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close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
Open this folder and view contentsCHAPTER 6: HIV/AIDS AND PREGNANCY
Open this folder and view contentsCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
Open this folder and view contentsCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
Open this folder and view contentsCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
Open this folder and view contentsCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
Open this folder and view contentsCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
close this folderCHAPTER 15: HIV/AIDS AND NUTRITION
View the document15.1 Malnutrition and HIV/AIDS
View the document15.2 Nutrient Requirements for People Living with HIV/AIDS (PLHA)
View the document15.3 Good Dietary Practices
View the document15.4 Dietary Practices and Nutrition for Adult PLHA and AIDS Related Symptoms
View the document15.5 Nutritional Issues Associated with ARVs and Other Modern Medicines
View the document15.6 Guidance on Effective Nutrition/Medication Management for Antiretroviral Therapy (ART)
View the document15.7 AIDS-wasting Syndrome
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

15.5 Nutritional Issues Associated with ARVs and Other Modern Medicines

People infected with HIV may take various modern medications, including antibiotics to treat opportunistic infections, ARVs to treat HIV/AIDS, anti-malarial, anti-helminthe, and anti-fungal medications to treat other conditions such as malaria, intestinal parasites, and thrush.

Foods and medications can interact in 4 major ways to create health and nutritional positive and negative outcomes in PLHA.

These are as shown below:

1. FOOD


(Affects)

MEDICATION ABSORPTION, METABOLISM, DISTRIBUTION,EXCRETION

2. MEDICATION


(Affects)

NUTRIENT ABSORPTION, METABOLISM, DISTRIBUTION,EXCRETION

3. MEDICATION SIDE EFFECTS


(Affects)

FOOD CONSUMPTION, NUTRIENT ABSORPTION

4. MEDICATION + CERTAIN FOODS


(Creates)

UNHEALTHY SIDE EFFECTS

Some side effects of medications can be similar to certain AIDS-related symptoms and call for similar dietary management. Proper dietary management can help to manage some side effects. The following are examples:

Changes in taste: The protease inhibitors saquinavir and ritonavir cause changes in taste and can cause food to taste metallic, sweeter, sourer, or too salty, which, in turn, may cause an individual to consume less food. This can be addressed by using flavour enhancers such as salt, sugar, spices, vinegar, or lemon to stimulate the taste buds, increase taste acuity, and mask any unpleasant flavours. Adding spices like onions to soup will boost flavour and can help to improve intake.

Anorexia: Several medications, such as isoniazid and the ARVs lamividune and stavidune, may cause anorexia and lead to reduced food intake. The dietary management of anorexia requires eating small and frequent meals and favourite foods. PLHA that experience anorexia should eat five to six small meals a day and should include energy- and nutrient-dense foods at each meal to ensure adequate nutrient intake. It is also important to maintain as much physical activity as possible, such as walking in fresh air, which also helps to stimulate appetite.

Some ARVs have been associated with increased risk of osteoporosis and weakening of bones that may require medical and dietary responses. For osteoporosis, a balanced diet with high calcium foods, such as milk, yogurt, cheese, and vitamin D supplement is recommended, along with medical care.

Some side effects of ARVs are similar to symptoms of opportunistic infections, such as diarrhoea. Therefore, the health worker must continue to be alert to recognize symptoms of infections and treat these infections appropriately.

Multiple Medications

Treatment of AIDS may require taking many pills on a daily basis, which can make it difficult to maintain food intake. If medications make it difficult to eat, a person is less likely to strictly adhere to the drug regimen, which can create drug resistance, especially in the case of ARVs. It is vital that health workers explain the necessity of healthy eating to the furthest extent possible, while also adhering to the drug regimen.

Multiple medications have multiple food-drug interactions and side effects that require setting specific timing, identifying recommended foods, and avoided foods for each drug. Health workers should spend enough time with the PLHA, to list all the drugs taken and counsel on the dietary management of the side effects and the interactions with food.

Drug-Drug Interactions

Drug interactions need to be managed adequately in order to ensure that the prescribed drug combination does not diminish drug efficacy, increase side effects, and affect nutritional status. For example, the ARV didanosine reacts with antacid medications containing magnesium and aluminium, leading to increased side effects of didanosine. Therefore, didanosine should not be taken at the same time with the antacid medications containing magnesium and aluminium.

Medication and Food Can Cause Unhealthy Side Effects

The combination of some medications and food can create unhealthy side effects or reduce the positive impacts of the drugs. Table 14.2 lists some of the medications used in Tanzania. The table shows their purpose, potential side effects, and recommended ways of taking the medications.

