The Importance of Nutrition for people living with HIV/AIDS

The effects of HIV (Human Immunodeficiency Virus) on the nutrition of a person infected with the virus are numerous. These effects follow a number of pathways, depending on the stage of the HIV infection. Health and nutrition depends on the stage and the severity of the infection. It is known that good nutrition can contribute to the wellness and sense of well-being of the person with HIV/AIDS at all stages of the disease and may even prolong life. Nutritional advice and support of people living with HIV/AIDS is therefore an important part of their care.
Good nutrition means different things at the various stages of HIV infection and Nutritional needs will vary according to the development of the disease.
What is needed in each stage?


Stage 1: HIV infected and still healthy
Even though one may already be infected with HIV, there may be no symptoms of the disease, except perhaps a feeling of tiredness. The goal during this stage is to keep the body weight stable in order to strengthen the body’s ability to fight infections with the immune system and to prevent progression of the HIV illness. During the early stage of the infection the emphasis is on a normal and healthy balanced eating pattern. Many people with the virus can live for 10 years or more if hey maintain good nutrition.
Stage 2: Some problems but generally well
When the HIV infection begins to cause health problems, it is necessary that the person with HIV/AIDS learns how to cope. The health problems may include sore mouth and throat and diarrhoea, caused by infections that take advantage of the weakened immune system. These infections put extra demands on the immune system and increase the body’s need for energy and other nutrients.
Poor eating habits will reduce the body’s ability to fight infection and will result in more infections. Illness will cause loss of appetite and medication may cause nausea, both of which lead to poorer food intake and contribute to weight loss. Furthermore, eating may sometimes be uncomfortable or painful with infections of the mouth. With time some people will learn to avoid certain foods that cause problems or to adjust the amounts that they eat in order to feel better. It is also important to maintain one’s current weight to delay the worsening of the disease.
Stage 3: More serious problems
As the disease develops, more serious health problems will appear. At this stage of the HIV infection the ability to fight off other infections is completely weakened and very serious infections can occur. This stage is called “full-blown” AIDS and the body gradually becomes weaker, making the person less able to cope alone. Physical help may be needed with daily tasks, including shopping, and in severe cases also food preparation and perhaps even eating. Weight loss or wasting becomes a serious problem and diarrhea occurs more often and lasts longer. With good nutrition the development of this stage is slower and the person can survive for longer. If a person with HIV/AIDS has a good appetite and is eating well, but is still feeling ill and losing weight rapidly during this stage, it might be a sign that there is another infection, such as tuberculosis. Advice should be sought from health workers if this is the case.
The relationship between HIV/ AIDS and Nutrition
The relationship between HIV/AIDS and poor nutrition is cyclical. This means that in the development of the disease, one problem worsens the other and so on. Unless the cycle is broken, poor nutrition will result. Poor nutrition due to poor food intake, increased nutrient usage in the body and loss of nutrients from the body, weakens the immune system, which in turn decreases the ability of the body to fight other infections. The weakened immune system results in repeated infections, which in their turn lead to poor nutrition and so the cycle continues. Although the causes of poor nutrition are complex, they can be divided as follows:
HIV/AIDS increases nutritional needs:
The virus itself has an effect on the nutrition of the person living with HIV/AIDS. The body reacts to the virus with an immune response that uses more energy and when the immune system is weakened by HIV/AIDS, other infections start to occur and every new infection raises the need for nutrients and energy. Worry about the disease leads to high anxiety levels, which further weakens the immune system. Certain nutrients are necessary to boost the immune system and the need for these is higher during periods of stress
HIV/AIDS lowers food intake:

    Infections and illness lead to poor appetite.
    Mouth and throat infections cause difficulties with eating.
    Some medicines cause a poor sense of taste as a side effect.
    Both the expense of treatment and the inability to work affect income that leaves less money available for food.
    Depression, fear and anxiety contribute to the loss of appetite.
    Isolation may result from social prejudice against people with HIV/AIDS. Because food and eating is a social event, loneliness will affect the way a person eats.
    In the late stage of the disease, people with HIV/AIDS may find it difficult to take care of themselves.

HIV/AIDS causes physical problems:

    The lining of the gut deteriorates due to HIV and other infections, affecting the ability of
    the gut to digest and absorb food.
    This inability of the gut to take up the nutrients from the foods that are eaten is called malabsorption.
    The result of mal-absorption is diarrhoea.

