Good nutrition and exercise can improve your health and slow the progression of your HIV infection. Eating well and working out can maintain your energy level and reduce your risk of acute infection.

You might have trouble eating if you have sores in your mouth, diarrhea, nausea, or just a poor appetite (which are common complications with an advancing HIV infection). If you have trouble eating or exercising, talk to your doctor.

If you are receiving treatment for HIV, you should follow regular dietary and exercise guidelines, which including many of the ideas below. If you condition advances, you may need to take the steps recommended here that will optimize your health.

Path to improved health

A few simple steps can help you make sure your food is healthy and safe:

• Wash your hands with soap and water before you eat so you won’t get an infection from germs on your hands.
• Wash fruits and vegetables before you eat them or cook them.
• Wash your hands with soap and water after you touch raw fish, chicken, or meat to help prevent infection.
• Be sure that meat, eggs, and fish are well cooked before you eat them.

Here are some ways to add nutrition to your diet:

• Have high-calorie protein drinks or shakes. Adding powdered milk can increase the nutrition in other drinks.
• Drink 8 to 10 glasses of filtered water each day.
• Keep nutritious snacks on hand, such as nuts, fruit, and carrot sticks.
• Eat high-calorie foods if you’re losing weight.
• Call your doctor if you lose 5 pounds or more when you didn’t intend to.
• Talk to your doctor about taking a multivitamin every day. Take your multivitamin with a meal to help prevent an upset stomach.

How can I increase my strength?

Aerobic exercise such as walking will make you stronger. And it improves your mental health. It’s good to begin exercising slowly. Little by little, increase the amount of time that you walk. For example, you might start walking for 20 minutes 3 times a week. Then, after you get a little stronger, you can increase the walking time to 30 minutes 4 times a week. Talk with your doctor before you start.

Weightlifting is also a good way to increase your strength. Start by trying to do a weightlifting exercise with a weight light enough that you can lift it 10 times. Lifting it once is called a “repetition.” More than one repetition is called a set. Try to do 2 sets of 10 repetitions. Rest for 90 seconds between each set.

You don’t need to have fancy exercise equipment to do weightlifting. You can use soup or juice cans, books and other objects you have in the house. Start by lifting a weight that’s comfortable for you and doesn’t cause too much strain.

In the first week, do 1 or 2 different weight-lifting exercises for each body part once or twice in the week. Start with a small weight in each hand, perhaps 10 to 15 ounces (a can of soup or a can of beans), depending on the exercise. Each week, increase the number of exercises you do and the number of times you exercise. Rest for 1 to 2 days between exercise sessions. When you’re feeling sick, either exercise less or stop for a while.

Here are some other exercises you might try:

Dumbbell bench press (for your chest, shoulders and the back of your arms)

Lie on a bench on your back. Hold a dumbbell in each hand, with your hands lined up with your shoulders. Have the palms of your hands facing down (toward your toes). Lower the dumbbells until your elbows are below the bench. Don’t relax your arms at the bottom of this movement. As soon as your elbows are as low as they can go, move your arms up again to the starting position. Don’t “lock” your elbows at the top of the movement. (This means, don’t make your arms be exactly straight — leave a tiny little bend in your elbows.)

Remember: You can use cans of soup instead of dumbbells in these exercises. You can also use your body weight and do push-ups or squats if you don’t have any equipment.

Crunches (for your abdomen)

Lie on your back on the floor. Keep your feet on the floor and your knees bent. Fold your arms across your chest. Raise just your head and shoulders from the floor. This is a small and slow movement, like a curl. Your back stays on the floor. Slowly lower your head and shoulders back to the floor. When you are curling your head up, keep your chin up and your eyes looking at the ceiling. You can add resistance to this exercise by holding a weight on your chest.

Upright row (for your shoulders, upper back and the front of your arms)

Hold a dumbbell in each hand. Let your arms be almost straight and resting on the front of your thighs. Your palms should face toward your legs. Now pull the dumbbells up to the level of your shoulders. Your elbows should go up first. When your elbows are about even with your ears, lower the dumbbells to your thighs again. Keep your knees bent just a tiny bit. Don’t let yourself lean backwards.

