Antiretroviral Drugs—Food and Nutrition Complications
Goulda A. Downer, PhD, RD, LN, CNS
Abstract
Antiretroviral drugs can have both implicit and explicit consequences for the person living with HIV/AIDS. Good nutrition is critical to the treatment, management and success of any medical intervention against diseases-including HIV/AIDS. While good nutrition cannot prevent HIV infection or cure AIDS, it can help to maintain and improve the nutritional status of persons with the virus and very possibly, delay the disease progression from HIV to AIDS—related diseases by boosting defenses. Medications can slow the progress of HIV/AIDS, relieve symptoms, and make life more tolerable. However, some foods can interact with these medications and affect the drugs’ efficacy. Individuals should be educated to understand that many of the potent antiretrovirals (ARVs) often need to be taken with food. Use of the right combination of food and ARV treatment is important to ensuring drug compliance and effectiveness.
The interaction between antiretroviral drugs (ARVs) and food and nutrition can have a significant impact on the nutritional status, efficacy of medication and medication adherence regimes on the quality of life of persons living with HIV/AIDS (PLWHA). Furthermore, the issues of food insecurity, malnutrition and hunger become of paramount importance. ARVs can interact with food and nutrition in a variety of ways-- generating both positive and negative consequences. It is therefore important that service providers, caretakers and PLWHA have a greater understanding of drug-food interactions when taking HIV/AIDS medications, since food intake can be the difference between the success and failure of these medications, and to a greater extent the success of antiretroviral therapies (ARTs). However, while good nutrition will complement and reinforce the effect of many ARVs, lack of food and poor nutrition can diminish medication efficacy and adherence. Likewise if patients experience side effects that interfere with food consumption they are likely to discontinue medications before completing the necessary course. This can accelerate the progression of disease.
Nutrition and ARVs
Good nutritional status is essential for individuals infected with HIV. Good nutrition not only strengthens the immune system, but it decreases vulnerability to infections and decreases the severity of these infections. By improving nutritional status and reducing complicating symptoms, quality of life can be enhanced at each stage of the disease. A well balance diet provides the energy and nutrients the body needs to stay alive; it can help to maintain and improve nutritional status and very possibly, delay the disease progression from HIV to AIDS-related diseases by boosting defenses. Thus, the consumption of an adequate amount of food in the appropriate proportions of macro and micro nutrients is critical. Because the virus damages the immune system, patients with HIV/AIDS are vulnerable to multiple infections.
Infections interfere with the body’s ability to absorb and use micronutrients, which are needed to fight HIV. Higher nutrient intakes are required when the patient suffers from secondary diseases such as diarrhea, vomiting, etc. Thus, a diet rich in protein, energy and micronutrients, especially vitamin A, can contribute to resistance to opportunistic infections in PLWHA. Poor nutritional status is one of the most prevalent factors that exacerbates HIV/AIDS. When individuals with HIV/AIDS are provided with a combination of medication and adequate nutrition, health advances are validated.
While antiretroviral drugs do not completely destroy HIV, they significantly reduce the replication of the virus in the body, thus slowing the progression of the disease. ARVs are usually classified into two classes-reverse transcriptase inhibitors (RTIs)-and protease inhibitors (PIs). These medications either keep virus from reproducing and affecting new cells or, keep immature viruses from maturing. Each type of ARV is active at different stages of the virus in the replication of HIV. ARVs are not required at all stages of HIV. It is important that PLWHAs understand how to take their medication and how to avoid any potential side effects and negative interactions.
Diet becomes especially important when taking drugs for HIV infection. This is because many anti-retroviral medications have special dietary needs for their effective absorption. Consequently, diet can be the difference between success and failure of a medication regiment. Because malabsorption is very common among people with HIV, many ARVs often need to be taken with food. This is because a certain amount of medication has to be maintained in the body in order for it to be effective against the virus. For some ARVs, food not only boosts the amount of medication that gets into the body but also impacts the amount that stays there. Multiple medications may have multiple food-drug interactions therefore the use of the right combination of food and ARV treatment is also important to ensure drug compliance and effectiveness. Drug therapy regardless of its benefits, can be harsh on the body, certain organs like the liver and kidneys require greater amounts of energy and certain micronutrients to effectively process high level of toxic therapies being consumed on a regular basis.
Conclusion
In general, good nutrition is essential for achieving and maintaining health, and well-being—while protecting the body against illness. Since PLWHAs may take a variety of medicines, not just for the virus, but other conditions resulting from the disease, good nutrition is critical. Poor nutrition can hinder the body’s ability to deal with medicines effectively. Though medications can slow the progress of HIV’AIDS, relieve symptoms, and make life a little more tolerable, unfortunately, some foods can interact with drugs and affect the drugs’ efficacy. Nutritional status could also be negatively affected when drugs interact with foods and nutrients. Therefore, as ARVs become more accessible, PLWHAs, must be educated on these issues, and there must be simultaneous discussions on good nutrition, and the importance of food-drug interactions. Nutritional care and support for people living with HIV/AIDS can contribute to an increase in the resistance to opportunistic infections, a delay in the progression of the disease and an improvement in the quality of life. Furthermore, it allows people living with the disease to live in dignity.
July, 2007