia in HIV+ subjects [7]

4. Fat Redistribution Syndrome (FRS) is being reported in 40-50% of HIV+ patients and it is generally agreed that HIV protease inhibitors, as a class, make an independent contribution to dyslipidemia and insulin resistance that may affect FRS [8]. However, Batterhorn et al. reported no association between total fat, saturated fat intake and serum lipids, insulin resistance or body composition parameters in a cross-sectional study of 100 HIV patients with FRS compared to non-HIV controls without FRS[9]. However, changes in exercise and diet have been reported to be helpful in reversing some parameters of the FRS [10]. The metabolic cause of the syndrome is still unknown but control of weight by exercise and a lower fat diet, with high quality food such as fruits, vegetables and whole grains is an appropriate and conservative approach. Hadigan et al. [11] carried out a cross-sectional study in N=85 HIV-infected subjects with FRS and found that dietary fiber was inversely associated with insulin area under the curve (AUC) (p=0.001).

5. Syndrome X is being reported in the HIV+ population at increasing frequency. It is characterized as having 3 or more of the following criteria: 1) abdominal obesity, 2) hypertriglyceridemia >150 mg/dl), 3) low HDL, 4) high blood pressure, and 5) high fasting glucose (>110 mg/dl) [12]. It is considered to increase risk of developing diabetes and cardiovascular disease. The intervention of diet focuses on high fiber, foods with a low glycemic index, low saturated fat diet and high intake of fruits and vegetables. Increased intake of n-3 fatty acids are included to decrease serum triglycerides. Exercise is suggested to decrease abdominal obesity and improve HDL. New research is investigating the role of nutritional status, defined as serum micronutrient levels, and progression of disease in order to duplicate data in the pre-HAART era of medications that indicated that higher serum levels of vitamin A, E, B12, zinc and selenium were associated with decreased progression of HIV+ [13].

Resources and Links - HIV+ as a Condition

1. HIV/AIDS
   Centers for Disease Control and Prevention - Divisions of HIV/AIDS Prevention

2. HIV Infection and AIDS: An Overview
   National Institute of Allergy and Infectious Diseases