During diarrhoea, water and nutrients are lost from the body. A combination of the factors listed above, cause poor nutrition and weight loss in people with HIV/AIDS. Poor nutrition itself leads to poor absorption and a weakening of the immune system, which gives the virus a chance to multiply, and so the cycle goes on. Poor nutrition also leads to a decreased ability of the body to cope with the medicines a person with HIV/AIDS has to take.
The Cycle of HIV/AIDS and Nutrition
Causes of poor nutrition in people living with HIV/AIDS include:

    The virus causes increased needs for energy
    Repeated infections and fever
    Loss of appetite
    Reduced food intake due to eating problems
    Poor absorption of nutrients from foods
    Nutrient losses in urine and stools
    Depression and anxiety
    Reduced ability to care for oneself
    Tiredness, even in the early stages
    Access to and availability of food

How to break the cycle of HIV/AIDS and poor nutrition
Effective and inexpensive ways to deal with the cycle of infection and poor nutrition do exist and they include:

    Awareness of HIV status
    Good nutrition
    Good hygiene and food safety
    Learning to cope with problems of HIV/AIDS
    Early detection and treatment of all infections
    Increased food intake after illness
    Learning to cope with stress
    Increased activity and exercise
    Getting enough rest and sleep
    Management of household resources (including money, family time and food distribution)

What is Good Nutrition for people with HIV/AIDS?
Good nutrition means eating foods that supply the body with all the nutrients that are needed daily. Not only is enough energy needed mainly from starchy foods, fats and oils, but also proteins, vitamins, minerals and water. The right balance of these nutrients promotes health and well-being.
The benefits of good nutrition
Good nutrition for people with HIV/AIDS will help to:

    Keep weight stable
    Prevent loss of muscle
    Replace lost nutrients
    Deal with some of the nutrition problems of HIV/AIDS
    Improve wound healing
    Recover from infections
    Deal better with medication and treatment
    Increase strength
    Improve feeling of well-being

Food Choices for People Living with HIV/AIDS
Start Early

Good nutrition is important for everyone. It is best to start taking better care of oneself as soon as one becomes aware that one is infected with HIV. The sooner a start is made, the more successful one will be at staying healthy. Once people with HIV/AIDS begin to fall behind in terms of nutrition, it might be difficult to catch up later when they are feeling less healthy or when they have other infections. In terms of poor nutrition, prevention is better than cure.
Choose your Own Food

There is more than one way to eat for health. Each of us is different in how we eat and what we like to eat. The next section will help people with HIV/AIDS to make some healthy food choices.
Each person will decide what and when to eat. Only they know what food they usually have in the house and what they can buy. Choices from foods that are easily available and affordable are encouraged.
Eat a Variety of Foods

Remember that no single food is either good or bad. It is the combination of different foods eaten over a long time that leads to better health. Different types of food supply different combinations of the nutrients our bodies need. It is important that food choices are made from a wide selection of different foods. This way one is more likely to enjoy one’s food and have a healthy eating pattern. Some of the foods that you need to include in your diet are discussed below.
Make Starchy Foods the basis of each meal

Starchy foods should make up the biggest part of the food intake of people with HIV/AIDS. These foods are relatively cheap and supply lots of energy, which will help to keep the body weight stable. Foods such as from bread, pap, porridge, cereals, rice, potatoes, sweet potatoes, samp, millet, mielies, sorghum and pasta should form the biggest part of each meal. Other foods should be eaten together with the starchy foods to make up a healthy eating pattern.
Eat lots of Fruits and Vegetables

Fruits and vegetables are an important part of a healthy food intake. They supply the vitamins and other substances that keep the immune system strong. These foods are especially important for people living with HIV/AIDS to help in the fight against infections. A wide variety of different fruits and vegetables should be eaten every day. Include fruits and vegetables of a yellow, orange, red or dark green colour. Examples include spinach, morogo, pumpkin leaves, green peppers, sweet potato, squash, pumpkin, carrots, yellow peaches, apricots, paw-paws and mangoes. These contain vitamin A, which keeps the linings of the gut and the lungs healthy and so prevents germs from entering the body. Citrus fruits like oranges, naartjies, grapefruit and lemons, and also guavas, mangoes, tomatoes, maroelas and potatoes supply vitamin C, which helps to fight infections. Besides Vitamin A and C, fruit and vegetables supply many other vitamins and other substances, which support the immune system and form part of a healthy eating pattern.
Meat and Dairy Foods may be eaten daily

