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Your diet and anti-HIV drugs
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.
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 analogues (NRTIs/NtRTI)
3TC (lamivudine, Epivir)
Food Requirements: May be taken with or without food.
Liquid Requirements: No special requirements.
abacavir (Ziagen)
Food Requirements: May be taken with or without food.
Liquid Requirements: No special requirements.
AZT (zidovudine, Retrovir)
Food Requirements: May be taken with or without food, though taking with food may reduce nausea.
Liquid Requirements: No special requirements.
d4T (stavudine, Zerit, Zerit PRC)
Food Requirements: 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.
Liquid Requirements: No special requirements.
ddI (didanosine, Videx) (100/200mg tablets)
Food Requirements: Essential to take on an empty stomach, at least either 30 minutes before or two hours after eating.
Liquid Requirements: 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)
Food Requirements: Essential to take on an empty stomach, at least either two hours before or two hours after eating.
Liquid Requirements: Cold water recommended.
ddC (zalcitabine, Hivid)
Food Requirements: May be taken with or without food.
Liquid Requirements: No special requirements.
Note: Production of ddC will cease in 2006.
FTC (emtricitabine, Emtriva)
Food Requirements: May be taken with or without food.
Liquid Requirements: No special requirements.
tenofovir (Viread)
Food requirements: Preferably taken with food. A high fat meal may improve absorption.
Liquid requirements: No special requirements.
Combination pills
AZT, 3TC combined (Combivir)
Food Requirements: May be taken with or without food.
Liquid Requirements: No special requirements.
AZT, 3TC, abacavir combined (Trizivir)
Food Requirements: May be taken with or without food.
Liquid Requirements: No special requirements.
3TC, abacavir combined (Kivexa)
Food Requirements: May be taken with or without food.
Liquid Requirements: No special requirements.
tenofovir, FTC combined (Truvada)
Food Requirements: May be taken with or without food.
Liquid Requirements: No special requirements.
Non-nucleoside analogues (NNRTIs)
efavirenz (Sustiva)
Food requirements: May be taken with or without food. However, taking the drug with food may increase drug levels by up to 50% in some people. High fat meals may also increase absorption of efavirenz, which may lead to increased side-effects, particularly in the early weeks of treatments.
Liquid requirements: No special requirements.
nevirapine (Viramune)
Food requirements: May be taken with or without food.
Liquid requirements: No special requirements.
Protease inhibitors
fosamprenavir (Telzir)
Food requirements: May be taken with or without food.
Liquid requirements: Alcohol should be avoided by people on the liquid formulation.
atazanavir (Reyataz)
Food requirements: Recommended to take with food, as food increases concentrations of the drug considerably.
Liquid requirements: No special requirements reported.
indinavir (Crixivan) three times daily
Food requirements: Take two hours after or one hour before food high in fat or protein. A light snack, without fat can however be taken at the same time.
Liquid requirements: Increase fluid intake by up to 1.5 litres of water a day to reduce the chances of developing kidney stones. Grapefruit juice reduces absorption of indinavir and should not be drunk at the same time as the drug is taken.
indinavir (Crixivan) twice daily in combination with ritonavir
Food requirements: With or without food.
Liquid requirements: Increase fluid intake by up to 1.5 litres of water a day to reduce the chances of developing kidney stones. Grapefruit juice reduces absorption of indinavir and should not be drunk at the same time as the drug is taken.
lopinavir/ritonavir (Kaletra)
Food requirements: Take with a substantial meal containing fat.
Liquid requirements: No special requirements.
nelfinavir (Viracept)
Food requirements: Take with a substantial snack, such as cereal with milk, a sandwich, baked potato or large chocolate bar.
Liquid requirements: No special requirements.
ritonavir (Norvir)
Food requirements: May be taken with or without food, but taking with a fatty meal minimises the risk of an upset stomach.
Liquid requirements: No special requirements.
saquinavir soft gel (Fortovase)
Food requirements: Take within two hours of a substantial meal containing fat.
Liquid requirements: No special requirements.
Note: Production of Fortovase will cease in 2006.
saquinavir hard gel (Invirase)
Food requirements: Take within two hours of a substantial meal.
Liquid requirements: No special requirements.
tipranavir (Aptivus)
Food requirements: Eating a high fat meal at the same time as taking the drug doubles concentrations of the drug.
Liquid requirements: No special requirements.
Fusion inhibitor
T-20 (enfuvirtide, Fuzeon)
Food requirements: Administered by injection.
Liquid requirements: No special requirements.
Managing drug related side-effects that interfere with eating
Nausea and vomiting
Some anti-HIV drugs can cause you to feel or be sick. Your doctor should prescribe anti-nausea medication at the start any course of treatment, which may cause these side-effects. However, you should note that anti-nausea medicines only stop you from vomiting, they do not remove feelings of nausea.
Diarrhoea
Diarrhoea as a drug related side-effect can normally be controlled by anti-diarrhoea medication, which your doctor can prescribe you or can be bought over the
counter. It is worthwhile having a stool sample checked for infections. A change in diet may also help to alleviate diarrhoea (see the section on ‘Diarrhoea’ below).
Unpleasant taste
This may be a direct consequence of the disintegration of drug capsules in the mouth, in which case strong mints or sweets, or brushing your teeth may help take the taste away.
However some drugs have been reported to cause changes in taste after the body has metabolised them. In some cases these are temporary and disappear after a few weeks, but in other cases they may persist, which may mean that you have to try food flavourings or cut out foods which have become unpleasant. Or you may choose to speak to your doctor about changing your drugs, especially if you are taking first-line treatment.
Size and number of pills
If you have difficulty swallowing pills you may be able to obtain a liquid or powder formula of some of the drugs causing the problems. You should speak to your doctor or a pharmacist as soon as possible about this.
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.