Fw: Hot Topics at The Body’s “Ask the Experts” Forums

From: “News at The Body” <update@news.thebody.com>
Date: 31 Jan 2012 16:52:12 -0500
To: <nelsonvergel@yahoo.com>
ReplyTo: “News at The Body” <update@news.thebody.com>
Subject: Hot Topics at The Body’s “Ask the Experts” Forums

If you have trouble reading this e-mail, you can see the online version at: www.thebody.com/topics.html

January 31, 2012 Visit the Forums “Hot Topics” Library Change/Update Subscription



LIVING WITH HIV/AIDS
 Could Exercise Cause Excessive Inflammation?
I do two heavy trainings and two light trainings at the gym each week, and I play golf on the weekends. I also have a viral load of 300 and a CD4 count of 1,340, though I don’t take HIV meds yet. My doctor is worried that my gym sessions and related fat burn will cause unnecessary inflammation, and encourages me to exchange my gym sessions for just swimming or walking. I’m a little confused about my doctor’s advice. What do you know about exercise and inflammation?

Nelson Vergel responds in the “Nutrition and Exercise” forum

 How Do I Tell My Loved Ones I’m HIV Positive?
I was just diagnosed, and I haven’t told anyone. I was diagnosed within four months of exposure and I’m in good shape, with good insurance and a good job. Things seem in my favor as much as they can be. My biggest stressor is the thought of telling my family, who all live out of state. I’m the “rock” who always helps them, and I can’t imagine delivering news that will devastate them. At the same time I feel not telling is a betrayal. Right now they help me without knowing because when I talk to them it’s the only time I’m not thinking about this disease. Once they know I fear I’ll have no escape. Do you have any advice?

David Fawcett, Ph.D., L.C.S.W., responds in the “Mental Health and HIV” forum

 Do I Have to Go on Medicare When I Reach 65?
I’m 59 years old. In six years my company’s insurance will drop me because my company requires I go on Medicare when I’m 65. Is this legal? My excellent HIV doctor doesn’t take Medicare. I’m already anxious. What can I do to prepare for this?

Jacques Chambers, C.L.U., responds in the “Workplace and Insurance Issues” forum
Visual AIDS: Art from HIV-Positive Artists
Image from the January 2012 Visual AIDS gallery Detail from:
“Sheer Gucci Underwear,” 1998
Edurado Mirales

Visit the January 2012 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! This month’s gallery, entitled "If You Didn’t Laugh, You’d Cry," is curated by Stuart Sandford.

BODY SHAPE CHANGES & HIV/AIDS
 What Diet Do You Suggest to Slow Weight Gain?
I’m on Sustiva (efavirenz, Stocrin) and Truvada (tenofovir/FTC) and I’ve been gaining weight around my belly. Can you recommend an eating plan that might help reduce this fattening?

Gerald Pierone, M.D., responds in the “Facial Wasting” forum
HIV/AIDS TREATMENT
 Can I Go Off Meds to See if My Virus Is Gone?
I’m 54 years old. I’ve been HIV positive for 18 years and I’ve been taking HIV meds since I seroconverted. My viral load is undetectable and my CD4 count is 602. I want to do some sort of test to see whether HIV is lying dormant anywhere in my body, and if it can’t be found I want to stop taking HIV meds for a while — not because of any health issues or side effects, but because I dislike taking them. Do you have any experience with people who have tried something like this? What effect could going off meds have on my sex life with my partner, who’s HIV negative?

David Wohl, M.D., responds in the “Safe Sex and HIV Prevention” forum

 Will My HIV Regimen Still Work After a 2-Month Break?
I had a hysterectomy in November 2011. I was so sick I couldn’t take my HIV meds for two months. Now that I’m better, will my HIV meds still be effective or should I change medications?

Keith Henry, M.D., responds in the “Managing Side Effects of HIV Treatment” forum

 Do I Have to Start HIV Meds if I’m Treating My Hepatitis C?
I’m HIV positive but not on meds. My viral load is low and my CD4 count is above 500. I was diagnosed with hepatitis C and it seems I’ll be starting meds for that. My doc mentioned briefly that I should start HIV meds as well, but I feel that treating hep C first is the way to go. Am I correct not to want to start HIV meds while I’m still doing well HIV-wise?

Barbara McGovern, M.D., responds in the “Hepatitis and HIV Coinfection” forum
Connect With Others How Can I Stay Healthy Before I Start HIV Meds?
(A recent post from the "Treatment & Side Effects" board)

I got my first labs in today: My CD4 count is 1,040 and my viral load is 9,095. Not considering HIV meds right now. I will evaluate after my next test in three months. However I was wondering what I can do NOW to prepare my body. One of my big concerns is the damage all of the unnatural chemicals in the meds will do to my body. Any advice? What can I do or take — herbs, etc. — to offset that before I start? What have others out there done? — TheGoodLife

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OTHER HEALTH ISSUES & HIV/AIDS
 What if Surgeons Won’t Operate on Me Because I’m HIV Positive?
I was given an AIDS diagnosis six years ago. I’ve started taking Atripla (efavirenz/tenofovir/FTC), and having good results. My CD4 count is 364 and my viral load is undetectable (up from less than 50, and down from 260,000, when I began). I’ve now been diagnosed with avascular necrosis in both hips, and urgently need a hip replacement on one of them. I’ve been to two orthopedic surgeons who’ve refused to take my case, and it’s obvious from what they both said that it’s because neither of them wants an HIV-positive patient. I know this is not legal, and I wouldn’t want a doctor who was prejudiced against me anyway. But how can I find the help I need without going through this discriminatory process over and over again?

