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Diet is especially important when taking
combination therapy for HIV infection. In many instances it can be the
difference between success and failure with these medications... |
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Dietary Considerations and Combination Therapy
by Edwin Krales, MS, CDN
Nutritionist/Outreach Coordinator,
The Momentum Project
Adjunct Professor of Nutrition, Hunter College
[This article was reprinted from the
AIDS Community Research Initiative of America Summer 1998 Update newsletter]
Diet is an important part of the battle against HIV infection. In general, a good diet of whole foods provides the body with the right nutrients it needs to perform its many functions. Diet is especially important when taking combination therapy for HIV infection. In many instances it can be the difference between success and failure with these medications, since many HIV medications have special dietary needs for their absorption in the body. Dietary management can also help alleviate some of the side effects of these medications.
The hardest part is setting up a system that is right for you. You must be realistic about your daily schedule and your available time. Are you an early riser with time to spare? Do you have time to eat in the morning, or do you jump out of bed at the last minute and rush out the door. Do you have to get kids ready for school? Do they eat before they leave? Is it important to eat with them? Do other duties or habits have priority? The more complex your daily life is, the more important it is to set up a realistic medication /eating schedule. Make sure you discuss these issues with your healthcare provider.
In order for medications to get into the body they must be absorbed by the gastrointestinal tract (through the stomach and intestines). Some drugs require stomach acid (with no food in the stomach) to be absorbed while others need to be absorbed in the presence of food. So what you eat or don't eat can directly affect whether your HIV medications get into your body and thus are able to suppress the virus.
When you start sorting out your HIV medications, particularly your antiretroviral medications, you find that they can be divided into three "eating requirement categories." The first and easiest category is those medications that have no specie c eating requirements. These medications can be taken on a full or empty stomach, with or without food. These medications include the non-nucleoside reverse transcriptase inhibitors nevirapine (ViramuneTM) and delavirdine (RescriptorTM), and the nucleoside analogues AZT + 3TC (CombivirTM), 3TC (EpivirTM), d4T (ZeritTM), ddC (HividTM and AZT ( Retrovir TM )
The second category is medications that should be taken on an empty stomach. They are the nucleoside analogue ddI (VidexTM) and the pretense inhibitor indinivar (CrixivanTM). Taking indinivar on an empty stomach may be a problem for some people because of stomach upset. If you need to, you can take indinivar with a light snack. The manufacturer Merck says that a low fat, low protein, low calorie snack will not interfere significantly with absorption. According to Merk's guidelines a "snack" has no more than 301 calories, with no more than 23 calories from fat, 23 from protein and the remainder of the 255 calories from carbohydrates. (See Table 1 for a list of snacks you can eat with CrixivanTM.)
Table 1
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Light snacks that can be taken with CrixivanTM |
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Food
Items |
Calories |
Fat
Grams |
Protein
Grams |
Carbo.
Grams |
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1
cup instant oatmeal, regular and 1/2 banana |
197 |
2.6 |
2.5 |
38.5 |
|
1
cup Cheerios, 1/2 cup skin milk, 1/2 banana |
184.5 |
1.7 |
7.5 |
35.5 |
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1/2
bagel, 1 oz nonfat cream cheese, 1 TBSP jam |
146 |
1.4 |
5.7 |
33 |
|
1
egg white, 1 slice wheat toast, 1/2 grapefruit |
135 |
1.2 |
7 |
21.2 |
|
1
English muffin, 1 TBSP jam, 1 orange |
244 |
1.4 |
5.2 |
49 |
|
1
pkg cream of wheat (mix & eat), 1 peeled apple |
165 |
2.2 |
3.2 |
37 |
|
1
cup white rice (instant), 1/2 cup vegetables |
199 |
0.4 |
5 |
43 |
|
1
cup white rice (instant), 1/4 cup black beans |
218 |
0.4 |
7 |
45 |
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1
baked potato, 1 TBSP low fat sour cream, 1/2 cup corn kernels (can or
frozen) |
241
|
1.9 |
5.2 |
54 |
|
1/2
cup macaroni, 1/3 cup tomato sauce, 1 TBSP Parmesan cheese (grated) |
147 |
2 |
6.5 |
26.2 |
|
1
cup vegetarian vegetable soup,2 rice cakes |
210 |
4 |
4 |
40 |
|
1/2
cup spaghetti, 1/2 cup mushrooms (sliced), 1/2 cup tomatoes (chopped) |
127 |
2.2 |
6.6 |
30 |
|
1
bagel |
92 |
1.2 |
5.5 |
19 |
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1
bagel with 1 oz nonfat cream cheese |
187 |
1 |
7 |
36 |
|
1
cup white rice (steamed) |
267 |
1 |
6 |
58 |
|
2/3
cup mashed potatoes & gravy (KFC) |
124 |
1 |
4 |
210 |
|
1/3
cup baked beans (KFC) |
105 |
1 |
5 |
18 |
|
banana |
60 |
0 |
0 |
15 |
The third category is medications that should be taken with food. They are the protease inhibitors Invirase, Fortovase, Norvir and Viracept. The amounts and types of food vary from drug to drug. Invirase and Fortovase should be taken within two hours of a meal. A "meal" is considered to be about one third of the calories you need each day if you eat three meals a day. The definition of a meal changes if you eat more or fewer than three meals a day. The total daily caloric intake usually is between 1500 and 2500 calories depending on your size, reduce the absorption of medications and therefore their effectiveness, it is important to deal with this problem as soon as possible. Instead of trying to eat three large meals, eat more smaller meals throughout the day. Remember that the meals must be large enough to meet the minimum guidelines necessary for absorbing medication. Try eating while watching a video or listening to music. Eat with friends. Don't drink anything that may fill you up right before you eat. Ask your doctor for an appetite stimulant such as MegaseTM or MarinolTM.
You should keep in mind that taking the current HIV medications on a daily basis is something you have to do until better mediations are developed. So having a diet that you can live with will make all the difference. Ask others how they are managing. Go to congregate meal programs to give yourself a break from cooking everyday. At first this may all seem so complicated, but with time it will eventually fit into your daily routine.
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