Choosing your treatment

Choosing a drug combination that you can fit into your existing eating habits is usually easier than trying to adjust your eating habits to fit the drugs.

Anti-HIV drugs are becoming easier to take and many drugs do not have any special food requirements – you can take them with or without food. But some drug combinations may demand one of the following adaptations:

• Eating at the same times as you take your drugs.
• Avoiding food for two hours before or an hour after you take your drugs.
• Eating or avoiding certain types of food in order to ensure that you absorb your medication.

Interactions between drugs and food

The following is a brief over view of dietary requirements for currently available HIV drugs. When you are prescribed a new drug you should be given written information about how to take it, including information about dietary restrictions. Ask your doctor, pharmacist or dietitian if you require any further information about your diet and HIV drugs.

Drug and food interactions – nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/NtRTI)

	Food requirements	Liquid Requirements
3TC (lamivudine, Epivir)	May be taken with or without food.	No special requirements.
abacavir (Ziagen)	May be taken with or without food.	No special requirements.
AZT (zidovudine, Retrovir)	May be taken with or without food, though taking with food may reduce nausea.	No special requirements.
d4T (stavudine, Zerit)	May be taken with or without food. The package information says that d4T should always be taken on an empty stomach for faster absorption; however, food does not make any difference to the amount of d4T absorbed and may help to reduce nausea.	No special requirements.
ddI (didanosine, Videx) (100/200mg tablets)	Essential to take on an empty stomach, at least either 30 minutes before or two hours after eating.	Must only be taken with cold non-carbonated water or clear apple juice (which may improve the taste). Take at least one hour apart from indinavir.
EC ddI (didanosine capsules) (Videx EC)	Essential to take on an empty stomach, at least either two hours before or two hours after eating.	Cold water recommended.
FTC (emtricitabine, Emtriva)	May be taken with or without food.	No special requirements.
tenofovir (Viread)	The information is contradictory. The packet information says preferably taken with food. But there is good evidence that it can be taken with or without food.	No special requirements.

Drug and food interactions - combination pills

Drug and food interactions – non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Drug and food interactions – protease inhibitors

Food and drug interactions – fusion and entry inhibitors

Drug and food interactions – integrase inhibitors

Managing drug-related side-effects that interfere with eating

Lipodystrophy

Changes in the way the body processes, uses and stores fat have been noticed in some people taking anti-HIV drugs. This can lead to changes in body shape or abnormally high blood fats. Another booklet in this series called Lipodystrophy deals with this subject in detail.

In particular, high levels of cholesterol and triglycerides have been found in the blood of people taking anti-HIV drugs. Having high levels of these substances in the blood for a long time has been linked to an increased risk of heart disease.

Stopping smoking and taking regular exercise cause blood fats to fall and reduce the risk of heart disease.

Changes in diet can help reduce cholesterol levels. In particular, try to reduce saturated fat intake (for cholesterol) and sugar and alcohol intake (for triglycerides).

Fish oils containing fatty acids of the omega-3 group can reduce triglycerides and LDL ("bad") cholesterol and increase HDL ("good") cholesterol, help maintain flexibility in the blood vessels and reduce blood thickness. You may also wish to eat more oily fish like mackerel, salmon, tilapia and kippers. In addition, eating plenty of fruit and vegetables (at least five portions a day) is known to offer protection to the heart. If you do not like oily fish, then your doctor may prescribe Maxepa, Omacor or linseed oil.