Jacques Chambers, C.L.U., responds in the “Workplace and Insurance Issues” forum

 Do Immunizations Patch the “Holes” in Our Immune Systems Left by HIV?
I’ve been HIV positive for over 24 years. A long time ago, my doc told me that upon initial infection with HIV, it pokes “holes” in your immune system that are presumably permanent. He used an analogy like: if you remove the letter Z from the alphabet, you can’t spell “zebra” any longer, but you can still describe it. If this “hole” theory is correct, are immunizations the thing to make up for these vulnerabilities?

Keith Henry, M.D., responds in the “Managing Side Effects of HIV Treatment” forum
HIV TRANSMISSION
 HIV Transmission Through Sharing a Crack Pipe: What’s the Risk?
I have never smoked crack before but one night, when I was very depressed, I was looking for cocaine and could only find crack, so I shared a pipe or two. I didn’t have any open cuts in the beginning or end of the night, but when I woke up, I saw dried blood on my lip. What are the chances that I contracted HIV from the pipe? What other kinds of HIV risks come with smoking crack?

David Fawcett, Ph.D., L.C.S.W., responds in the “Substance Use and HIV” forum

 Could My Lesbian Partner Have Put Me at Risk for HIV?
I am a lesbian and have been dating a close female friend for a few months. Recently it came to light that she has never been HIV tested before, as she for some reason thought it was part of routine blood tests. She had unprotected vaginal and anal sex one time with a man she met at a bar back in 2008. He did not ejaculate inside of her. I’m concerned that she may have been exposed to HIV during her one-night stand because he obviously didn’t care about using condoms. Could she be HIV positive, and could I have been exposed to HIV through her vaginal fluids coming into contact with small cuts on my lips when I perform oral sex on her?

Shannon R. Southall responds in the “Safe Sex and HIV Prevention” forum

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 Young AIDS Activists! Apply for C2EA’s 2012 Youth Action Institute — June 10 – 16, 2012

 Ohioans Living With HIV/AIDS Need Our Help!

 Activists Launch New Survey to Help Speed HIV Cure Research

 Demand Hershey Reverse Decision on HIV+ Student and Dismiss School Officials

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Fw: Smoking, Not HIV Disease, Is Most Important Lung Cancer Risk

From: AIDSmeds <news@aidsmeds.com>
Date: Wed, 25 Jan 2012 09:56:54 -0500
To: <nelsonvergel@yahoo.com>
Subject: Smoking, Not HIV Disease, Is Most Important Lung Cancer Risk
AIDS Meds: Founded & Operated by People with HIV

Treatment News


January 24, 2012
Many at Risk for Hep B in U.S. Aren’t Getting Vaccinated
Missed opportunities to vaccinate people at the highest risk for hepatitis B virus (HBV) explain why 80,000 people continue to be infected ever year in the United States, according to a new study published online ahead of print by the journal Infection.
Concerns on HIV Social Services Funds Going to Treatment
Some HIV/AIDS service providers are concerned that recent breakthroughs in HIV/AIDS treatment will have a negative impact on social services, New America Media reports.
January 20, 2012
Viread Approved for Children 2 and Up
Viread (tenofovir), Gilead Sciences’ nucleotide reverse transcriptase inhibitor, has been approved for children living with HIV, according to a U.S. Food and Drug Administration (FDA) announcement. To facilitate correct pediatric use of the drug, the agency also approved a powder formulation for children between the ages of 2 and 5 and low-dose tablets to meet pediatric dosing needs. 
CDC: Fewer Americans Having Unsafe Sex
The number of Americans who practice behaviors that put them at risk for HIV has declined significantly, according to data from the U.S. Centers for Disease Control and Prevention (CDC) and reported by HealthDay. 
First PrEP Study for MSM in Europe to Launch
The first HIV pre-exposure prophylaxis (PrEP) trial for men who have sex with men (MSM) in Europe is about to launch, according to a statement by ANRS (French National Agency for Research on AIDS and Viral Hepatitis). 
January 19, 2012
Vitamin D May Protect Bone Health in Tenofovir Takers
Vitamin D supplementation may help prevent hormonal changes that can lead to bone loss among adolescents and young adults being treated for HIV with tenofovir—found in Viread, Truvada and Atripla—according to a National Institutes of Health (NIH) study published online ahead of print by Clinical Infectious Diseases.
An Aspirin a Day to Keep HIV-Related Cervical Cancer Away?
Might an aspirin a day help keep cervical cancer away? Though there aren’t yet any studies indicating it will, researchers have uncovered a biological connection between HIV-associated inflammation and cervical cancer that may be curtailed by the affordable and widely available drug.
January 18, 2012
Smoking, Not HIV Disease, Is Most Important Lung Cancer Risk
Cigarette smoking, not HIV disease-specific factors, is the most important risk factor for lung cancer in people living with HIV, according to a new paper in the British Journal of Cancer reported by aidsmap.

Heard in the Blogs

Paul  Kawata's BlogPaul Kawata

Ending the Epidemic: Look to the Beginning, Prepare for the End

A young reporter recently asked me "what was like in the olden days, before Protease Inhibitors and combination therapy?" I always find it difficult to truly express what happened. Sometimes I feel like a soldier who fought in some horrible war and I wonder if I will ever be able to recover from my experiences. Many folks who fought and survived the early days of the epidemic will understand. We can’t quite verbalize what that time was like, yet the epidemic continues to define our life and our relationships. Thirty years later our struggle continues. But now there is light at the end of the tunnel – maybe we can end the epidemic! Maybe we will live to see the end of this tragedy. Peter  Staley's BlogPeter Staley

How to Survive a Plague, ctd.

