What is HIV?
HIV is theorized to have been passed from the chimpanzee to humans around the 1800’s. There are currently 1.2 million people diagnosed with Human Immunodeficiency Virus, HIV, in the US, and there are around 35.3 million people with HIV worldwide. HIV is a Sexually transmitted infection, or STI, involving the weakening of the immune system over the course of 3 different stages and, if left untreated, will progress into the third stage of HIV, referred to as acquired immunodeficiency syndrome, AIDS. HIV is contracted through the transfer of certain bodily fluids between a person that has untreated HIV, or AIDS, and an HIV negative person. Bodily fluids can be transferred by a used needle, birth, or unprotected sexual activities. HIV and AIDS cannot be transferred through saliva, sweat, amniotic fluid or tears  .
What are some HIV Treatment options?
There is no cure, currently, for HIV. However, the HIV treatment options have advanced tremendously over the course of just a few decades, which have allowed people with HIV to live full, long lives. There are a simple set of pills, antiretroviral treatment (ART), that help make the HIV virus undetachable in the blood and therefore largely non-transmissible, while also dramatically slowing and even sometimes stopping the onset of AIDS. There are different generations of antiretroviral medications, each more effective than the last. For instance, the most recent, highly active antiretroviral treatment (HAART), has reduced overall HIV morbidity by 80%. Even though these miracle medications exist that does not mean that nutrition should be ignored. People with HIV should be very cognizant of what they are consuming, in order to aid their immune function and response .
Why is nutrition especially important for HIV positive people?
At the onset of HIV, the first 2 to 4 weeks of contraction, people in the first stage of HIV often have flu-like symptoms, such as coughing, fever, nausea, etc. During this period, HIV positive people are highly contagious, which is why it is extremely important to be regularly tested for STI’s and STD’s. The second stage is characterized by little to no symptoms. This period lasts around 10 to 15 years, but the progression can be prolonged or even stopped with medication. The third stage, also called AIDS, is a period where the body is extremely vulnerable to illness of any kind. Nutrition is highly important in all three of these stages.
According to a study, done by Thuppal, Jun, Cowan, etc. (2017), HIV positive women and men have higher levels ofserum protein, and lower levels of serum albumin and serum folate
in their blood. High levels of serum protein are a sign that the body is suffering from chronically high inflammation. Low levels of serum albumin indicate a lack of vital nutrients in the body and signifies high inflammation within the body. Low serum folate is characterized by a low red blood cell count in the blood that can lead to anemia, which prevents the blood from being able to carry sufficient oxygen to all areas of the body. Women with HIV are more likely to have a high BMI, while men with HIV are likely to have a slightly low BMI. HIV positive women are also more likely to be deficient in vitamin K, vitamin E, magnesium, and potassium. Additionally, HIV positive women have higher prevalence of osteoporosis due to vitamin D deficiency. The gender distinctions within this study are very curious and could be evidence of societal gender differences in nutrition in populations with high incidence of HIV   .
Martin-Cañavate, Sonego, Sangrado, etc. (2018) did a study, in El Salvador, where they tested the nutritional health of over 300 HIV positive children, who were taking antiretroviral medication. They found that a little more than a third of the children were not in a healthy height nor weight range, and that 3.3% of the children were considered “wasted”. Waste syndrome is a horrific disease affiliated with stage three HIV, or AIDS, caused by the body’s inability to retain nutrients due to the symptomology of HIV. Additionally, 10% of the children were considered obese. This lack of nutrition is not entirely theorized, in the article, to be caused by HIV, but also due to the higher prevalence of HIV in food scarce populations. They also found, in the study, that the children with HIV had metabolism issues, specifically hyperglycemia, which is characterized by excessive glucose in the blood, and dyslipidemia, characterized by excess fat in the blood. Both of which are seen in people with heart issues and diabetes.
People with HIV have a higher prevalence of cardiovascular disease, type 2 diabetes, and metabolic syndrome. It is notable that all these diseases have a large nutritional component to their development. The cause of this high volume of afflictions in HIV positive people are unknown, but there are numerous theories. One theory claims that people with HIV often struggle with vomiting and diarrhea, due to nutrient imbalances and metabolic difficulties, which further prevents nutrients from being absorbed in the body. HIV has been theorized to disrupt the entire metabolic system, regardless of food consumption. It has also been theorized that HIV medication could be interacting with the body’s ability to absorb and utilize nutrients. Additionally, it is thought that the high cost of HIV medications is likely leaving less, or even little, budgeted money for healthy, nutrient-rich foods. Lastly, some people with HIV are unable to eat numerous foods due to dysphagia (inability to swallow), food aversions, an inability to process food, etc.; rendering a lot of HIV positive people only able to eat easily digestible, small portions of, foods that are often not nutrient dense.
What is some dietary advice that would be helpful for HIV positive people?
Cardiovascular disease, type 2 diabetes, metabolic syndrome, obesity, and waste syndrome can all be combated with good nutrition. These diseases are not solely caused by nutritional deficiencies due to poor diets in HIV positive people, but the incidence of these afflictions can be decreased with increased attention toward proper nutrition. Nutrition is not only a strong predictor of the quality of life of someone with HIV, but also one of the predictors of age of mortality. Effective nutrition can also decrease the side-effects from the ART medication within the body, help alleviate some of the harsh symptoms of HIV, and bolster the immune response.