Lunge (for the front and back of your legs and your buttocks)

Hold a dumbbell in each hand. Keep your arms down at your sides. Your palms should face your legs. Your feet should be even with your shoulders. Take a large step forward with your left leg. Lower your right knee until it’s 1 inch above the floor. Now straighten your left leg and step back to the starting position. Repeat on the other leg. Remember that the movement is up and down, not really forward. Keep your back straight and your head up. Don’t let yourself lean forward.

Things to consider

If you don’t have an appetite, try to eat your favorite foods. Instead of eating 3 big meals each day, eat 6 to 8 small meals. Drink high-calorie protein shakes with your meals or between meals.

If you have diarrhea, don’t eat fried foods and other high-fat foods like potato chips. Avoid high-fiber foods. Instead, eat bland foods such as bread, rice, and applesauce. Ask your doctor about taking nutritional supplements, such as Ensure.

If you have mouth sores, avoid citrus fruits like oranges and grapefruit. Avoid overly hot or cold foods. Don’t eat spicy foods. Try not to eat hard foods like chips and pretzels. Use a straw to drink liquids.

If you have nausea and vomiting, avoid drinking any liquid with your meals. Eat 6 to 8 small meals each day instead of 3 large meals. Eat foods with a mild flavor. Eat foods at a medium temperature, not too hot or cold. Drink nutritional supplements and sports drinks. Sit and relax for 30 minutes after you eat.

You should also avoid the following:

• Smoking and vaping
• Alcohol
• Drugs

Questions to ask your doctor

• Am I healthy enough to begin an exercise program?
• Are there certain foods I should be eating?
• Are there any diet supplements I should be taking?
• Are there other things I should be doing to boost my health?
• Is there anything else I can do to prevent complications/infections?
• Will the medicines I take affect my appetite?

Resources

American College of Sports Medicine: Being Active When You Have HIV/AIDS

Centers for Disease Control and Prevention: Healthy Living with HIV

U.S. Department of Veterans Affairs: Living with HIV/AIDS: Nutrition and Exercise

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What is pneumocystis pneumonia (PCP)?

Pneumocystis pneumonia (PCP) is a kind of pneumonia caused by a fungus called Pneumocystis jirovecior, or P. jiroveci. It used to be called Pneumocystis carinii pneumonia.

Most people exposed to P. jiroveci don’t get pneumonia because their immune systems are healthy and strong. People whose immune systems are weak because of an HIV infection or other medical conditions can get PCP. PCP is less common than it used to be. However, it’s still one of the most common serious infections in people who have advanced HIV disease in the United States.

Others who get PCP are usually taking medicines that lower the body’s ability to fight germs or sickness. They may have other medical conditions, such as:

• Blood cancer
• Inflammatory or autoimmune diseases (for example, lupus or rheumatoid arthritis)
• Organ or stem cell transplant

Symptoms of PCP

See your doctor right away if you have a weakened immune system and have the following symptoms:

• Fever
• Cough
• Trouble breathing (especially with exercise)
• Chest pain
• Chest pain
• Fatigue (extreme tiredness)

Most cases are mild. However, people with severe PCP may die if the infection isn’t treated quickly.

What causes PCP?

Most scientists believe PCP is spread in the air. They don’t know if it lives in the soil or anywhere else. The P. jiroveci fungus is common all over the world. It’s not spread through sexual contact. You can’t prevent being exposed to the fungus.

How is PCP diagnosed?

PCP is diagnosed by lab tests of fluid or tissue from your lungs.

Can PCP be prevented or avoided?

If you’re at risk of PCP because you have HIV, you may be able to lower your risk. A good medicine for preventing PCP is trimethoprim-sulfamethoxazole, or TMP-SMX. TMP-SMX is a combination of two medicines. Ask your doctor if you should be taking this medicine (or another medicine) to prevent illness.

Talk to your doctor about medicines you might be able to take if you have other medical conditions that weaken your immune system.