In December, 2008, a journalist named David France came over to my Brooklyn apartment and told me about his dream of making a documentary that honored the history he witnessed of AIDS treatment activism in the late 80’s and early 90’s. From the heady-optimism of ACT UP’s Treatment & Data Committee, to the painful split of ACT UP & TAG (the Treatment Action Group) just as the plague years were at their worst in the U.S., and finally to the remarkable research breakthroughs that made the death rate decline by 70%. Three years later, David’s film is done, and will be premiering at Sundance in Park City, Utah this Sunday. I finally got to see it Tuesday afternoon at a screening with David Barr, Sam Avrett, Gregg Gonsalves, and Catherine Gund. David France and his entire crew, including Joy Tomchin, Howard Gertler, Dan Cogan, Woody, Tyler, and seemingly dozens of others, should be incredibly proud. HOW TO SURVIVE A PLAGUE honors this remarkable slice of history.

Heard in the Forums

I have to make a very important decision and not sure which way to go. I have been UD on Atripla for over 4yrs, but suffer from acute insomnia. I switched my dose to the morning but I still suffer every night from insomnia. I am not sure whether it is the atripla still causing my insomnia, or just that i have it regardless. Either way my dr has advised that it may be worth trying Eviplera (Complera), which has the sustiva component removed and therefore may not cause insomnia. I don’t want to change or rock the boat as i am UD. I am concerned that if I do change and I don’t like it, I won’t be able to go back to Atripla and also may loose complera as a drug because of resistance if i come off it. —Delby’s "Atripla versus Eviplera (Complera)"
 

 

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Fw: Hot Topics at The Body’s “Ask the Experts” Forums

From: “News at The Body” <update@news.thebody.com>
Date: 10 Jan 2012 17:14:11 -0500
To: <powertx@aol.com>
ReplyTo: “News at The Body” <update@news.thebody.com>
Subject: Hot Topics at The Body’s “Ask the Experts” Forums

If you have trouble reading this e-mail, you can see the online version at: www.thebody.com/topics.html

January 10, 2012 Visit the Forums “Hot Topics” Library Change/Update Subscription



Lisa B. Hightow-Weidman, M.D., M.P.H., and David Wohl, M.D.MORE NEW SAFE SEX AND HIV PREVENTION FORUM EXPERTS
 Two Seasoned HIV Docs Join the Safe Sex and HIV Prevention Forum
Please join us in welcoming Lisa B. Hightow-Weidman, M.D., M.P.H., and David Wohl, M.D., as the newest experts in our “Ask the Experts” forums. Both are professors as well as clinicians at the University of North Carolina — Chapel Hill, and both have extensive experience working with people living with or at risk for HIV/AIDS. Dr. Wohl is also an “Ask the Experts” veteran, having answered questions in the Choosing Your Meds forum from 2002 to 2008. His and Dr. Hightow-Weidman’s perspectives are excellent additions to the diverse and growing Safe Sex and HIV Prevention forum expert team.
LIVING WITH HIV/AIDS
 How Do I Control Water Weight While on Testosterone?
What are some of the causes and symptoms of increased water retention while using testosterone? Is there anything that can be done to manage this effect?

Nelson Vergel responds in the “Nutrition and Exercise” forum

 Is Sauna Use Safe for People Living With HIV?
I love to go to the gym because exercise helps me look and feel good. I love to use the sauna at the gym as well. Is using the sauna potentially harmful for HIV-positive people?

Benjamin Young, M.D., Ph.D., responds in the “Choosing Your Meds” forum
MIXED-STATUS COUPLES
 Am I Missing Out on an Important Experience by Playing It Safe?
I’m 37 and I’ve never had anal sex. My boyfriend tested HIV positive a year ago, he takes HIV meds and and his viral load is undetectable. Since I’ve never experienced the complete intimacy involved in having somebody cumming inside me without a condom, do you think I’ll someday start to regret being with someone with whom I always use condoms? I love my boyfriend, but is love enough?

Shannon R. Southall responds in the “Safe Sex and HIV Prevention” forum
BODY SHAPE CHANGES & HIV/AIDS
 How Do My New Meds Measure Up in Lipoatrophy Risk?
I just started taking Norvir (ritonavir), Prezista (darunavir) and Truvada (tenofovir/FTC) about a week ago. Is this regimen considered low risk where lipoatrophy is concerned? Are there better regimen options for avoiding this effect?

Gerald Pierone, M.D., responds in the “Facial Wasting” forum
announcing the "strangest but truest" of 2011
Dr. BobWe here at TheBody.com scoured the “Strange but True” sections of last year’s Hot Topics newsletters and nominated some of the most unusual HIV-related scenarios people asked about in 2011. We also brought back some old “bests of the worst” from previous years as a tribute to Bob Frascino, M.D., (“Dr. Bob”), master of the “Strange but True” response, who passed away in September 2011.

Hundreds of you voted on which of the 10 finalists represent the zaniest of what the forums have to offer. We’ve tallied up the votes and calculated their average ratings, so check out the “Best of Dr. Bob” from 2011 and beyond!

HIV/AIDS TREATMENT
 Is Kidney or Liver Failure Inevitable on HIV Meds?
I currently take Complera (rilpivirine/tenofovir/FTC). I was talking to someone who told me that the HIV meds will eventually lead to kidney or liver failure 20 years or so down the road. This idea is just irking me. Is it true? Is it inevitable that HIVers eventually die from kidney or liver failure because of the meds?

Benjamin Young, M.D., Ph.D., responds in the “Choosing Your Meds” forum

 Doesn’t My Size Mean I Should Take Less of My Medication?
I take Aptivus (tipranavir) and Norvir (ritonavir). After reading that many HIV meds are tested in men who are at least 200 pounds, I thought that since I’m a small guy of only 140 pounds, I could cut the dosages of both my meds in half. I’ve been doing this for two weeks now and my side effects have been gone ever since; in fact, I feel like I have more energy. What are the potential risks of this plan?

