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Food and Water Safety for Persons Infected with HIV
CDC, June 9, 2003

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Malnutrition, severe weight loss, and gastrointestinal problems are common complaints of HIV/AIDS. Continuous nutritional care can help to promote intake of food and improve weight gain during periods of wellness. Nutritional care can also help address malnutrition and gastrointestinal complications during periods of illness.

Enjoy foods with a smooth creamy texture like yogurt, whipped potato, melted ice-cream. Avoid lumpy foods. Instead blend all foods.

Choose soft foods such as macaroni and cheese, stews, custard, well-cooked vegetables, soft fruit such as banana, mango, papaya, pineapple, etc.

Eat less acidic foods such as orange juice; spicy foods made with a lot of pepper; salty foods such as salt fish; rough or "grainy" foods such a popcorn, chips or raw vegetables.

Foods at room temperature or even cold foods are generally less irritating. Avoid hot foods.

Rinse your mouth after every meal with a mild mouthwash. (Suggestion: 1 teaspoon baking soda to 2 cups warm water).

Diarrhea is common among patients with HIV infection and may be resistant to treatment. Regardless, a causative intestinal pathogen should always be sought, since many do respond to treatment. Although diarrhea in HIV/AIDS often cannot be alleviated by dietary changes, the following suggestions may be helpful. The primary goal here is to prevent dehydration.

Eat less foods with a laxative effect such as prunes, prune juice, raw fruits and vegetables. They may make diarrhea worse.
Because they can make diarrhea worse, cut back on fatty foods and milk or milk-based beverages such as ice-cream, milk shake, cheese, milk powder etc.

Drink liquids between meals, rather than with meals.
Fill ice-cube trays with favorite juices instead of water and suck them throughout the day.

Watch for signs of dehydration. Take small, frequent sips of fluid to replace fluid and mineral losses; broth, juices and nectars are good choices.

Eat foods that are good sources of pectins and gums such as oatmeal, dried beans, apples, beans, pears and other fruits and vegetables. Bran-type fibers, seeds, and husks of grain should be limited at this time.

Avoid caffeine containing foods such as coffee, tea, chocolate and some carbonated beverages.

Since they may cause gas and cramps, avoid carbonated drinks, cabbage, and some green leafy vegetables, beans, cauliflower, highly spiced foods, and too many sweets if cramping is a problem.
Eat small, frequent meals served at room temperature.

REMEMBER: Taking charge of what you eat should give you a sense of control over a very important part of your life. Make what you eat a priority and part of your daily routine.

Nausea and vomiting can affect food intake and nutritional status. Not eating only contributes to more nausea and wasting. So eat anyway! The following recommendations are made to help combat this discomfort:

Munch on dry crackers or plain toast to help absorb stomach acid.
Avoid raw, fried or spicy foods. Instead, enjoy well-cooked foods that are easy for you to digest.

Do not eat and drink at the same time. Eat first, then wait at least half hour before drinking any beverage.

Enjoy ginger tea, ginger ale or just grate fresh ginger and sprinkle in drinks and food.

Sniff a slice of fresh lemon or lime for 2-3 minutes to help settle your stomach.

Sip peppermint tea throughout the day. It will help settle your stomach. It relieves gas and bloating as well

Eat slowly and chew your food well.

Eat frequent small meals and snacks instead of large meals.

Sit upright for at least 1 hour after eating to ease digestion.

Eat larger meals at times when feeling better.

Monitor and reschedule meals if nausea occurs at the same time of day.

Avoid an empty stomach by eating small frequent meals slowly throughout the day since they are often easier to handle.

In the absence of lesions, eat dry foods such as crackers or toast especially if nausea occurs in the morning.

Eat soft, bland foods that are easy to tolerate, such as custards, mashed potato, yams or other vegetables, yogurt, etc.

Eat meals before taking medications that may cause nausea.
Maintain good room ventilation.

Since they are usually less aromatic and better tolerated, try cold entrees instead of hot ones.

Stay away from meal preparation areas if food odor provokes nausea.
Avoid fatty or greasy foods.

Avoid very sweet foods.

Chew foods thoroughly and slowly.

Replace fluids when vomiting occurs. Broth, ginger ale and juices are good choices.

Avoid reclining or lying down immediately after eating.

Sip juices and other fluids throughout the day.

Dip dry foods into liquids before eating. For example bread into tea, crackers into milk, etc.

Suck on hard candies, ice or sour fruit such as lemon, lime, sour orange or tamarind throughout the day.

Use extra gravy, margarine, mayonnaise, sauce, etc. to moisten foods.

When oral and esophageal lesions from candidiasis, herpes simplex, etc., make chewing and or swallowing food painful or difficult, nutritional status may be compromised. In such cases, foods that will not irritate the throat are highly recommended. The following suggestions are recommended:

Foods eaten at room temperature are more soothing. Avoid very hot or very cold foods.

Enjoy foods with soft-texture such as whipped potatoes, well-crushed banana, yam, dasheen, etc. Use a blender or grinder when possible.

Avoid sticky, dry foods like peanut butter since they may be difficult to swallow.

