HIV & Nutrition and Food Safety

Why maintaining good nutrition is important for people living with HIV:

Good nutrition can support overall health as well as help maintain the body’s immune system. It can also help those living with HIV maintain a healthy weight and properly absorb any HIV medication.

As you know, HIV attacks and destroys the immune system, which makes it harder for those living with HIV to fight off any infections. Daily use of HIV medication prevents HIV from destroying the immune system. In addition to a medication regimen, a healthy diet will also help to strengthen the immune system and keep people with HIV healthy.

What a healthy diet looks like:

Generally, the basics of a healthy, nutritious diet are the same for everyone, including people with HIV. Unless given special dietary instructions by a medical professional, the United States Department of Agriculture makes the following recommendations:

  • Choose a variety of foods from the five food groups: fruits, vegetables, grains, proteins, and dairy
  • Eat the right amount of food for your body to maintain a healthy weight
  • Stick to foods low in saturated fat (found in animal products such as fatty meats, whole milk, and butter), sodium (salt), and added sugars

How HIV can impact nutrition:

Thanks to HIV medications, people living with HIV are living longer and healthier lives. However, HIV and HIV medication can sometimes cause nutrition-related problems. Here are some examples of nutrition-related issues that have the ability to affect those with HIV:

  • HIV-related infections can make it hard to eat food or swallow
  • Changes in metabolism can cause weight loss or weight gain
  • Side effects from medication (like changes in appetite, nausea, or diarrhea) can make it hard to stick to an HIV regimen

If you have HIV and are experiencing what you think might be a nutrition-related problem, your health care provider can help resolve the issue. To avoid potential nutrition-related problems, make sure you’re also paying attention to food safety.

What food safety means:

Food and water can become contaminated with germs that cause illnesses. Food safety refers to the proper ways to handle, prepare, and store food to prevent these foodborne illnesses.

Why food safety is important for people living with HIV:

A weakened immune system makes it hard to fight off any infections, this includes foodborne illnesses. In people with HIV, foodborne illnesses are likely to be more serious as well as last longer than in HIV negative folks. Following food safety guidelines reduces the risk of foodborne illnesses.

How to prevent foodborne illness:

People living with HIV can reduce their risk of foodborne illnesses by avoiding certain foods and taking the time and care to prepare and store their food in a safe matter. Here are a few guidelines to follow:

Food and beverages to avoid:

  • Raw or undercooked eggs (example: in homemade mayonnaise or uncooked cookie dough or cake batter)
  • Raw or undercooked poultry, meat, and seafood
  • Unpasteurized milk, cheeses, or fruit juices
  • Raw seed sprouts (example: alfalfa sprouts or mung bean sprouts)

Four steps to food safety – clean, separate, cook, and chill:

  • Clean: Wash your hands, any cooking utensils, and your countertops when preparing food
  • Separate: Separate your food to prevent spreading any germs from one food to another. As an example, keep any raw meat, poultry, seafood, or eggs separate from any foods that are already cooked or otherwise ready to eat (fruits, vegetables, or bread).
  • Cook: Use a food thermometer to make sure that foods are cooked to the recommended safe temperatures
  • Chill: Refrigerate or freeze any meat, poultry, eggs, seafood, or other foods that are likely to spoil within 2 hours of either cooking or purchasing

Contaminated water (most typically due to human or animal waste) can also cause illness. To be safe, don’t drink any water directly from a lake or river, and don’t swallow any water while you’re swimming.

It’s also important to be careful about what you eat/drink if you’re traveling outside of the U.S., especially in developing countries. Before taking a trip abroad, check out this fact sheet for people living with HIV who are traveling outside the United States from the Centers for Disease Control and Prevention (CDC).

 

Resources:

USDA: Food Safety Guidelines
CDC: Traveling With HIV Guidlines
USDA: Choose My Plate
NIH: HIV and Nutrition

Drug Expert: HIV

Treatment with HIV medicines is called antiretroviral therapy (ART). ART can’t cure HIV, but taking HIV medicines help those living with HIV live longer, healthier lives. People on ART take a combination of HIV medicines (referred to as their HIV regimen) every day. A person’s initial HIV regimen generally includes three HIV medicines from at least two different drug classes. Today we’re going to discuss those drug classes, what they do, and what drugs belong to them.