The pneumonia vaccine does not protect you against PCP. It protects you against a different kind of pneumonia. There is no vaccine for PCP.

PCP Treatment

If you have HIV, your doctor will test your blood regularly to check how strong your immune system is. Your doctor may prescribe TMP-SMX to prevent PCP. Your doctor may also have you start taking the medicine as a preventive therapy if you get certain symptoms. These symptoms may be a temperature above 100°F that lasts for two weeks or longer, or a yeast infection in your mouth or throat (also called “thrush”).

People who have severe cases of PCP are treated in a hospital with IV medicine. The medicine is put into a vein through a tube. As people get better, or if the illness was mild to begin with, the medicine can be taken in as a pill. If you can’t take TMP-SMX, or don’t get better quickly with it, you can take other medicines or combinations of medicines.

Living with PCP

If you have conditions that would make you more likely to get PCP, talk to your doctor about medicines that could lower your risk for getting PCP.

Know that taking TMP-SMX might cause a rash. It might make you feel sick. If you have a mild reaction, you should keep taking TMP-SMX because it works better than any other medicine to prevent PCP.

If you’ve already had PCP, you can get it again. Taking TMP-SMX can prevent second infections with PCP.

Questions to ask your doctor

• Do I have a condition that requires me to take PCP?
• How will I know if my medicine is working to treat my PCP?
• I can’t take TMP-SMX. What other medicines can I take to treat PCP?

Resources

Centers for Disease Control and Prevention: Pneumocystis Pneumonia

National Institutes of Health, MedlinePlus: Pneumocystis jirovecior pneumocystis

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Highly active antiretroviral medicines are used to treat human immunodeficiency virus (HIV). They are used in combination to fight infections. This combination of antiretroviral medicines is often referred to as highly active antiretroviral therapy (HAART). If you have HIV, HAART will not cure you. However, it can fight infections and live longer. But you must take medication as prescribed and on schedule.

HIV attacks your body by entering cells and copying itself. As the amount of virus in your body (called the viral load) increases, you get sick because your body has a hard time fighting infections. HAART keeps your viral load low. The lower your viral load is, the longer you can stay healthy. The goal of therapy is to get your viral load so low that it can’t be measured by blood tests. But it’s important to remember that even when your viral load is this low, you can still potentially pass HIV to other people.

Path to improved health

Why is it so important to take my medicine correctly?

HAART works well if you take the medicines the right way. But if you don’t take your medicines just the way your doctor tells you to, your HIV might not be exposed to enough medicine to control it. If this happens, the HIV becomes resistant, and the medicines stop working. Resistance to HAART medicines can be permanent.

There are not many kinds of medicine that can be used to treat HIV. So, if your HIV becomes resistant, you can run out of ways to treat it.

Do I need to take all of my medicine?

Great improvements have been made in HAART medications. Most patients are now on once daily medication. It is important that you remember to take it without skipping any days.

Some people put their pills in a daily pillbox and use alarms to remind themselves to take their medicines. You could also download a free app to remind you.

Do I have to eat or drink something when I take my medicine?

Some medicines must be taken with food. Others must be taken on an empty stomach. Check with your doctor and pharmacist about your particular medicines.

Some people who take the medicine indinavir get kidney stones. If your doctor wants you to take this medicine, you should drink at least 10 cups of water per day to help prevent kidney stones.

Grapefruit juice can affect the way some medicines work. Ask your doctor if it’s okay for you to drink or eat it. Also, ask your doctor if it’s safe for you to have alcoholic drinks.

Is it safe to take HAART with other medicines or with herbal products?

HAART can be dangerous if you take it with certain medicines or herbs. These include medicines for:

• High cholesterol
• Heart or blood problems
• Tuberculosis infection
• Migraine headaches
• Anxiety
• Insomnia

For example, some prescription medicines and herbal products can make your body push the HAART medicines through too fast, before they have time to work. St. John’s wort and garlic pills can make the level of HAART in your body drop too low to be helpful.

Tell your doctor about every other medicine you take. This includes all prescription medicines, over-the-counter medicines, and herbal products.