Nutrition is also different depending on HIV positive people’s age, body’s interaction with the medication, stage of progression, physical activity, weight, HIV symptoms, the number of co-morbid diseases, etc. Fat and protein intake varies based off the numerous factors mentioned above. For instance, someone that has been afflicted with constant diarrhea and has suffered a mass decrease in weight would need a higher fat and protein intake than the average population. It is pivotal that an HIV positive person is consuming protein with every meal, which is crucial for cell health and immune functioning. Generally, HIV develops the need for the body to work harder to fight off even simple infections, like the common cold, meaning a higher caloric intake is often necessary for someone with HIV  .
Additionally, certain supplements are typically beneficial for all people that are HIV positive, regardless of their stage status. Namely, selenium, vitamin C, Vitamin D, vitamin A, and vitamin E. Selenium supplements, if needed, have been found to reduce the number of hospital visits for people with HIV, by decreasing inflammation and oxidative stress within the body. Oxidative stress happens, within the body, when there are too many free radicals and not enough antioxidants to keep the free radicals within a healthy range. Oxidative stress leads to higher risk for cancer, high blood pressure, neurodegenerative disorders (ex: Alzheimer’s), etc. Vitamin C and vitamin D are suggested to reduce the likelihood of thyroid problems, which are common in HIV positive people. Vitamin D has also been found to reduce the transmissibility of HIV and increase longevity of people with HIV. Vitamin A helps reduce incidence of diarrhea. Vitamin E helps reduce oxidative stress within the body and increases cell survival. It is very pivotal to note that people taking supplements should consult with their doctor first and receive a blood test to ensure that taking a supplement would be beneficial, and not increase the level of a vitamin in the blood to an unhealthy degree  .
It is crucial to acknowledge that HIV symptoms may make eating difficult. In order to maintain a healthy body weight, it is necessary to stick to certain foods that make eating and digestion manageable for the individual. Another important acknowledgement is that food safety is especially important for HIV positive people. HIV positive people need to be extremely cognizant of food hazards that could lead to food poisoning, which HIV positive people are very susceptible to contracting and could reap harsher repercussions  .
What are some important take-aways regarding HIV positive people and nutrition?
In conclusion, HIV itself is not curable, but the progression, transmissibility and symptomology of HIV is treatable. It is notable that HIV also increases the likelihood of multiple diseases. Thus, it is so important to ensure that people with HIV are filled with all the nutrients necessary to function optimally, in order to help the body stave off other illnesses. HIV naturally increases the level of inflammation within the body, without the additive effect of poor nutrition. Meaning the body is under stress from HIV, whether HIV positive people are riddled with symptoms in the first and third stages of HIV or are undergoing no symptoms in the second stage. So, it is vital for HIV positive people to pay attention to their nutritional intake. There are some straightforward, aforementioned, supplements that most HIV positive people would benefit from taking that would increase their health demonstrably and reduce likelihood of hospitalizations. These supplements would include vitamin C, vitamin D, vitamin A, vitamin E, and selenium. All of these vitamins can be found naturally in food, yet, HIV has been theorized to disrupt the body’s ability to properly absorb nutrients. This means that supplements might allow the body to digest more of the benefits of vitamins, if, their primary care physicians deem it beneficial.
 Kourkouta, et al. (2017). “AIDs and nutrition in patients.” Progress in Health Sciences. 7 (1): 182-186. doi.org/10.5604/01.3001.0010.1881  Thuppal, et al. (2017). “The nutritional status of HIV-infected US adults.” Current Developments in Nutrition. doi.org/10.1371/journal.pone.0196380  “About HIV.” (2021). Center for Disease Control and Prevention.  Kourkouta, et al.  Thuppal, et al.  “About HIV”  Stephens, Carissa. (2019). “Serum Albumin Test.” Healthline.  Thuppal, et al.  “Serum Protein.” (2021). Fitzgerald. https://www.fitzgerald-fii.com/protein-targets/serum-proteins.html  “Folate, Serum.” (2021). Mayo Clinic Labortories. https://neurology.testcatalog.org/show/FOL  Martin-Cañavate, et al. (2018). “Dietary patterns and nutritional status of HIV-infected children and adolescents in El Salvador: A cross-sectional study.” PlosOne. doi.org/10.1371/journal.pone.0196380  Thuppal, et al.  Thuppal, et al.  Klemm, Sarah. (2020). “Nutrition tips to keep the immune system strong for people with HIV-AIDS.” Eatright  Kourkouta, et al.  Kubala, Jullian. (2019).”7 Science based health benefits of selenium.” Healthline  Klemm, Sarah  Kourkouta, et al.  Kubala, Julian  Klemm, Sarah  Kourkouta, et al.  Kubala, Julian
Author- Katrina Peavy
Editor- Kaitlyn Longstaff
Public Health Scientist- LaCher E-W, MPH