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

NRTIs block reverse transcriptase, an enzyme HIV needs to make copies of itself.

Generic Name (other name, abbreviation) Brand Name
abacavir (abacavir sulfate, ABC) Ziagen
emtricitabine (FTC) Emtriva
lamivudine (3TC) Epivir
tenofovir disoproxil fumarate (tenofovir DF, TDF) Viread
zidovudine (azidothymidine, AZT, ZDV) Retrovir

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

NNRTIs bind to and later alter reverse transcriptase, an enzyme that HIV needs in order to make copies of itself.

Generic Name (other name, abbreviation) Brand Name
doravirine (DOR) Pifeltro
efavirenz (EFV) Sustiva
etravirine (ETR) Intelence
nevirapine (extended-release nevirapine, NVP) Viramune / Viramune XR (extended release)
rilpivirine (rilpivirine hydrochloride, RPV) Edurant

Protease Inhibitors (PIs)

PIs block HIV protease, an enzyme HIV needs to make copies of itself.

Generic Name (other name, abbreviation) Brand Name
atazanavir (atazanavir sulfate, ATV) Reyataz
darunavir (darunavir ethanolate, DRV) Prezista
fosamprenavir (fosamprenavir calcium, FOS-APV, FPV) Lexiva
ritonavir (RTV)** Norvir
saquinavir (saquinavir mesylate, SQV) Invirase
tipranavir (TPV) Aptivus

**Although ritonavir is a PI, it is generally used as a pharmacokinetic enhancer as recommended in the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents and the Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection.

Fusion Inhibitors

Fusion inhibitors block HIV from entering the CD4 cells of the immune system.

Generic Name (other name, abbreviation) Brand Name
enfuvirtide (T-20) Fuzeon

CCR5 Antagonists

CCR5 Antagonists block CCR5 coreceptors on the surface of certain immune cells.

Generic Name (other name, abbreviation) Brand
maraviroc (MVC) Selzentry

Integrase Inhibitors

Integrase inhibitors block HIV integrase, an enzyme HIV needs to make copies of itself.

Generic Name (other name, abbreviation) Brand
dolutegravir (DTG, dolutegravir sodium) Tivicay
raltegravir (raltegravir potassium, RAL) Isentress, Isentress HD

Pharmacokinetic Enhancers

Pharmacokinetic enhancers are used in HIV treatment to increase the effectiveness of an HIV medicine included in an HIV regimen.

Generic Name (other name, abbreviation) Brand
cobicistat (COBI) Tybost

Combination HIV Medicines

Combination HIV medicines contain two or more HIV medicines from one or more drug classes.