Joseph P. McGowan, M.D., F.A.C.P., responds in the “Choosing Your Meds” forum

 How Can I Tell if My HIV Meds Are the Reason I Can’t Sleep?
My HIV med regimen includes Intelence (etravirine), Isentress (raltegravir) and Truvada (tenofovir/FTC). Could one of these meds be causing my sleeplessness? How can I figure that out?

Keith Henry, M.D., responds in the “Managing Side Effects of HIV Treatment” forum

More Questions About HIV/AIDS Treatment:

OTHER HEALTH ISSUES & HIV/AIDS
 How Does Heavy Drinking Affect HIV?
My wife was diagnosed with HIV in March 2011. Her CD4 count was 100 and her viral load was 273,000. She was put on Atripla (efavirenz/tenofovir/FTC) and long-term antibiotics; but because of immigration problems she was deported back to Africa, where she has been binge drinking two to three times a week for the past three months. She’s still taking meds, however. Is heavy drinking while on HIV meds detrimental to her health?

Nelson Vergel responds in the “Nutrition and Exercise” forum

 Is It Too Late to Be Vaccinated for HPV?
My CD4 count is 350 and my viral load is undetectable. I recently had a slightly abnormal anal Pap smear, so my doctor had me get an anoscopy. The specialist said that everything looked fine, and suggested that I consider getting a Gardasil vaccine for human papillomavirus (HPV). My regular HIV doctor thinks I should wait until more research into the benefits of this vaccine is completed. Given that I’m sexually active, not in a monogamous relationship, and can afford the vaccine, should I just do it? What do you recommend?

Keith Henry, M.D., responds in the “Managing Side Effects of HIV Treatment” forum
Connect With Others Getting Comfortable With Sex Again: Can Anyone Relate?
(A recent post from the "Gay Men" board)

After almost two years of living with HIV, I’m finally starting to be open about my status and to let people really get to know me. However, I’m still not comfortable with sex. Therapy really isn’t an option for me because of where I’m located.

Can anyone suggest books or anything that may help me? — engmoto

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UNDERSTANDING HIV/AIDS LABS
 How Could a Person With the CCR5 Mutation Become HIV Positive?
I have an HIV-positive friend who has the CCR5 mutation. He’s never had a detectable viral load and he is not on HIV meds. If bone marrow with this genetic mutation cured “Berlin patient” Timothy Brown, then how can someone who has the gene naturally be infected? If the virus needs the CCR5 protein to infect the cell then how can someone in my friend’s situation become HIV positive?

Mark Holodniy, M.D., F.A.C.P., C.I.C., responds in the “Understanding Your Labs” forum
HIV & STD TRANSMISSION & TESTING
 Would Syphilis Cause a False-Positive HIV Test?
I’m a 30-year-old man with no history of sexually transmitted diseases (STDs). I had a possible exposure to STDs and HIV through unprotected oral sex (I was the insertive partner — the one getting sucked). It happened exactly seven days ago. How accurate would an HIV test be at 28 days? What about tests for other STDs? If I contracted syphilis from this encounter and was tested for HIV, could syphilis antibodies cause my HIV antibody test to mistakenly come back positive?

Lisa B. Hightow-Weidman, M.D., M.P.H., responds in the “Safe Sex and HIV Prevention” forum


 Swallowed Something From a Stripper’s Breast: Am I At Risk?
I swallowed a small amount of breast milk from a stripper. I don’t know her HIV status, and my mouth is intact — no sores, cuts or bleeding gums. How likely is it that I could become HIV positive as a result of this encounter?

Richard Cordova responds in the “Safe Sex and HIV Prevention” forum

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 Activists Launch New Survey to Help Speed HIV Cure Research

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 African American HIV University Community Mobilization College: Apply Today!