Avoid commercial mouthwash because the alcohol may dry your mouth
Eat foods that will not irritate your throat.

Eat single textured foods like mashed potatoes or cooked oatmeal.

Eat soft/semi-sold foods or liquid/pureed foods.

Use a straw to help when drinking to avoid irritating lesions.

Soak some dry foods in liquids such as soups, stews, coffee, milk, cooked cereal, soup, or tea.

Use hard candy or chewing gum to help stimulate saliva production if mouth is dry.

Avoid coarse foods such as nuts, corn and rice, since they can get stuck in the throat.

Avoid dry, crisp, rough-textured foods.

Avoid irritating lesions by eliminating spicy, as well as acidic foods including citrus fruits and juices.

Avoid sticky, dry foods like peanut butter since it may be difficult to swallow. Also avoid slippery foods like Noodles, etc., they may slide down too fast and possibly result in aspiration pneumonia or aspiration-related illnesses.

With HIV/AIDS, your body becomes less effective at fighting bacteria that can grow in unsafely handled food. The following suggestions can be useful when buying, preparing and storing food. A basic knowledge of the most common harmful bacteria can go a long way in assisting you to eat defensively.

Wash all food preparation utensils in hot soapy water.
Use separate cutting boards for cooked and raw foods.

When eating out, persons with HIV/AIDS need to avoid the same foods in restaurants that they would avoid at home.

All food should be well-cooked.

If the food looks undercooked send it back. Don't be afraid to ask questions!

If you are unfamiliar with a particular dish or are unsure about the ingredients, ask before ordering.

If the food looks undercooked send it back. Don't be afraid to ask questions! If you are unfamiliar with a particular dish or are unsure about the ingredients, ask before ordering.

REMEMBER: Taking charge of what you eat should give you a sense of control over a very important part of your life. Make what you eat a priority and part of your daily routine.

Do not buy or use cans with bulges or those with leaks or dents.

Never buy excessive amounts of food since it may spoil before you eat it.

In the supermarket, select canned and dry foods first then, select perishables such as meat, poultry, fish, eggs and milk before going to the cashier.

Place packaged meat, poultry or fish in a plastic bag before putting it in the shopping cart. This prevents drippings from coming into contact with other foods which can cause contamination.

The chilled and frozen foods you purchase, should be placed in the refrigerator or freezer as soon as possible.

Refrigerate or freeze perishable items as soon as possible.

Use airtight containers, plastic wrap or foil to protect opened foods

Date foods before storing to help you use previously bought foods first.

Heat kills bacteria! Prevent food poisoning by properly cooking all foods

Don't eat food that has been left at room temperature for more than 2 hours.

Do not thaw food at room temperature. Instead, thaw food in the refrigerator, under cold running water, or defrost in a microwave oven.

Eat cooked foods while they are still hot.

Thoroughly cook meat, poultry, fish, and eggs. Do not eat foods made with raw animal flesh.

Heat leftovers thoroughly before eating.

Wash and scrub vegetables and fruits before eating or cooking them.
Avoid runny eggs; make sure that the yolk and white are firm.

Boil all drinking water for at least 3 minutes before drinking. Don't forget to boil water used for making ice.

Never eat food you think may be spoiled. Wash your hands thoroughly with warm, soapy water before handling or eating food.

Good nutrition is important for everyone. It is a key part of the treatment for HIV and AIDS. One fact is clear, malnutrition is common in HIV and AIDS. When faced with the risk of malnutrition, it is important to act quickly to maintain nutritional health. Nutrition intervention can enhance your quality of life.

The following nutrition principles can provide a blueprint for this health plan:

Eat a variety of foods from each of the food groups everyday.

Select foods that are rich in micronutrient.

Eat small, frequent meals or snacks (at least four-six times per day).

Drink sufficient fluids (at least 8 cups) every day.

Increase caloric intake from carbohydrates and/or protein-rich foods to gain or maintain desirable weight.

Take a multivitamin/mineral supplement.

Avoid using chemical stimulants such as caffeinated drinks brewed coffee, some dark teas, and regular sodas), alcoholic drinks, or recreational drugs.

Guidelines for Poor Appetite:
Anorexia, a lack of appetite, is a common symptom for individuals diagnosed with HIV. Anorexia may result from depression, fever, side effects of medication, and other causes. The most useful technique to enhance intake is the consumption of small, frequent meals and snacks consisting of nutritionally dense foods. Nausea and vomiting occur with many opportunistic infections. Cool, clear beverages, dry bread and crackers may help to calm the stomach. When they do feel like eating, individuals diagnosed with HIV tend to prefer and can tolerate frequent small meals and snacks rather than large meals. When diarrhea is present, meals should also be low in caffeine, fat and lactose-containing foods such as milk and milk-based beverages, due to malabsorption.

The following suggestions may be helpful:
Pass up low-calorie foods and beverages for example, tea, and coffee.

Try to eat at regularly scheduled times each day.

Encourage high calorie/protein snacks.

Eat favorite foods.

Drink liquids between rather than with meal or snack.

Arrange to eat with family or friends.