Generic Name (other name, abbreviation) Brand
abacavir and lamivudine (abacavir sulfate / lamivudine, ABC / 3TC) Epzicom
abacavir, dolutegravir, and lamivudine (abacavir sulfate / dolutegravir sodium / lamivudine, ABC / DTG / 3TC) Triumeq
abacavir, lamivudine, and zidovudine (abacavir sulfate / lamivudine / zidovudine, ABC / 3TC / ZDV) Trizivir
atazanavir and cobicistat (atazanavir sulfate / cobicistat, ATV / COBI) Evotaz
bictegravir, emtricitabine, and tenofovir alafenamide (bictegravir sodium / emtricitabine / tenofovir alafenamide fumarate, BIC / FTC / TAF) Biktarvy
darunavir and cobicistat (darunavir ethanolate / cobicistat, DRV / COBI) Prezcobix
darunavir, cobicistat, emtricitabine, and tenofovir alafenamide (darunavir ethanolate / cobicistat / emtricitabine / tenofovir AF, darunavir ethanolate / cobicistat / emtricitabine / tenofovir alafenamide, darunavir / cobicistat / emtricitabine / tenofovir AF, darunavir / cobicistat / emtricitabine / tenofovir alafenamide fumarate,  DRV / COBI / FTC / TAF) Symtuza
dolutegravir and rilpivirine (dolutegravir sodium / rilpivirine hydrochloride, DTG / RPV) Juluca
doravirine, lamivudine, and tenofovir disoproxil fumarate (doravirine / lamivudine / TDF, doravirine / lamivudine / tenofovir DF, DOR / 3TC / TDF) Delstrigo
efavirenz, emtricitabine, and tenofovir disoproxil fumarate (efavirenz / emtricitabine / tenofovir DF, EFV / FTC / TDF) Atripla
efavirenz, lamivudine, and tenofovir disoproxil fumarate (EFV / 3TC / TDF) Symfi
efavirenz, lamivudine, and tenofovir disoproxil fumarate (EFV / 3TC / TDF) Symfi Lo
elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide fumarate (elvitegravir / cobicistat / emtricitabine / tenofovir alafenamide, EVG / COBI / FTC / TAF) Genvoya
elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (QUAD, EVG / COBI / FTC / TDF) Stribild
emtricitabine, rilpivirine, and tenofovir alafenamide (emtricitabine / rilpivirine / tenofovir AF, emtricitabine / rilpivirine / tenofovir alafenamide fumarate, emtricitabine / rilpivirine hydrochloride / tenofovir AF, emtricitabine / rilpivirine hydrochloride / tenofovir alafenamide, emtricitabine / rilpivirine hydrochloride / tenofovir alafenamide fumarate, FTC / RPV / TAF) Odefsey
emtricitabine, rilpivirine, and tenofovir disoproxil fumarate (emtricitabine / rilpivirine hydrochloride / tenofovir disoproxil fumarate, emtricitabine / rilpivirine / tenofovir, FTC / RPV / TDF) Complera
emtricitabine and tenofovir alafenamide (emtricitabine / tenofovir AF, emtricitabine / tenofovir alafenamide fumarate, FTC / TAF) Descovy
emtricitabine and tenofovir disoproxil fumarate (emtricitabine / tenofovir DF, FTC / TDF) Truvada
lamivudine and tenofovir disoproxil fumarate (Temixys, 3TC / TDF) Cimduo
lamivudine and zidovudine (3TC / ZDV) Combivir
lopinavir and ritonavir (ritonavir-boosted lopinavir, LPV/r, LPV / RTV) Kaletra
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PrEP: The Basics

PrEP (short for Pre-Exposure Prophylaxis) is the use of anti-HIV medications to keep HIV negative people from becoming contracting HIV. PrEP is FDA approved and has been shown to be safe and effective when it comes to the prevention of HIV. Even though PrEP has been around in the United States since 2012, many people are still looking to learn more about how it works.

Daily PrEP lowers the risk of contracting HIV from sex by over 90% and by more than 70% among those who inject drugs. Your risk of getting HIV from sex can be lowered even more by combining PrEP with condoms and/or other prevention methods.

PrEP is not something that’s taken for life. It’s normally taken for anywhere from a few months to a few years, during periods of time when a person feels the most at risk of getting HIV. Examples of these time periods could be during specific relationships, dating new people, knowing you will be sexually active with new people whose status you don’t know, dealing with drug use problems, or while trying to conceive with an HIV-positive partner.

The CDC (Centers for Disease Control and Prevention) has a informative video with more information on how PrEP works, how to get it, and if it’s the right choice for you. You can find the video here: https://www.youtube.com/watch?v=TR8-3uAuZGo

 

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HIV Testing FAQ

Should you get tested for HIV? The CDC recommends that everybody from age 13 to 64 get tested for HIV at least once, just as part of your routine health care. Did you know that around 1 out of 7 people in the US who have HIV don’t know they have it? However, those that are at higher risk should get tested more often.