Outsmarting HIV with Healthy Nutrition

From: http://www.positivelyaware.com/2012/12_01/hiv_wellness_series.shtml

Pictured - Nelson Vergel
Living with a chronic illness like HIV can present certain nutritional challenges. Without effective HIV medication treatment, replicating virus can tax the body, destroying lean body mass and impairing immune function and quality of life.12
While this destruction of lean tissue can be controlled with effective HIV antiretroviral combination therapy, other challenges like fat accumulation and increases in lipids (cholesterol and triglycerides) and/or insulin resistance may arise in some patients after treatment initiation.3 Although limited research has been done on the effects of nutritional approaches on pre- and post-HAART (highly active antiretroviral therapy) metabolic issues, general suggestions can be extracted from studies regarding other conditions like diabetes, cardiovascular disease, and obesity. These suggestions are aimed at helping the body deal with the effects of HIV or its medications on metabolism, body shape, and quality of life as we live longer with HIV.
mixing carbohydrates with protein, fiber, and good fats is one way to reduce their problematic effect on blood sugar and insulin.The components of whole food.
Foods are made up of many different components—some are “micro” or smaller quantity nutrients, like vitamins, and some are “macro” or larger quantity nutrients. The three macro groups that compose the majority of our diets are carbohydrates, proteins, and fats. These three units are the basic materials that fuel our activities and metabolism and maintain body composition. Selecting the best sources and amounts of these three macronutrients may help to minimize metabolic disorders (such as high cholesterol and blood sugar) and prevent loss of lean body mass and accumulation of body fat.456
The best carbohydrates.
Carbohydrates provide our body’s main source of quick energy. After carbohydrates are digested and after some processing by the liver, they are released into the bloodstream as a sugar called glucose to be delivered to the cells.
Throughout the majority of the last million years of our evolution, the human diet consisted of animal carcasses, some seeds, nuts, and fibrous vegetable and fruit carbohydrate sources that are generally nutrient-rich with lots of water, but are not calorie-dense like processed foods of today. The majority of these carbohydrate sources are vegetables, leaves, roots, and fruits (all rich in fiber). Because vegetable fiber tends to slow down digestion, a majority of the carbohydrates in these foods are absorbed relatively slowly, inducing less blood sugar (glucose) and insulin spikes than processed sweets that contain no fiber. Some people call these “slow carbs.”
It was only after the advent of agriculture that human beings were introduced to higher intakes of grains as carbohydrate sources. Higher intakes of grains deliver lots of calories. Additionally, some grains deliver their sugar energy relatively quickly, especially if the grain is milled (which removes the fiber that slows down sugar absorption), as are the grains in breads and pasta. Unless you are very active and exercise enough to metabolize nutrients more rapidly, this quick glucose release into the bloodstream can create a dysfunctional hormonal environment that can ultimately promote obesity, cardiovascular disease, and diabetes. This hormonal shift also has a profound effect on lean body mass and fat metabolism, and possibly immune function.789 The key hormone involved in this problem is called insulin, produced by an organ called the pancreas.
Insulin and insulin resistance.
The hormone insulin is produced by the pancreas to control blood sugar and store it in muscles for later use as glycogen. Insulin’s main job in the body is to promote the delivery of sugar energy as glucose to cells. When a small amount of glucose is delivered into the bloodstream, a small amount of insulin is produced by the pancreas to accompany it. When there is a large amount of glucose, the pancreas works to produce a large amount of insulin to facilitate its delivery so that cells can take in as much glucose as possible. Extra glucose that cannot be taken in by the cells circulates in the bloodstream and can be toxic to brain cells, so under normal circumstances, most of it is soon converted into triglycerides (fat) in the liver to be stored for later use. But we have to be careful with high blood levels of triglycerides, since they are what feed fat cells.
The correct amount of carbohydrate sources will provide enough sugar to give a healthy amount of glucose to the cells, but not too much at once. Thus, levels of glucose and insulin in the bloodstream are not unusually elevated for any long period of time. The pancreas works, but it is not overworked trying to keep up with an unusual demand for insulin.10 However, in the U.S., much of the diet consists not only of large amounts of high-calorie carbohydrate sources, but also of carbohydrates from sweets and sodas, which are very concentrated sources of sugar. The net effect that intake of these calorie-dense carbohydrate foods creates is a bloodstream that is occasionally flooded with large amounts of glucose, a pancreas that is overworked, and large amounts of insulin and triglycerides circulating in the bloodstream. Note that excess insulin causes increased production of cholesterol.
Over time, these occasional glucose, triglyceride, and insulin floods can cause a decrease in the sensitivity of the cells’ response to insulin, which reduces the cells’ ability to take in glucose. Insensitivity to insulin is called insulin resistance, and it is a serious consideration in HIV because we are now seeing it as one of the core components of lipodystrophy and metabolic problems.11 Some HIV medications can worsen insulin resistance, so we need to be aware of nutritional considerations that can help. Ways to decrease insulin resistance are to exercise, choose more metabolic-friendly HIV medications, and follow a proper diet. For instance, a prominent study from Tufts School of Medicine found that HIV-positive people consuming an overall high-quality diet, rich in fiber and adequate in energy and protein, were less likely to develop fat deposition.12 This is why it is best to select the majority of your carbohydrate intake from fiber-rich, slow-releasing carbohydrate sources that do not contain an excessive amount of calories. And these good carbs should be accompanied by good sources of protein and fats.
Recent data have shown that mono-unsaturated fats decrease the risk of certain cancers, and have an anti-inflammatory effect.14 AIDS is an inflammatory disease, so mono-unsaturated fat intake logically has a place of importance in managing AIDS, too.
Combining carbohydrates with protein, fiber, and fat.
Protein, fiber, or fat will slow the absorption into the blood of glucose from carbohydrates, which helps to reduce the rise in blood sugar and insulin spikes. So, mixing carbohydrates with protein, fiber, and good fats is one way to reduce their problematic effect on blood sugar and insulin. Ensure that every meal and snack you consume has a mix of these three macronutrients. But what are the best fats, protein, and high-fiber carbohydrates sources out there?
Fats and oils.
There are a number of different kinds of fats. There is motor oil, there is butter, and there are essential fatty acids. The most important oil to keep a Honda running right is not the kind with essential fatty acids (EFAs), but if you want to help your body stay healthy and your immune system operating at its best, you had better consider getting these EFAs on a daily basis. They are called “essential” because your body cannot manufacture them, and must obtain them from an outside source, like food or supplements. These oils are necessary for every critical function in your metabolism, including building lean body mass and fighting infections.
The main point is that since we need EFAs and other fats for health, we should be getting them in our diets from fresh, high-quality sources. A proper diet reduces the amount of starchy carbohydrates while maintaining a certain amount of healthy fats so that there is a different macronutrient balance than the old high-carbohydrate, high-protein, low-fat diets contained. This means striving to get fatty acids from several sources, the least of which are the saturated fats in butter or animal fat. Understand that saturated fats are not the demons we have been led to believe. When we realize that we evolved getting a certain amount of saturated fat from foods in the wild, it is only logical that they would have a place in a healthy diet. One recent study showed that dietary saturated fat and mono-unsaturated fat were associated with healthy testosterone production in humans, while EFAs had no effect. So it appears that we need a little saturated fat for optimal hormonal health. However, most people get far too much saturated fat, which promotes insulin resistance and metabolic problems, and not enough EFAs, which are needed for healthy cells and immune function.13
