There has been much in the news regarding the importance of good nutrition in HIV disease and Aids, but very little specific guidance. People frequently have widely diverging ideas on what constitutes ‘good nutrition.’ It is therefore important that any nutritional advice for HIV-positive people should be based on the best available scientific evidence relating to the specific demands of this disease.
Infection with the HIV virus is the scientifically accepted cause of Aids and Aids-related disease. The virus progressively destroys the body’s immune system making it harder and harder to fight off diseases such as TB and the development of cancer. However studies have shown that, with the right sort of nutrition, it is possible to slow down the progression of the disease and also reduce the number and severity of opportunistic infections such as TB and pneumonia.
People with HIV disease can quickly become malnourished because the disease has the following effects:
- It makes people lose their appetites so they don’t eat as much as they did before they were infected
- It speeds up the body’s metabolism and so additional food is needed to stop the person from losing weight (these two effects explain why body wasting is such a common symptom of HIV disease)
- It reduces the amount of nutrients the body can absorb from food because the gut becomes progressively damaged by repeated opportunistic infections
To make sure someone with HIV disease maintains a good nutritional status it is therefore important to do the following:
- Increase overall food intake to provide more energy – this is best done by eating more high-protein foods as HIV disease alters the way the body processes fats and carbohydrates. The best foods include all types of dried beans, fish, chicken, lean meat, eggs and low-fat dairy products.
- Increase the consumption of foods rich in antioxidant nutrients (beta-carotene and vitamins C and E, zinc and selenium) and B vitamins. Good foods include green leafy vegetables; red, orange and yellow fruits and vegetables; whole grains; dried beans; fish and meat
- Take a balanced multivitamin and vitamin supplement as people with HIV disease are unlikely to meet their full requirements through diet alone, due to reduced absorption and the other metabolic consequences of the disease.
What are the most protective vitamins and minerals?
Research suggests that the following nutrients are especially important in supporting immune function and therefore delaying the progress of HIV disease to Aids:
- Selenium. This antioxidant mineral appears to be one of the most important nutrients in HIV disease. An infected person who is selenium-deficient is 20 times more likely to die from opportunistic infections compared with an HIV-positive person who has a good selenium status. Selenium-deficient HIV-positive people also progress much faster to full-blown Aids. There is some evidence that selenium deficiency may be a widespread problem in sub-Saharan Africa and therefore making the epidemic worse. The best food sources of this nutrient are Brazil nuts (2-3 nuts per day will provide your daily requirements), offal (kidneys, liver) and fish. It is recommended that selenium intake should be around 200mcg/day for people with HIV disease. It should not exceed 400mcg/day
- Vitamin B complex vitamins, including folic acid. Deficiency of vitamin B12 is associated with an eight-fold increase in the risk of dying from an opportunistic infection, such as pneumonia. HIV-positive people who have the highest intake of the full range of B complex vitamins show significantly improved survival rates over 8 years. Good food sources include: dried beans, whole grains (whole-wheat bread, oats, coarse maize meal, sorghum), chicken, fish, meat, liver, eggs, dairy products (milk, cheese, yoghurt, sour milk), nuts, bananas and avocados
- Vitamin A (including plant-based sources of vitamin A such as beta-carotene). Deficiency of vitamin A is associated with a three-fold increased mortality risk due to opportunistic infections. Transmission rates of HIV disease from the mother to her baby are also reduced in those mothers with a good vitamin A status. Good food sources include: dairy products, margarine, green leafy vegetables (spinach, kale, broccoli), carrots, pumpkin, butternut, sweet potatoes, tomatoes, guavas and mangoes.
- Zinc. Deficiency of this mineral is associated with a two-fold increase in mortality risk. Good food sources include: meat, eggs, leafy green vegetables, nuts, seeds and whole grains.
- Vitamin E. HIV-positive people with the highest blood levels of vitamin E show a 34% decreased risk of disease progression compared with those patients with the lowest vitamin E levels. Good food sources include: whole grains (especially wheat germ and oats), nuts and seeds (including peanuts and healthy vegetable oils like olive and canola oils) and leafy green vegetables.
The best form of supportive multivitamin and mineral supplements should supply the full range of essential nutrients in amounts approximating the Recommended Dietary Allowance (RDA) or no more than 2-3 times this value. The B vitamins, beta-carotene (but not animal-derived vitamin A), vitamin C and vitamin E can, under supervision, be safely taken in larger quantities. However mineral values should always approximate RDA values, as many can be toxic in excess.