 

How can testing help you? Knowing your status gives you the knowledge and power to take the appropriate steps to keep yourself and your partner healthy. If you test positive, you can take medicine to treat HIV and prevent it’s transmission to others. If you’re pregnant, testing can help determine whether you need to start treatment. When HIV-positive women are treated early in their pregnancies, the risk of transmitting HIV to the baby is very low.

 

Where can you get tested? Ask your health care provider for an HIV test. Medical clinics, substance abuse programs, community health centers, and hospitals offer testing, as well. Additionally, you can find a testing site in your area by either:

 

  • calling 1-800-CDC-INFO (232-4636)
  • visiting gettested.cdc.gov, or
  • texting your ZIP Code to KNOW IT (566948)

HIV’s Impact on Mental Health

Almost everyone comes face to face with mental health challenges at some point in their lives. Major stresses—like mourning the death of a loved one, going through a divorce, losing a job, or moving—can all have a pretty big impact on mental health. Having a serious illness like HIV can also be a major stressor that impacts one’s mental health. Some people living with HIV find that it challenges their sense of well-being or even complicates existing mental health conditions. HIV can also affect your nervous system or lead to behavior changes. Having good mental health will absolutely help you live your life to the fullest and is essential to successfully treating HIV.

HIV Depression: What it is and where you can find treatment

One of the most common mental health conditions that people living with HIV battle is depression. Depression can range anywhere from mild to severe and the symptoms can affect your day-to-day life on different levels. According to the CDC, symptoms of depression can include:

  • Persistent sadness
  • Anxiety
  • Feeling “empty”
  • Feelings of helplessness
  • Negativity
  • Loss of appetite
  • Disinterest in engaging with others

The good news is that depression is manageable and treatable. Your health care provider, social worker, or case manager can refer you to a mental health provider that will get you on the right track to treatment. Curious about what kind of mental health providers are out there? They can include:

  • Psychiatrists: Psychiatrists are medically trained physicians that treat mental health conditions with therapies such as talk therapy and by prescribing medicine.
  • Psychologists: Psychologists are trained professionals who help people cope with life challenges and mental health conditions with therapies, but usually cannot prescribe medicines.
  • Therapists: Mental health or marriage and family counselors who help people cope with life issues and mental health problems.
  • You might also choose to join a support group.

Substance Abuse & Mental Health Services Administration (SAMHSA)’s Find Help website provides a list of organizations and contact numbers that can help you find mental health treatment and support in your local area.

To learn more about depression’s causes, symptoms, and treatments, consult the National Institute of Mental Health resources on this topic. For more information about other mental health conditions, visit the Substance Abuse & Mental Health Services Administration (SAMHSA)’s Mental Disorders.

Proper Disposal of Unused Medications

Prescription medications are a very important part of millions of Americans lives. However, expired medications or drugs that are left unused often stay in the back of medicine cabinets for months or sometimes even years. These unused and unattended drugs, whether expired or not, become serious health hazards to toddlers, teens, and even family pets who may inadvertently consume them. Some medications could even be fatal if accidentally ingested. Did you know that researchers at Johns Hopkins University found that nearly 70% of prescription opioids in homes with children aren’t stored safely?

There are other important safety issues at play here, as well. The misuse of prescription narcotic drugs is becoming an increasingly serious public health concern. Over 46,000 Americans die each year from drug-related deaths, and over half of them are related to heroin and prescription opioids.

These statistics really show the need for proper disposal of expired/unused prescription medications from homes to help prevent any misuse or accidental consumption of dangerous drugs. But how? In addition to Drug Take Back Day and similar community programs (check with your local law enforcement to find out if your community participates – and when it does), medications can be properly disposed of at home. Below are the FDA’s recommendations on proper home-disposal of your unused and expired prescription drugs.

 

There are two different ways to dispose of medicine at home, depending on the drug.

  1. Flushing. Some medicines can be especially harmful to others, so they have specific directions to flush them down the sink or toilet immediately when they are no longer needed.

But how do know if your mediation calls for disposal by flushing? You can check the label or a patient information leaflet, if it requires this method of disposal, it will say so. You can also check the FDA’s list of medicines recommended for disposal by flushing.