The other important kind of fat that we should consciously include in our daily diet is mono-unsaturated fat, which we get from foods like olive oil. Recent data have shown that mono-unsaturated fats decrease the risk of certain cancers, and have an anti-inflammatory effect.14 AIDS is an inflammatory disease, so mono-unsaturated fat intake logically has a place of importance in managing AIDS, too.
vegetarian or vegan diets present a challenge to people with HIV or AIDS who need a full spectrum of amino acids and micronutrients. Unless you are vegetarian for ethical reasons, consider eating eggs and fish.
Fatty acid recommendations.
EFAs include the omega-3 and omega-6 fatty acids. Most people get an imbalance of these two by consuming too small an amount of omega-3 fats, which have anti-inflammatory properties, and relatively too large an amount of omega-6 fats, which tend to promote inflammation when out of balance.15 To get more omega-3s, eat more fish, including salmon, tuna, sardines, anchovies, mackerel, rainbow trout, and herring. Omega-6s are contained in common vegetable oils, like sunflower, safflower, and corn oils. Try to reduce your intake of these.
Oils and cooking.
Olive oil is one of the best oils to cook with. You can also cook with high-oleic sunflower oil, avocado, canola, macadamia, or any oil that is high in mono-unsaturated fatty acids.
Avoid cooking with oils made from corn and sesame. These oils contain more omega-6 fats, and less mono-unsaturated fats, so they have a higher potential for spoiling and turning to trans-fats, which are bad for the immune system. Try to avoid any intake of these oils when they are not absolutely fresh.
Also, choose oils that are minimally processed. Most of the clear oils in supermarkets are stripped of some of their natural components to make them more suitable for sitting on store shelves for long periods of time without spoiling. Do not use these stripped oils. When you do cook, do not overheat the oil so that it smokes, which causes the formation of carcinogens and destroys the beneficial fatty acids.
Avoid margarine, hydrogenated fats, or processed oils.
Do your best to avoid processed fats or oils, as they have negative effects on cellular health, overall metabolism, and your immune system. Look out for the words hydrogenated and partially-hydrogenated. These kinds of manipulated fats probably do increase the risk of cancer and heart disease. They also weaken healthy cellular immune metabolism, which means that they might increase HIV progression. Lastly, they are also likely to promote high lipid levels and insulin resistance.
Protein, food for the immune system.
Dairy protein fractions, such as caseine (contained in milk curd) and whey, are at the top of the list of proteins that optimally feed lean body mass growth. In dairy products, the amino acid balances, insulin-raising potential, and overall growth factor content add up to one thing: milk proteins were created to make mammals grow bigger. While there is a lot of hoopla related to which dairy protein fractions are best, there is more misinformation than reality in this area. Those with lactose intolerance should be careful in their selection of milk-based products. Aged cheeses and yogurt may be more tolerable for those who cannot digest lactose.
Egg protein.
Next on the list are egg proteins. The important thing to remember is that whole egg is probably somewhat better than egg white for lean body mass growth and overall health effect, because the yolk is a rich nutrient source, and its protein content complements the protein in the egg white. Together they are a better source of protein.
Meat protein.
While real food like meat often seems to take a back seat to protein powders because of a mindset created by slick advertising, professional athletes know the value of real food related to lean body mass growth. If you do not make real food and meat fundamentals in your diet, you will not grow lean body mass tissue as well. Fish, chicken, turkey, and beef are vitally important foods, not only because of their protein content, but because they contain numerous other nutritional components that are important for a healthy metabolism. The message is: eat real food, then supplement food with protein powder drinks if you need them.
Lean red meat is a superior source for lean body mass growth and blood-building nutrients. These include creatine, carnitine, phenylalanine, conjugated linoleic acid (CLA), and heme- (blood) iron, the most absorbable form of iron. And meat, in general, is less likely to cause allergic reactions than eggs or dairy proteins, like casein and whey. The only caution about red meat is that the high amount of saturated fat most commercial red meat contains could promote metabolic problems. So be moderate about including it in your diet and choose leaner meats if you do.
Important details on meat: cooking kills bacteria in meats. Stewed meat is better for digestion (chicken soup, beef stew). Roasting is okay. Try not to fry or barbecue with charcoal. Charred foods are associated with increased risk of gastrointestinal system cancers. Any cooking of meat or vegetable protein that causes the formation of a hard outer skin renders the protein that becomes the skin to be much less digestible because it cross-links the protein.
Vegetarian diets
It is very difficult to gain lean muscle weight on a vegetarian diet. In fact, it is almost impossible for most people, especially when they are fighting infections that burn lean body mass. While I know a very few HIV-positive people who can do well adhering to a vegetarian regime, I find that the vast majority cannot do it and keep their lean body mass. Additionally, vegetarian diets increase the potential for anemia because of a lack of blood-building components such as highly absorbable heme-iron and vitamin B12.
If you do choose a vegetarian diet, your best protein sources are beans, seeds and nuts. Digestion of nuts and seeds will be improved by soaking them overnight to reduce the enzymes they contain that inhibit digestion of proteins. If you can eat them without digestive problems, many nuts and seeds are ideal foods because they contain protein, healthy fat, and complex carbohydrates in a very good balance for overall health. They also make a great snack between meals. However, the amino acid balances in these proteins do not appear to be optimum for lean body mass growth for humans. Again, vegetarian or vegan diets present a challenge to people with HIV or AIDS who need a full spectrum of amino acids and micronutrients. Unless you are vegetarian for ethical reasons, consider eating eggs and fish.
Caution:
People who are on HIV medications like tenofovir (in Viread, Truvada, Atripla, Complera, and the Quad), which may affect kidney function in some patients, should be careful about increasing their protein intake too high (over 1 gram per pound of body weight per day), as this can increase the potential for kidney problems. Ask your doctor if you are taking kidney burdening medicines, and, if so, only eat a higher protein diet under your doctor’s direction. Those who have liver problems need good protein intake for the repair of liver tissue, but should also be careful about higher protein intake, and should also do so only under a doctor’s supervision.
Calcium and vitamin D—two important micronutrients
Bone loss has been reported in several HIV studies. It seems to be caused by the effect of the virus on the body. Certain medications like tenofovir (Viread) may make this problem worse. We also seem to have a high incidence of vitamin D deficiency due to potential HIV medication effects or metabolism issues. We know that calcium and vitamin D help to strengthen bone. Many of us chose to take calcium plus vitamin D supplements, but there are also foods that are rich in these nutrients. Calcium-rich foods include milk, cheese, spinach, fortified orange juice (be careful with the sugar, though!), fish, eggs, and beans. Vitamin D-rich foods include milk, most fish, and eggs. However, most of us do not consume the 1000 mg and 2000 IU needed per day for calcium and vitamin D, respectively, and need to take over-the-counter supplements. One word of caution: do not take your calcium supplements with your HIV medications since they may interfere with their absorption (at least two hours before or after is okay).
Miscellaneous nutrition tips

