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“No”, Stellenbosch University dietician Roy Kennedy told doctors, dieticians and nurses at the 21st Biennial Nutrition Congress held in Port Elizabeth this week.
“Nutrition is vital for HIV/Aids patients, but they should not concentrate on any particular food. They should include five vegetables and fruits a day and a multivitamin and mineral supplement up to a maximum of three times the recommended daily allowance (RDA).”
Kennedy, a lecturer at the University of Stellenbosch’s Department of Human Nutrition, has had a special interest in HIV/Aids nutrition for many years and is the author of the SA National Guidelines for Nutrition for People Living with TB, HIV/Aids and Other Debilitating Disorders. The guidelines are available online at www.sun.ac.za/nicus.
More vitamins, minerals
He stated that antiretrovirals work better in patients with a good nutritional status – and that it minimises the side effects of these drugs.
He says recent evidence found that HIV patients have a greater requirement for vitamins and minerals than the RDA and that it may now be ethically questionable not to provide these micronutrients to patients routinely.
"We recommend giving double to triple the RDA," Kennedy says. The first step is to make up for the deficiency that could be present, while the second and third steps are to help handle the extra requirements due to the infection. "The body needs more to handle the increased oxidative stress caused by HIV infection."
“After twenty years of research, we don’t know if the vitamin deficiencies are the result of the progression of HIV disease or whether the progression is helped along by the nutrient deficiencies,” he said. “All we know is that patients need general supplementation but not of any one vitamin or mineral in particular.”
ARVs, food interactions
As there are different types of antiretroviral drugs, patients need to know exactly what type they are receiving to understand what the nutritional interactions may be.
“Eating large amounts of garlic while on some kinds of antiretrovirals can make treatment up to 50% less effective,” he said. “And while grapefruit can enhance some antiretrovirals, it has a definite negative effect on others.
“This is why it is best not to eat large amounts of any one food and to stick to good eating habits as recommended by the SA National Guidelines ”
Increased energy requirements
Kennedy said that when HIV was discovered in the early eighties, it was realised that patients had increased requirements for energy.
“We concentrated on keeping the body weight up through feeding, since if lean body mass, or muscle mass, dropped below 55%, the person would not survive.”
In 1995, a new class of drugs was introduced: protease inhibitors (PIs).
These drugs were thought to be greatly beneficial as patients started gaining weight – a solution to the wasting.
But the weight gain was fat – and did not go to the right places in the body. It caused lipodystrophy syndrome, a derangement of fat distribution and also blood lipid levels putting the patient at an increased risk of cardiovascular disease.
As research went on, nutrition became more complicated. Apart from the derangement of blood lipids, it was found that the insulin of HIV patients also did not function as well as it should.
A state of high nutrition
So, an approach had to be found to keep patients in a state of high nutrition while taking the diabetic and cardiovascular risks into consideration as well as making provision for nutrient losses, such as with diarrhoea.
The HI virus does not only occur in the blood but also in the cells lining the gastrointestinal tract. This means that vitamins and minerals may not be well absorbed.
Antiretrovirals do not kill the virus. They work on enzyme systems in the lymphosites to stop the virus from replicating as fast as usual. By keeping the viral count down, it helps to protect the immune system.
Research also showed that having too much of one nutrient could be detrimental. For instance, too much zinc accelerates the disease and high levels of vitamin A have also been shown to be detrimental.
The Nutrition Congress was held under the auspices of the SA Nutritional Society and the Association of Dietetics of South Africa. – (Bay Public Relations, September 2006)
