Vitamins, minerals, and antioxidants are called micronutrients. Even though the body only needs small amounts, micronutrients are essential for good health. HIV+ people need more micronutrients than HIV- people to help fight damage done by the virus.

Vitamins regulate chemical reactions such as digestion and energy production.

Fat-soluble vitamins, including vitamins A, D, E, and K, are stored by the body to meet future needs. There is a risk of harmful side effects if large amounts of these vitamins, particularly vitamin A, build up in the body.

Water-soluble vitamins, including B vitamins and vitamin C, are absorbed by the body and the excess is removed in urine. Side effects from water-soluble vitamins are less common, but can occur. For example, large doses of vitamin C can cause nausea, stomach cramps, and diarrhea.

Minerals form the structures in the body (calcium in bone, iron in blood) and regulate metabolic processes involving nerves, muscles, hormones, etc. Several minerals, including zinc, selenium and iron, have a role in fighting HIV.

The body produces free radicals in response to infections, pollution, smoke, bad fats, and sunlight. Free radicals stress the immune system. Antioxidants neutralize free radicals and protect cells from being damaged. Some vitamins, including vitamin C and vitamin E, are antioxidants. Beta-carotene and selenium are also antioxidants.

While micronutrients can be found in foods, most HIV+ people cannot meet all their nutrient needs through their diet. It is common for HIV+ people to have deficiencies (or not enough) micronutrients. This can happen because of HIV infection itself, poor absorption of nutrients, changes in metabolism, HIV drugs, poor appetite, diarrhea, or infections or damage in the gut.

Micronutrients that are often deficient in HIV+ people include vitamin A, vitamin E, selenium, zinc, and B complex vitamins (B6 and B12). Some research shows these deficiencies can lead to lower CD4 cell counts, worsening of HIV, and early death. The deficiencies can also cause problems like diarrhea, neuropathy, skin conditions, and lactic acidosis (an increase of lactate in the blood).

Most research shows that micronutrient deficiencies can have a negative effect on your immune system before you even have symptoms of HIV. Even if you have a good diet and feel fine, you may not be getting enough of certain vitamins, minerals, and antioxidants.

The Recommended Dietary Allowance (RDA) guidelines are set by the government to let people know how much of each micronutrient they need each day to maintain good health. However, the RDA does not take into account that HIV infection increases these needs. One study showed that HIV+ people needed between 6 and 25 times the RDA of some nutrients.

Due to dieting, eating unhealthy foods, lack of time, or other pressures, half of all women in the U.S. do not eat what they need to meet even the basic RDA requirements for folic acid, iron, zinc, calcium, magnesium, copper, vitamins A, D, E, and certain B vitamins. This puts women, especially HIV+ women, at particular risk for micronutrient deficiencies. 

In addition women are more likely to suffer from nutrient deficiencies because of menstruation, pregnancy, and menopause.

It is important to get as many of the vitamins and minerals you need from food as possible. This is because nutrients found in food are more potent (better) than nutrients found in supplements.

Eating a well-balanced diet should be the basis of any plan to correct micronutrient deficiencies. Since different vitamins and minerals are found in different food groups, you should include foods from each group in your diet every day.

• Protein group – Healthy foods from this group include lean red meats, skinless chicken or turkey, fish, nuts, peanut butter, and cooked dried beans
• Bread group – Healthy foods from this group include whole grain breads, whole grains like oats and wheat, oatmeal, and brown rice
• Fruit group – Any fresh fruit is a good choice
• Vegetable group – Fresh and frozen vegetables are the best
• Dairy group – Try to choose 1 percent or skim milk, low-fat yogurt and cottage cheese, and small amount of cheeses

While supplements do not replace a well-balanced diet, they can help you get the additional micronutrients you need. In addition, supplements may help combat some HIV drug-related side effects such as neuropathy or diarrhea.

Speak to your doctor and see a registered dietician for a nutritional evaluation. They can help you determine what combination of diet changes and supplementation can correct any micronutrient deficiencies you have.

Here are some recommendations:

• Take a multivitamin/multimineral supplement (without extra iron) every day
• Multivitamins should be taken with food and a full glass of water to help absorption and prevent stomach upset
• Consider a B complex vitamin and an antioxidant supplement in addition to your multivitamin
• Because women are at higher risk for bone disease, make sure you are getting 1,000 mg of calcium from foods or supplements each day
• Iron may be deficient in women, especially during their periods. This can lead to anemia. However, it is not recommended that HIV+ people take extra iron without their doctor’s advice
• If you are planning to get pregnant, speak to your doctor about prescription pregnancy vitamins that contain 400 mcg of folic acid
• Avoid taking higher doses of vitamin A, vitamin D, copper, niacin, selenium, and zinc without speaking to your doctor

Don’t select supplements based on highest price or promises of "immune boosting" abilities. Read the label to see what's really inside. Deciding which supplements to take can be difficult and confusing because there are so many different kinds on the market. In addition, the effects of taking extra vitamins and minerals on the body have not been studied enough. Play it safe by speaking to your doctor and an HIV-knowledgeable dietician about what supplements to take and possible side effects or interactions with your HIV drugs.

1		Bert-Moreno, A. (2003). What’s food got to do with it? Presentation given at Florida AIDS Education and Training Center conference.
2		McComsey, G.A. (2002). High doses of riboflavin and thiamine may help in secondary prevention of hyperlactatemia. AIDS Reader 12. 222-224.
3		Singhal, N. & Austin, J. (2002). A clinical review or micronutrients in HIV infection. Journal of the International Association of Physicians in AIDS Care 1(2). 63-75.