Try new foods to tempt the appetite.

Guidelines for Altered Taste:
Nutrition plays a big part in enabling patients to properly take medication, manage side effects and maintain adequate nourishment. Oral candidiasis is common in persons with HIV/AIDS. Symptoms include soreness of the mouth and tongue, often described as a "burnt" feeling and pain or difficulty with swallowing. Alternate feeding routes should be considered when painful mouth affect food intake. Oral complications and drug treatments can cause changes in taste. This may adversely affect food intake and in turn nutritional status.

To help overcome unpleasant or reduced taste sensations, the following are recommended:
Alter the sweetness or saltiness or tartness of foods.

Try new foods.

Eat foods cold or at room temperature.

Enhance flavors by experimenting with herbs and spices.

Marinate meat, poultry, fish and beans to further enhance flavor.

U.S. Government Resources- Centers for Disease Control and
Prevention (CDC): An agency of the Department of Health and Human Services, the CDC health surveillance system monitors and attempts to prevent the outbreak of disease.

HHS - AIDSInfo: On December 2, 2002, the HIV/AIDS Clinical Trials Information Service (ACTIS) and its sister service, the HIV/AIDS Treatment Information Service (ATIS), were merged into AIDSinfo.

The AIDSinfo project provides all of the services that are currently available from ACTIS and ATIS, as well as quick and easy access to wide-ranging Federal resources on HIV/AIDS clinical research, HIV treatment and prevention, and medical practice guidelines for health care providers and consumers.

Center for Disease Control (CDC) National Prevention Information Network: The HIV/AIDS section of the NPIN Web site is designed to facilitate the sharing of information and resources on HIV and AIDS for all individuals searching for prevention information.

Centers for Medicare & Medicaid Services (CMS): Formerly known as HCFA, this federal agency administers Medicare, Medicaid and the State Children's Health Insurance Program (SCHIP).

HHS Office on Women's Health: The Office on Women's Health coordinates women's health efforts in HHS to eliminate disparities in health status and supports culturally sensitive educational programs that encourage women to take personal responsibility for their own health and wellness.

Department of Health and Human Services HIV/AIDS Bureau (HAB/HRSA/DHHS): Provides federal funding for HIV/AIDS care for low-income, uninsured, and underinsured individuals.

HHS - Office of Minority Health Advises the Secretary and the Office of Public Health and Science (OPHS) on public health issues affecting minority populations.

National Institutes of Health Office of AIDS Research: The NIH Office of AIDS Research (OAR) is "responsible for the scientific, budgetary, legislative, and policy elements of the NIH AIDS research program."

Substance Abuse and Mental Health Services Administration (SAMHSA): Federal agency responsible for improving the quality and availability of prevention, treatment, and rehabilitation services in order to reduce illness, death, disability, and societal costs resulting from substance abuse and mental illnesses.

Center for Disease Control (CDC) National Health Statistics HIV/AIDS
Fast Stats Page: Quick government statistics on the incidence of HIV and AIDS in the U.S.

National/International Consulting. TvT Associates, Inc., in collaboration with USAID Ethiopia. Health/Nutrition Consultant. Work as part of a technical evaluation team throughout Ethiopia to evaluate the impact of USAID’s Title II program of food security and health outcome measures; develop strategic plan for further improvements.

Land O’Lakes, Inc., in collaboration with USAID South Africa. HIV/AIDS Nutrition Consultant. Work as part of a team in South Africa to develop nutrition and food related strategies to prevent Mother-To-Child Transmission of HIV. Develop nutrition response to HIV/AIDS.

Comprehensive AIDS Training Initiative (CATI) at Howard University, Washington, DC, Expert Nutrition Faculty. Educate professionals and paraprofessionals about nutrition andHIV/AIDS; help in the development of community-based HIV/AIDS nutrition-related programs.

National Minority AIDS Education Training Center (NMAETC) at Howard University, Washington, D.C. —Expert Nutrition Faculty. Provide current scientific information, clinical nutrition guidelines and training and act as preceptor to medical/clinical professionals in the field of HIV/AIDS.

HIV/AIDS have taken a foothold worldwide. While prevention remains the most effective tool in managing HIV/AIDS, poor nutrition is one of the most pervasive factors that exacerbates this virus. Malnutrition weakens the immune system and makes illness worse. The challenge is to not only prevent the spread of HIV/AIDS but, to help those already infected to continue to live a productive life in spite of the disease. For this reason nutrition intervention is paramount in helping to mitigate the impact of HIV/AIDS.

Babamento G and Kotler DP (1997) Malnutrition in HIV infection Gastrointestinal Clin North Am 26:393-415.

Chandra RK. (1997) Nutrition and the immune system: An introduction. Am J Clin Nutr 66:460S-463S

Fields-Gardner, C. et. al (1997). A Clinician’s guide to Nutrition in HIV and AIDS. American Dietetic Association, Chicago IL.

Nerad JL et. al (1994). Nutritional aspects of HIV infection. In Management of Infection in HIV Disease. Infect Dis ClinNorth Am. 1994;8:499-515.



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