Things to consider

Can my medicines cause side effects?

Like most other medicines, HAART can cause side effects. Your doctor will talk to you about what side effects your particular medicine might cause.

If a serious reaction occurs, it usually occurs in the first few weeks of therapy. You should call your doctor if you have any of the following symptoms:

• Constant thirst
• Frequent need to urinate
• Fever
• Rash
• Long-lasting groin pain (the groin is the area between the stomach and the thigh)
• Weakness
• Feeling bloated
• Abdominal pain, especially pain that gets worse after eating

Even when you are feeling well, your doctor will do laboratory tests to make sure you are not having side effects from your medicine. It is very important to keep a check on this.

Questions to ask your doctor

• Will an antiretroviral treatment help me?
• When should I begin treatment?
• I am feeling fine. Do I still need to take medication?
• Can HAART reduce my chance of passing HIV to my partner?
• How long can I take antiretroviral medicines?

Resources

HIV.gov: Tips on Taking Your HIV Medication Every Day

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As a health care worker, you may be exposed to sources of infection. These may be transmitted in three ways. First, you can come into contact with an infected person’s blood or body fluids. This also includes droplets from a cough or sneeze. You can come into contact with infectious materials. The last way infections are spread is through the air.

Path to improved health

You can protect yourself from infection by:

• Following the infection control guidelines in your workplace.
• Using protective gear, such as gloves, goggles, and/or masks.
• Treating all blood and body fluids as though they are infectious.
• Handling and disposing of needles and sharp instruments correctly.
• Getting immunized for necessary vaccines.

Infections and diseases can spread through certain body fluids. The main sources are blood, vomit, semen, vaginal discharge, breast milk, and pus. Internal fluids, like those from the lungs, heart, or stomach, also can transmit disease. Clear fluids, such as tears, saliva, sweat, and urine, contain little or no threat for infection. They cannot transmit infection unless mixed with blood.

For a skin or mucus splash, your risk is lower. Exceptions are if your skin has a wound, rash, or crack. Also, if the blood or fluids splash into your mouth or eyes. For a needlestick injury or cut, your risk is higher. In all cases, wash the affected area and get medical care right away.

A doctor will assess and test you for infection. They also may want to test the infected person (source).

• If the source has HIV, you may need to take preventive medicines. These should be started within hours of the incident.
• If the source is infected with hepatitis B, you will get hepatitis B immune globulin. This is if you haven’t been immunized or don’t have immunity.
• If the source has hepatitis C, you may need antiviral medicines.
• If the source has syphilis, you’ll be treated with antibiotics.

You may need follow-up or repeat testing to check for infection. This will depend on the source and the type of disease.

Things to consider

Some infections are more serious, including HIV, hepatitis B and C, and syphilis. However, you should protect yourself against all infections and viruses. To help with this, you can get vaccines.

If you haven’t had chickenpox, you should have a blood test. It will check your immunity to varicella, the virus that causes chickenpox. Most adults are immune, even if they haven’t had chickenpox. If you aren’t immune, you should have the 2-shot varicella vaccine series. Without the vaccine, you’re at risk of getting chickenpox and spreading it to others.

In rare cases, people can get chickenpox a second time. This can happen even if you’re immune to varicella. Chickenpox is usually milder the second time. If you get it again, tell your work so you can avoid contact with patients.

A Tdap vaccine is routinely given at age 11 or 12. It protects against tetanus, diphtheria, and pertussis (whooping cough). Pertussis is responsible for some coughs or cases of bronchitis that last longer than the usual cold. If your cold lasts more than 2 weeks, talk to your doctor. Pertussis can be life threatening to unimmunized infants. Anyone who did not receive the Tdap vaccine as a child should get it as soon as possible. Health care workers should get the Tdap booster for tetanus and diphtheria once every 10 years.

It’s important to know which patients might have tuberculosis. Those who are homeless or have immigrated from certain countries are at higher risk. They will have a chronic cough that lasts for weeks and brings up mucous or blood. They also may have fever, night sweats, or weight loss. You can catch this disease by breathing in droplets that get into the air when an infected patient coughs. Wear a protective mask if you work around patients who have tuberculosis. Infected patients also should wear masks to contain the infection. In an office setting, move them out of the waiting room. In a hospital setting, put them in isolation.