Table 20: Modern Medications and Recommended Food Intakes and Side Effects

Medication

Purpose

Nutrition Recommendations

Foods/Beverages/Herbs to Avoid

Potential Side Effects

Sulfonamides: Sulfamethoxazole, Cotrimoxazole (Bactrim ® Septra ®)

Antibiotic for treating pneumonia and toxoplasmosis

Take with food

 

Nausea, vomiting, abdominal pain

Rifampin

Treatment of TB

On an empty stomach one hour before or two hours after meals

Alcohol

Nausea, vomiting, diarrhoea, loss of appetite

Isoniazid

Treatment of TB

One hour before or two hours after meals
Supplement with 10 mg vitamin B6 daily

Alcohol

Anorexia, diarrhoea; may cause possible reactions with foods such as bananas, beer, avocados, liver, smoked or pickled fish, yeast, yogurt; may interfere with vitamin B6 metabolism, therefore will require vitamin B6 supplement to prevent peripheral neuropathy and anaemia

Quinine

Treatment of malaria

With food

 

Abdominal or stomach pain, diarrhoea, nausea, vomiting; lower blood sugar

Sulfadoxine and Pyrimethamine (Fansidar ®)

Treatment of Malaria Pyrimethamine is also used to treat toxoplasmosis

With food and consume large quantities of water
Supplement daily with folinic acid (leucovorin), the active form of folate (5-10 mg/day)

 

Nausea, vomiting, taste loss and diarrhoea; not recommended if folate deficient; not recommended for breastfeeding women

Chloroquine

Treatment of malaria

With food

 

Stomach pain, loss of appetite, nausea, vomiting; not recommended for breastfeeding women

Fluconazole

Treatment of thrush

With food

 

Nausea, vomiting, diarrhea; can be used during breastfeeding

Nystatin ®

Treatment of thrush

With food

 

Infrequent occurrence of diarrhea, vomiting, nausea

Antiretroviral drugs

Abacavir (ABC)
NNRTI

Antiretroviral

Can be taken without regard to food

 

Nausea, vomiting, fever, allergic reaction, anorexia, abdominal pain, diarrhoea, anaemia, rash, hypotension, pancreatitis, dyspnea, weakness and insomnia, cough, headache

Didanosine (ddl)
NNRTI

Antiretroviral

Take one hour before or two hours after eating with water only

Alcohol, juice

Anorexia, diarrhoea, nausea, vomiting, pain, headache, weakness, insomnia, rash, dry mouth, lost of taste, constipation, stomatitis, anaemia, fever, dizziness, pancreatitis; do not take with antacid containing aluminium or magnesium

Lamivudine (3TC)
NNRTI

Antiretroviral

Can be taken without regard to food

Alcohol

Nausea, vomiting, headache, dizziness, diarrhoea, abdominal pain, nasal symptoms, cough, fatigue, pancreatitis, anaemia, insomnia, muscle pain, and rash

Stavudine (d4T)
NNRTI

Antiretroviral

Can be taken without regard to food

Limit alcohol

Nausea, vomiting, diarrhea, peripheral neuropathy, chills and fever, anorexia, stomatitis, diarrhoea, anaemia, headaches, rash, bone marrow, and pancreatitis

Zidovudine (AZT)
NNRTI

Antiretroviral

Can be taken with food, but do not take with a high fat meal

Alcohol

Anorexia, anaemia, nausea, vomiting, bone marrow suppression, headache, fatigue, constipation, fever dizziness, dyspnea, insomnia, muscle pain, rash

Efavirenz NRTI

Antiretroviral

Can be taken with food, but do not take with a high fat meal

Alcohol

Elevated blood cholesterol levels, elevated triglycerides levels, rash, dizziness, anorexia, nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, flatulence

Nevirapine (NVP)
NRTI

Antiretroviral

Can be taken without regard to food

St John’s wort

Nausea, vomiting rash, fever, headache, skin reactions, fatigue, stomatitis, abdominal pain, drowsiness, paresthesia; high hepatoxicity

Lopinavir
PI

Antiretroviral

Can be taken without regard to food

St John’s wort

Abdominal pain, diarrhoea, headaches, headache, weakness, nausea; may increase the risk of lipodystrophy and or diabetes

Nelfinavir
PI

Antiretroviral

Take with meal or light snack

St John’s wort

Diarrhea, flatulence, nausea, abdominal pain, rash; may increase the risk of lipodystrophy

Ritonavir
PI

Antiretroviral

Take with meal if possible

St John’s wort

Nausea, vomiting, diarrhoea, hepatitis, jaundice, weakness, anorexia, abdominal pain, fever, diabetes, headache, dizziness; may increase the risk of lipodystrophy

Saquinavir
PI

Antiretroviral

Take with meal or light snack; take within two hours of a high fat meal and high calcium meal Garlic supplements

St John’s wort

Mouth ulceration, taste changes, nausea, vomiting, abdominal pain, diarrhoea, constipation, flatulence, weakness rash, headache; may increase the risk of lipodystrophy

Table 21: Food Interactions and Side Effects of Isoniazid

Medication

Dietary Interactions and the Medication Side Effects

Dietary Responses/Instructions for PLHA

Isoniazid TB treatment

Food reduces absorption of isoniazid

Do not take isoniazid during meals. Take one hour before or two hours after meals.

 

May affect vitamin B6 metabolism

Daily consumption of food sources of vitamin B6 such as white beans, maize avocado, meat, and fish, or vitamin B6 (25 to 50 mg daily) supplementation is recommended

 

Increased risk of hepatitis when combined with alcohol

Avoid alcohol.

 

Anorexia (i.e., loss of appetite)

Eat small and frequent meals. Eat favourite foods.

 

Diarrhea

Drink plenty of fluids and eat energy- and nutrient rich food. Avoid fried foods.

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