Doctor's Reference Guide To Dietetics
Infectious diseases

HIV Infection / AIDS


Best time to refer to the dietician:

  • Diagnosis of HIV  infection/AIDS combined with at least one of the following:
  • unwanted weight loss of more than 5% in a 1-month period or > 10% within a 6-month period
  • if it is expected that food intake for at least 10 days will be < 500 kcal
  • metabolic complications due to Highly Active Anti Retroviral Therapy (HAART)
  • lipodystrophy, excessive weight (overweight or obese) and/or insulin resistance, hyperlipidemia
  • renal impairment
  • liver impairment
  • osteoporosis
  • decline in the growth curve for weight by > 1 SD and height by > 0.25 SD per year, in young children by > 1 SD in 3 months.


Relevant information for the dietician:

  • Diagnosis of stage of HIV infection and related medical history, possible cause of decreased food intake and/or absorption, any comorbid conditions
  • Symptoms: anorexia, nausea, vomiting, chewing difficulties, problems with food passage, painful mouth/esophagus, diarrhea, constipation, failure to thrive / weight loss
  • Laboratory tests: CD4, viral load, total cholesterol, HDL cholesterol, triglycerides, glucose, HbA1c (depending on symptoms, measurement concerns renal function and liver function)
  • Medications: antibiotics, antidiarrheal agents, antiemetics, appetite-stimulating drugs, antiretroviral drugs (HAART), chemotherapy
  • Other: height, (changes in) weight


Aims of the diet:

  • reduce symptoms
  • maintain/achieve good growth curve / nutritional status
  • extend life expectancy
  • improve quality of life


Characteristics of the diet:

  • Energy-enriched: asymptomatic HIV infection: basal metabolism (Harris & Benedict) + extra allowances
  • Protein-enriched:


  • 1.5 - 3 g/kg of actual body weight, depending on age


  • 1.5 - 2 g/kg of actual body weight
  • Consistency: modify if necessary, based on the symptoms
  • If there is diarrhea: If necessary, a lactose and sucrose restriction. In children, also possibly fructose restriction.
  • Ensure a sufficient intake of fat, dietary fiber and fluids, based on national Nutritional Guidelines
  • Recommend taking a multivitamin 1-2 x daily which has 100-150% RDA
  • Pay attention to the impact of nutrition while antiretroviral drugs are being taken
  • Pay attention to general hygiene
  • For overweight: (see “Overweight”)
  • For hyperlipidemia: see “Hypercholesterolemia”
  • For Diabetes Mellitus: see “Diabetes Mellitus”
  • For osteoporosis: see Metabolic Diseases > “Osteoporosis”


Treatment time:

  • Care level 3*, see “Dietician’s working methods.”



Drain PK, Kupka R et al. Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy. American Journal of clinical Nutrition. 2007 feb; (2):333-45


European AIDS Clinical Society. Guidelines on the Prevention and Management of Metabolic diseases in HIV. EACS: Paris, France; 2008


Jonkers-Schuitema CF, Eden J van. Voeding bij hiv en aids. Bohn Stafleu van Loghum, Houten: 2009


Ockenga J, Grimble R et al. ESPEN Guidelines on Enteral Nutrition: Wasting in HIV and other chronic infectious diseases. Clinical Nutrition (2006)25:319-329


Valk M van der, Reiss P. Metabole bijwerkingen van antiretrovirale therapie. Ned Tijdschr Geneeskd. (2008) 31 mei; 152(22):1260-4


 HIV Infection/AIDS was updated by Patricia Bruynzeel and Nienke ter Horst, dieticians at Academisch Medisch Centrum (AMC).


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