  • If diet, weight loss, and exercise fail to lower your LDL cholesterol and triglycerides, ask your doctor for a prescription for lipid-lowering agents (statins, fibrates, etc.) or to switch your meds to a more lipid-friendly HIV medication combination.
  • For your food, shop mostly in the outer part of the grocery store where the fresh produce, meats, and milk products/eggs are. Avoid overly processed canned or packaged foods, except for frozen vegetables. Read the labels and avoid products with many preservatives and additives. Trans-fats and hydrogenated oils, high fructose corn syrup, and high sugar should be on your radar when reading labels. Watch this funny video for more details on healthy eating.
  • Try to eat several smaller balanced (protein + good carbs + good fats) meals or snacks instead of two to three large ones. Smaller meals/snacks are more easily digestible, keep blood sugar and insulin more constant through the day, and keep you from binge eating late at night.
  • Eat more almonds, walnuts, pecans and pistachios (good cholesterol-lowering fats). Twice a day, snack on such nuts to get your good fats and fiber. If you wish, mix them with some dried fruit. Research has shown that people who eat nuts tend to have lower LDL cholesterol.
  • Avoid junk and fast food. The best way to do this is to have enough food at home and to bring lunch to work. Cook a lot of food on weekends and freeze meals in small containers you can heat up later.
  • Do not sabotage yourself by bringing sweets and junk into your home. Watch your cravings at night, when most people find it the most difficult to avoid overdrinking alcohol or eating ice cream, cookies, and comfort foods.
  • Eat a large breakfast, a moderate lunch, and a small dinner. Skipping breakfast makes you more prone to overcompensate by eating more calories late in the day. Your body has spent several hours without food and is starved for nutrients in the morning. Do not feed it sugar and white flour products at this important time. Eggs, oatmeal (the type that has no added sugar, and you can add whey protein powder to it!), Greek-style yogurt with nuts and fiber supplements, low-fat cottage cheese with fruit, almond butter on multigrain (high-fiber) bread, and fruit are all good choices for breakfast.
  • For lunch have some soup and a glass of water first and wait 10 minutes to trick your body into feeling full faster. Grilled chicken with vegetables, tuna salad over greens and nuts, a Greek salad with sliced steak, and any Mediterranean food choices are good.
  • For dinner, fill yourself with stir-fried (use olive oil!) vegetables and lean meats. Two hours before bed, you can have half an almond butter sandwich or yogurt with fruit. You will not be hungry and desperate with this diet!
  • Eat fruits and vegetables of all colors. Each has a different antioxidant profile. The produce section of the market is basically a fresh vitamin department and a medicine chest. Some foods like garlic, onions, and ginger have genuine therapeutic effects. Eating the widest variety of fresh produce on a daily basis assures you of getting all the ingredients that nature provides that can help keep your body strong enough to handle bacteria and viruses so that you stay healthy.
  • Avoid sodas, sweet drinks, and fruit juices (fruit sounds healthy, but juice contains too much sugar and no fiber to slow down its absorption into the blood).16 Consuming sugar daily can affect your metabolism, create insulin resistance, make you fat, and have all kinds of negative health consequences. The suggested pecking order of carbohydrate food sources that support your health without increasing insulin resistance follows. Best are vegetables in their many forms. Next are beans and peas. These deliver more calories than vegetables, but the carbohydrates release much more slowly than grains. Next are whole grains, which are calorie-dense but contain carbohydrates that, in general, release somewhat slowly. At the bottom, and the most likely to promote body fat problems, are carbohydrates from milled grains, like wheat and corn. Whole grains are marginally better than processed grains, but when they are milled into flour the difference is not that great. The very worst carbohydrate sources are sweets, like candies, which can deliver as many as 2,000 calories per pound. Try to eat from the first group of slow-release carbohydrate sources most of the time, and if you are relatively healthy, you can have small amounts of milled wheat products or sweets once in awhile.
  • Drink lots of water. Six to eight glasses a day is a good goal. If you get thirsty, you are already dehydrated!
  • Eat a high-protein, complex carbohydrate-rich meal after workouts. Examples: chicken salad with nuts, cottage cheese or yogurt and nuts/fruit, celery sticks and hummus (chickpea butter), etc.
    Manage your intake of caffeine (it reduces appetite but can increase anxiety). Do not have any caffeine after 4 p.m., since it can impair your sleep.
  • Minimize hidden sugars like high fructose corn syrup. Read the labels of food you buy. Diet sodas tend to make your brain crave sweets in general, so they are not good substitutes for sugary drinks. Water, water, water!
  • If you do not consume at least 20 grams of fiber a day, add to your intake supplements like Citrucell or Benefiber, purchased in any grocery store. Fiber improves insulin sensitivity, makes you feel full longer, keeps your gut healthy (friendly gut bacteria that produce vitamins love fiber), keeps you regular and reduces diarrhea, and can lower the chances of getting colon cancer.17
  • Eating healthy is eating smart, and it does not mean that you should starve yourself. Hopefully, this information has shed some light on healthy food sources and how they can affect health and the body. Now that we are living longer, food choices can determine how well we do as we age with HIV. So, take charge of your health and take care of your body. It is the only one you have.

