Manual of Clinical Nutrition

HIV Infection and AIDS

Manual of Clinical Nutrition Management III- 55 Copyright © 2013 Compass Group, Inc.

Generic Name (commercial name);
Class of Drug (manufacturer);
Forms (tablets, capsules, oral
solutions, or injections)

Food, Drink, and

Other Interactions

Potential Side Effects

Zalcitabine, ddC (Hivid);
NRTI (Roche);
Tablets (contain lactose)

Take on an empty

stomach;

Avoid drinking alcohol

Loss of appetite, mouth sores, nausea
and vomiting, diarrhea, constipation,
problems with feeling in your arms
and legs, lactic acidosis (rare),
inflamed pancreas (rare), increased
triglyceride levels, anemia
Dose may be changed for kidney
problems
Zidovudine, AZT, Compound S,
Azidothymidine (Retrovir);
NRTI (Glaxo SmithKline);
Tablets, capsules, syrup (strawberry),
injections

Take with or without

food;

Do not take with a

high-fat meal

Loss of appetite, nausea and vomiting,

upset stomach, constipation, taste

changes, anemia, muscle disease in

long-term use;

Dose may be changed in impaired liver

or kidney function

(^1) NRTI = nucleoside reverse transcriptase inhibitor
(^2) NNRTI = non-nucleoside reverse transcriptase inhibitor
Sources: Compiled from manufacturer information
Drug Facts and Comparisons. Drug Facts and Comparisons 2004. 58th ed. 2003.
Pronsky ZM, Meyer SA, Fields-Gardner C. HIV Medications-Food Medication Interaction Guide. 2nd ed. 2001.
DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents—A Working Group of the Office of AIDS Research Advisory Council.
Guidelines for the Use of Antiretroviral Agents in HIV- 1 - Infected Adults and Adolescents. October 10, 2006.
©Academy of Nutrition and Dietetics. Reprinted with permission. HIV medications in HIV/AIDS. In: Nutrition Care Manual. Academy of
Nutrition and Dietetics; Updated annually. Available at: http://www.nutritioncaremanual.org. Accessed November 15, 2010.
Medications for symptom management: Symptom management is a key strategy in maintaining both
nutritional status and ART regimen adherence (1). Medications may be used to control symptoms and
conditions including nausea, vomiting, diarrhea, mouth and throat sores, and organ diseases (1). Two
commonly used medications, megestrol acetate (Megace) and dronabinol (Marinol), are currently approved
for appetite stimulation. It should be noted, however, that the weight gain associated with these appetite
stimulants is typically in the form of fat mass and not the desired LBM (9). Megestrol acetate also compromises
testosterone balance, making it difficult to maintain and restore BCM and possibly exacerbating diabetes
mellitus (9). Coadministration of testosterone with megestrol acetate has not been shown to increase lean
tissue accrual. Testosterone replacement and anabolic steroids have been explored to assist with the
restoration of body weight and BCM in addition to improving strength and quality of life (49). However,
anabolic steroids can cause liver toxicity and negative changes in lipid profiles (1). The use of testosterone
and recombinant human growth hormone to treat wasting and central fat accumulation has been explored
(50). Higher doses of growth hormone promote recovery from HIV-related wasting by restoring BCM, while
lower doses of growth hormone reduce central fat accumulation (1). Anti-cytokine therapies, such as
thalidomide, have been explored for treatment of tuberculosis and HIV-related wasting (1). More recently,
thalidomide has been used to treat recurrent aphthous ulcers and HIV-related colitis; however, its use is
limited due to teratogenicity, peripheral neuropathy, and other adverse effects (51).
Nutrition Intervention and Monitoring
Symptom management is an important component of nutrition intervention and monitoring (1). Nutrition
interventions should support the patient’s medical treatment goals while reducing any negative nutrition-related
health effects of the disease and medication regimens (1). Complications are diverse and develop frequently,
interfering with nutritional intake and outcomes. Some of the more common complications, as well as nutrition
management strategies to optimize nutritional status, are listed in Table III- 12 : Nutrition Management Strategies
for People With HIV Infection or AIDS.