  1. Disposing in the trash. Almost all medicines (with the except of those that call for being flushed) can be thrown away in your household trash. This includes both prescription and over-the-counter drugs in the form of pills, liquids, drops, patches, creams, and inhalers.

Follow these steps to ensure a proper disposal:

  1. Remove the drugs from their original containers and mix them with something undesirable (commonly used items for this are used coffee grounds, dirt, or cat litter). This makes the drugs less appealing to children and pets who could otherwise ingest them, as well as rendering them unrecognizable to someone who could be intentionally go through the trash in search of drugs.
  2. Put the mixture you made in something close-able, like a resealable storage bag or empty can, to prevent the drugs from leaking or spilling out.
  3. Throw the container away in the garbage.
  4. Scratch out any personal information that might be on the empty medicine packaging to protect your identity and privacy, then throw the packaging away.

Be sure to ask your health care provider or pharmacist if you have any questions about your medications and how to dispose of them. If you’re looking for more information about Drug Take Back Day or want to find a location near you, you can visit the FDA’s Take Back Day website.

 

 

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Newly Diagnosed: What Does It Mean?

Being diagnosed with HIV means that you were exposed to the HIV virus and that you’re living with it in your body, according to the CDC. The human body can’t completely get rid of the HIV virus like it can with some other viruses. While treatment is available and important, once you’re diagnosed with HIV, you have it for life.

Like we just mentioned, it’s very important that anyone diagnosed with HIV starts medical care as soon as possible. The medicine used to treat HIV is called antiretroviral therapy, or ART for short.  Taking medicine as prescribed can lower your viral load. When the load is very low, it’s called viral suppression, which means that you have less than 200 copies of HIV per milliliter of blood. Proper medication can also make your viral load so low that a test can no longer detect it. When this happens it’s called undetectable viral load. Achieving and maintaining an undetectable viral load is one of the top things you can do to stay as healthy as possible. In fact, if you consistently maintain an undetectable viral load, the risk of transmitting HIV to a partner becomes almost non-existent.

Now, what happens if someone diagnosed with HIV doesn’t get medical care? Without treatment, HIV will attack the immune system and they will then develop AIDS. When this happens, it allows for different types of life-threatening infections and cancers to develop, which can lead to death. A cure for HIV still does not exist, but proper medical care and treatment with medicine can keep people living with HIV healthy for many, many years and help reduce their risk of transmitting the virus to other people.

HIV Diagnoses and Prevention Among Older Americans

Nearly half of those in the U.S living with diagnosed HIV are aged 50 and older, according to the CDC. Older generations are more likely than younger generations to have late-stage HIV infection at the time of diagnosis. This means that treatment occurs later and they can possibly suffer more damage to their immune systems.

There are many possible reasons why late diagnoses occur. One reason could be that health care providers might not be testing older people for HIV infection. Another common reason is that some older people may not consider themselves at risk of infection, or they may even mistake HIV symptoms for those of the normal aging process. The CDC reports that among people aged 55 and older who received an HIV diagnosis in 2015, 50% have had HIV for four and a half years before receiving an official diagnosis. That is the longest delay for any age group in their study.

Older people typically have most of the same risk factors as younger people, including a lack of knowledge about HIV prevention and sexual risk, including having multiple partners. Older people however, face some unique issues.

  • Women that longer worry about preventing pregnant can be less likely to use condoms or other methods of practicing safer sex. Additionally, age-related thinning and dryness of vaginal tissue also may raise the risk for HIV in older women.
  • Although it’s common for older people to visit doctors more frequently than younger people, they are less likely to discuss their sexual or drug use behaviors.

Aging with HIV also presents additional challenges for preventing other diseases. Age and HIV both increase a person’s risk for health conditions like cardiovascular disease, bone loss, or even certain cancers. Older HIV patients and their health care providers need to make sure they keep an eye out for early signs of illness. Mindfulness about medical interactions between those used to treat HIV and common age-related conditions (hypertension, diabetes, elevated cholesterol, obesity, etc.) is also extremely important.