THE DOWNSIDE TO GOOD MEDICINE
Even if you are on the simplest anti-HIV cocktail, it can be tricky to figure out how to time having your snacks and meals. Some medications should be taken on an empty stomach. Some are best used by the body if taken with food or even a high-fat meal. To sort it all out, let's take a look at three common side effects of anti-HIV medications and how your diet can work for you in combating them.

Each of the anti-HIV medications has reported side effects, such as appetite loss, diarrhea, and nausea and vomiting. While these problems are no fun at all, many people with HIV infection or cancer who have experienced such problems have shared their experiences in trying to reduce these symptoms. Dietary modification is one of the ways you can overcome some of the diseases or medication-induced setbacks that can put you at additional nutritional risk.

Appetite Loss. This side effect has been reported with the use of Epivir, Droxia/Hydrea, Hivid, Norvir, Rescriptor, Retrovir, Sustiva, Zerit, and Ziagen. This symptom often creeps up slowly and is easy to ignore or miss until you end up with weight loss and fatigue. If your appetite declines, something is likely to be amiss, so you might have to pay special attention to eating enough food.

Here are some strategies to help in trying to improve appetite:

• Eat small, frequent meals (and coordinate them with your medication schedule).
• Go for a walk before eating.
• Have someone prepare your food.
• Avoid food odors when not eating.
• Have convenient foods around that are quick and easy to prepare.
• Ask your physician about appetite-stimulant medications.

Diarrhea. This has been reported with Agenerase, Coviracil, Epivir, Droxia/Hydrea, Norvir, PMPA, Sustiva, Videx, Viracept, Zerit, and Ziagen. It is quite easy to become dehydrated before you know it. Staying hydrated and restoring other nutrients that can be lost with severe diarrhea will be essential to recovery. Try some of the following strategies:

• Eat and drink plenty of fluids to replace lost fluids and nutrients.
• Avoid caffeinated beverages and foods (coffee, cocoa, chocolate).
• Avoid some high-fiber foods (whole grains, bran, granola, nuts, vegetables and fruits with skins).
• Eat meals at room temperature.
• Avoid fatty foods.
• Ask your physician about the use of antidiarrhea medications.
• Be aware that studies have reported success in using prescription pancrelipase when diarrhea occurs with Viracept.

Be sure to report diarrhea of any kind to your physician if it lasts more than a few days.

Nausea and Vomiting. These have been reported with the use of Agenerase, Coviracil, Crixivan, Epivir, Droxia/Hydrea, Norvir, PMPA, Retrovir, Videx, Zerit, and Ziagen. Nausea, understandably, can impair your appetite, and vomiting can make you lose precious nutrients before they have a chance to be absorbed. Try some of these tips:

• If vomiting, drink plenty of fluids for replenishment.
• Avoid food odors between meals.
• Eat cold or room-temperature meals.
• Keep in mind that some people have reported that eating a few saltine crackers or a small slice of ginger root helps ease nausea.
• Drink cold beverages (lemon-lime or ginger ale) between meals.
• Eat meals without beverages; drink beverages one to two hours before and after meals.
• Allow an hour or so before lying down after a meal.
• Ask your physician about antinausea medications.

Fields-Gardner is the director of services for The Cutting Edge, an HIV nutrition company in the Chicago area. She is a member of the International AIDS Society and the American Dietetic Association's Dietetic Practice Group on HIV and AIDS. She has written a book on HIV medications and a clinicians' guide to nutritional management of HIV.