HIV Infection and AIDS
Manual of Clinical Nutrition Management III- 50 Copyright © 2013 Compass Group, Inc.
type of fat consumed may be related to lipodystrophy, further research is needed to examine this possibility (Grade
II) (1,21). Omega-3 fatty acid supplementation may affect several types of metabolic modulations, but additional
research is needed to determine its role in the management of hypertriglyceridemia (Grade II) (1). Research has
shown that lifestyle modifications adopted by HIV-infected persons with hyperlipidemia result in improved
serum lipid profiles (Grade I) (1,21). Because of the increased prevalence of lipodystrophy in HIV patients, especially
patients who receive ART, the National Cholesterol Education Panel recommends comprehensive lifestyle
modifications including lowered fat intake, increased physical activity, and the use of lipid-lowering medications
(1,9). In addition, for persons with diarrhea and malabsorption studies of fat malabsorption have shown that
consumption of medium chain triglycerides (MCTs) resulted in fewer stools, decreased stool fat and weight
and increased fat absorption (Grade II) (21).
Carbohydrate and fiber requirements: Recommendations have been made for increasing fiber intake toward
the levels suggested in general nutrition guidelines because of the association with lower prevalence of
lipodystrophy (1,41). Limited evidence supports a relationship between low-fiber diets or high–glycemic index
diets and increased risk of fat deposition (Grade III) (1,21). Further investigation regarding the dietary intake of
carbohydrate in people with HIV infection is warranted (1,21).
Fluid requirements: Water requirements for patients with normal fluid status can be estimated from the Dietary
Reference Intakes (9). It may be prudent for patients with HIV or AIDS to avoid carbonated beverages and
alcoholic beverages, as well as caffeinated beverages because they act as gastrointestinal stimulants and may
contribute to dehydration and diarrhea or interact with ARTs. Consider increasing fluid requirements in patients
who develop fever, nausea, vomiting, or diarrhea; the initiation of medication, physical activity, and inclement hot
or dry weather may also necessitate increased fluid intake (9). Fluid restrictions may be indicated for patients with
renal or hepatic failure (9).
Vitamin and mineral recommendations: Micronutrients, including both vitamins and minerals, play a key role
in the maintenance of immune function, reduction of mortality from disease and treatment-related symptoms,
and rehabilitation of nutritional status in HIV-infected persons (1). Studies have found that micronutrient
deficiencies are common in individuals with HIV infection (Grade II) (1,21). Zinc, selenium, B vitamins, vitamin C, and
vitamins A, E, and D may be at risk for deficiency due to inflammatory and metabolic responses and/or
interactions with ARTs (1,15-17,21,42). However, it is difficult to adequately study these nutrients effectively due to
the inability to separate the effects of individual nutrient deficiencies from the effects of generalized malnutrition
on the immune system (1,21,42). A recent review yielded no conclusive evidence to show that micronutrient
supplementation reduces morbidity and mortality among HIV-infected adults; however, there is evidence that
vitamin A supplementation is beneficial for HIV-infected children (Grade II) (1,21). Further research regarding type,
dose, and duration of micronutrient supplementation is needed before recommendations can be provided to
persons with HIV or AIDS (Grade II) (1,21). Routine biochemical assessment of vitamin and mineral levels is
recommended to determine the best treatment options if symptoms are present and deficiencies are suspected
(1,9). Supplementation based on levels described in the Dietary Reference Intakes that remain below the upper
limits of safety seems prudent in the absence of sufficient evidence (9).
Bone mineral density recommendations: Patients with HIV may experience a progressive loss of bone mineral
density that leads to osteopenia or osteoporosis (1). Patients with HIV often have multiple risk factors for the loss
of bone mineral density, including low BMI, weight loss, steroid use, nucleoside reverse transcriptase inhibitor
use, and smoking (1,21). Bone density should be monitored with routine bone density tests (1). Bone density can
be preserved through the maintenance of optimal weight and the prevention of rapid weight loss (1). Diet
modifications that promote the maintenance of bone density include: reducing alcohol and caffeine consumption;
choosing calcium-rich beverages (such as milk or fortified soy beverages) instead of high-phosphorus carbonated
beverages; eating a variety of protein foods; eating calcium-rich and vitamin D–fortified foods, and taking a daily
calcium supplement of 500 to 1,200 mg (1,9,43). Vitamin K, vitamin C, and zinc are also important for bone
formation and should be included in an adequate diet (1,43). Assess the ART regimen and suggest adjustments to
regimens so as to minimize side effects In addition, encourage physical activity and regular weight-bearing or
resistance exercise (1).
Use of herbal supplementation: Supplemental nutrients, herbs, and other medications may be processed by
the pathways used by antiretroviral medications. As a result, the levels of the supplements or medications may be
greater or less than the expected levels (1). Potential interactions include the reduction of drug efficacy during the
concomitant use of St. John’s wort, garlic, and echinacea with protease inhibitors or non-nucleoside reverse
transcriptase inhibitor antiretroviral drugs (1). Other herbal substances with a potential for drug interactions