For people living with HIV/AIDS it is very important to maintain healthy and strong muscles. Foods from animal sources provide the body with proteins to build strong muscles and they also help to keep the immune system healthy. All forms of meat (beef, mutton, pork and chicken) and fish may be eaten daily. Organ meats from animals (liver, kidney, heart and brains), trotters, chicken feet and tripe or afval may be included. Eggs, milk and other dairy products may also be chosen. Dairy products include maas, sour milk, yoghurt, buttermilk, milk powder and cheese. If mopani worms and other insects are part of the usual eating pattern, they may be included as well.
Eat Dried Beans, Peas, Lentils, Peanuts or Soya regularly
This group of foods from plant sources also supplies proteins needed to strengthen the immune system and the muscles. More cooked dried beans, peas, lentils, peanuts, peanut butter and soya beans should be included as part of a healthy eating pattern for people with HIV/AIDS. For vegetarians who are HIV positive, these foods and tofu should form an even more important part a healthy eating pattern. For people who are not vegetarian these foods are a more economical protein source than foods from animals.
Include Sugars, Fats and Oils

Sugars, fats and oils are also part of a healthy, balanced eating pattern. They provide much needed energy for the person living with HIV/AIDS. After periods of weight loss these foods should be included in bigger amounts to help with weight gain. Table sugar may be added to food and any foods made with sugar may be included in the daily food intake. Vetkoek, cakes, pastries, biscuits, cookies, tarts, puddings and desserts may be included especially after infections or after periods of weight loss. Fats and oils include butter, lard, margarine, cooking oils, cream, mayonnaise and salad dressings. Add fats and oils to the food to increase energy intake. Note that in the late stage of HIV infection, eating a lot of fat can cause diarrhoea.

Use Salt sparingly

With diarrhoea and vomiting, salt is lost from the body. Some salt is necessary to replace such losses (refer to the homemade recipe for water and salt replacement). Eating a lot of salt contributes to high blood pressure and it is advisable to use salt sparingly because many people in South Africa suffer from high blood pressure. Using sparingly helps to control the blood pressure and may help to reduce the need of medicines.
Be as Active as you can

In order to remain healthy it is very important for people with HIV/AIDS to maintain the muscles in their bodies. Weight loss in HIV/AIDS is often due to the loss of weight in the muscles. Keeping the muscles active and working is one way to help keep them strong. People with HIV/AIDS are encouraged to be as active as they can be taking into account how well they feel at the time. Doing work around the house as far as possible and regular walking help to increase activity. There is no need to join a gym if they do not already belong to one, simple daily activities all help to keep the muscles strong.
Drink lots of clean, safe Water

Diarrhoea and vomiting both cause loss of water from the body. Night sweats also cause losses of large amounts of water. Losses have to be replaced by drinking enough fluids everyday and more is needed if there is diarrhoea or vomiting. About 8 cups of liquid per day should be enough. People with HIV/AIDS do not have to drink only water, all liquids add water to the body. Cold drinks, milk, fruit juice and any other beverages should be taken throughout the day. Water from taps is usually safe, but if the water comes from a well, river or borehole it is safer to boil and cool it before use.
Do not take Alcoholic Drinks

People living with HIV/AIDS should not drink any alcoholic drinks. Alcohol is harmful to the liver and causes the body to lose vitamins, which are important for the support of the immune system. Many people with HIV/AIDS have to take medicines and the combination of alcohol and medicine is very unhealthy for the liver. The influence of alcohol may make it more difficult to practice safe sex. Unsafe sex (not using a condom) can cause the virus to be passed on to the partner(s). Alcoholic drinks include wine, beer (including home-brewed beer and sorghum beer), ciders, alcoholic coolers, whiskey, rum, gin, vodka, cane and other hard drinks.
Weight Loss in HIV/AIDS

HIV infection and diarrhoea over a long period of time result in weight loss or wasting. In fact, in parts of Africa the illness is called “slim disease”. This weight loss is a major problem and causes poor health and earlier death. In Africa the wasting seen in HIV infection is not always the result of HIV/AIDS alone. Often TB infection is present as well. Weight loss is very rapid in people with combined HIV and TB infections. Most people with HIV do not lose weight constantly. Weight loss usually occurs in episodes when the HIV positive person has an infection, for example pneumonia, tuberculosis and diarrhoea. These periods of weight loss can easily lead to the loss of 10 to 15kg. After recovering from the infection, the HIV positive person can regain some weight, although often not back to the original weight. Repeated episodes of infections will therefore cause gradual weight loss over time. It is important to eat well at all times, especially when recovering from infections.
Taken from the South African National Guidelines on Nutrition for People Living with TB, HIV/AIDS and other Chronic Debilitating Conditions.