Healthy Eating Shopping List

1. Produce

  • Spinach and other green leafy vegetables
  • Broccoli and cabbage
  • Green beans
  • Avocados
  • Raspberries and all berries. You can buy frozen ones and add to whey protein shakes
  • Whole fruits (remember no juices).
  • Sweet potatoes, carrots
  • Hummus
  • Beans and other legumes (you can buy canned or frozen ones)

2. Nuts, Grains, Oil

  • Mix of almonds and other nuts
  • Peanut, almond, and cashew butters without hydrogenated oil   (the   healthy   nut   butters   show   oil   and   butter separated since the lack of hydrogenated oils prevents emulsification)
  • Pumpkin and sunflower seeds
  • Wild rice (the darker the rice, the better)
  • Whole grain breads and pasta
  • High fiber crackers
  • Oatmeal (not the little packets; those are loaded with sugars)
  • Olive oil

3. Dairy

  • Low fat milk, cheese
  • Yogurt (Greek style, no sugar added)
  • Eggs (free range or Omega 3 enriched if possible)

4. Meat

  • Lean meats
  • Salmon, sardines and tuna
  • Occasional glass of red wine per day (optional)

5. Supplements

  • Whey protein (I like the Isopure brand since it does not give me gut problems and it is very light)
  • Vitamin D
NELSON VERGEL, a chemical engineer from Venezuela, has been HIV-positive since 1983, and is a leading treatment advocate on HIV disease. He created the Program for Wellness Restoration (PoWeR) and founded the Body Positive Wellness Center in Houston. Nelson has lectured extensively around the country and overseas, and with his research partner, Michael Mooney, co-authored the book Built to Survive. In 2010, he wrote and published Testosterone: A Man’s Guide—Practical Tips for Boosting Physical, Mental and Sexual Vitality.
He is currently a member of the DHHS Panel on Antiretroviral Guidelines, the AIDS Treatment Activists Coalition, and moderates PozHealth, one of the largest HIV health discussion listservs online.

Read posts from Nelson’s blog, “Surviving HIV”
Read Nelson’s blog, “Outsmarting HIV: A Survivor’s Perspective”

References:

  1. Wanke, C. et al. Pathogenesis and Consequences of HIV-Associated Wasting JAIDS Journal of Acquired Immune Deficiency Syndromes.  December 2004 – Volume 37 – Issue – pp S277-S279
  2. Brad M. Dworkin, M.D. Dietary Intake in Patients with Acquired Immunodeficiency Syndrome (AIDS), Patients with AIDS-Related Complex, and Serologically Positive Human Immunodeficiency Virus Patients: Correlations with Nutritional Status   JPEN J Parenter Enteral Nutr November 1990 vol. 14 no. 6 605-609
  3. Shah, M et al. The role of diet, exercise and smoking in dyslipidaemia in HIV-infected patients with lipodystrophy.  HIV Medicine Volume 6, Issue 4, pages 291–298, July 2005
  4. Batterham, M. et al.   Dietary intake, serum lipids, insulin resistance and body composition in the era of highly active antiretroviral therapy ‘Diet FRS Study’.  AIDS: 18 August 2000 – Volume 14 – Issue 12 – pp 1839-1843
  5. Williams, B. Protein Intake Is Positively Associated with Body Cell Mass in Weight-Stable HIV-Infected Men.

    The American Society for Nutritional Sciences J. Nutr. 133:1143-1146, April 2003

  6. Mayere, K. et al.   Modifiable Dietary Habits and Their Relation to Metabolic Abnormalities in Men and Women with Human Immunodeficiency Virus Infection and Fat Redistribution. Clin Infect Dis. (2001) 33 (5): 710-717
  7. Sanchez A, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973; 26: 1180-84
  8. Mynarcik, D. et al. Association of Severe Insulin Resistance With Both Loss of Limb Fat and Elevated Serum Tumor Necrosis Factor Receptor Levels in HIV Lipodystrophy. AIDS Journal of Acquired Immune Deficiency Syndromes:1 December 2000 – Volume 25 – Issue 4 – pp 312-321
  9. Carr, Andrew. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors.AIDS:7 May 1998 – Volume 12 – Issue 7 – p F51-F58
  10. Eizirik, D. et al.  Prolonged exposure of human pancreatic islets to high glucose concentrations in vitro impairs the beta-cell function. J Clin Invest. 1992 October; 90(4): 1263–1268.
  11. Carr, Andrew  . A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors.AIDS:7 May 1998 – Volume 12 – Issue 7 – p F51-F58
  12. Hendricks , K. et al.  High-fiber diet in HIV-positive men is associated with lower risk of developing fat deposition American Journal of Clinical Nutrition, Vol. 78, No. 4, 790-795, October 2003
  13. Tishaa, j. Dietary fat intake and relationship to serum lipid levels in HIV-infected patients with metabolic abnormalities in the HAART era. AIDS: 31 July 2007 – Volume 21 – Issue 12 – p 1591-1600
  14. O’Keefe, J. et al.  Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health.  J Am Coll Cardiol, 2008; 51:249-255, doi:10.1016/j.jacc.2007.10.016
  15. Giuglian, D.  The Effects of Diet on Inflammation: Emphasis on the Metabolic SyndromeJournal of the American College of Cardiology. Volume 48, Issue 4, 15 August 2006, Pages 677-685
  16. Bolton, R. et al. The role of di