Questions to ask your doctor

• What other vaccines should I get to avoid infections at work?
• If I’m exposed to blood or body fluids in my workplace, what are the chances I will get infected?
• When and how will I know for sure if I’m infected?

Resources

National Institutes of Health, MedlinePlus: Infection Control

U.S. Department of Labor, Occupational Safety and Health Administration: Infectious Diseases

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Finding out that you are infected with HIV (human immunodeficiency virus) can be frightening. One way to fight your fear is to learn as much as you can about the disease. Remember that HIV is manageable. It can be treated with medicines. Knowing about HIV and AIDS (acquired immunodeficiency syndrome) will also help you take the best care of yourself.

You can fight your worry about HIV infection with reliable information. Your friends and family may give you advice. The best information comes from your doctor or counselor, or from local, state, or national AIDS resources.

Path to improved health

The good news is that early treatment is helping many people with HIV live longer, healthier lives. It’s normal to feel sadness, anxiety, and fear when you first learn that you have tested positive for HIV. However, if you have trouble sleeping, eating, or concentrating, or if you have thoughts of suicide, tell your doctor right away.

If you’ve been told you have HIV, give yourself permission to be afraid. But don’t let this fear keep you from doing all you can to help yourself. Here are some things you can do:

• See your doctor as soon as possible after being diagnosed, even if you don’t feel sick. Your doctor will have you start taking HIV medicines right away.
• Ask your doctor how often you should have a check-up. Always keep your appointments.
• Always use a latex condom during sex.
• Help your body fight infection by not abusing alcohol and by quitting smoking.
• Eat a balanced diet. Get regular exercise. Get enough sleep.
• Find out what causes stress in your home and work life. Do whatever you can to reduce this stress.
• Don’t share needles for drugs, steroids, piercing, or tattooing.
• Get regular dental check-ups. Bleeding gums can increase your risk of infecting someone else.
• Volunteer to work for an AIDS organization. Facing your fears directly can be a good way to cope with them.

Things to consider

If you have tested positive for HIV, you must tell your past and present sexual partners. They should get tested, too. You must also tell any future sexual partners that you have tested positive for HIV. If you are now in a relationship, ask your doctor about how to explain your positive test results to your partner.

Let your doctor and dentist know that you have HIV. This will help them give you the care you need. Your privacy will be respected. Your doctor and dentist can’t refuse to treat you just because you have HIV.

Consider setting up an advance directive and medical power of attorney. Advance directives are written guidelines that tell doctors your wishes for different kinds of treatment if a time comes when you can’t make those decisions yourself.

The medical power of attorney is a legal document that names someone in your life to make decisions for you if you are seriously ill. A lawyer can draw up these documents.

Questions to ask your doctor

• If I have HIV, what are the chances that I will get AIDS?
• How did I get HIV?
• How can I prevent passing HIV to others?
• How can I avoid getting other infections?
• Do I have to tell my employer that I am HIV positive?
• Are there support groups for people with HIV?

Resources

Centers for Disease Control and Prevention: HIV/AIDS

Centers for Disease Control and Prevention: Resources for People Living with HIV

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A plasma viral load test (also called a PVL test) measures how much human immunodeficiency virus (HIV) is in your blood. The amount of HIV in your blood is called your “viral load.” The lower the viral load, the less amount of the virus is in your blood.

Path to improved health

If your doctor knows your viral load, they can tell more about your risk of health problems caused by HIV infection. A PVL test helps your doctor determine if your current method of treatment is working or if it’s time to change to different medicines.

Who needs a PVL test?

PVL tests are intended for people who have already been diagnosed with HIV or acquired immunodeficiency syndrome (AIDS). This kind of test can help your doctor monitor how efficient and healthy your immune system is. Regular PVL tests can also help you and your doctor make decisions about which treatment is right for you and when to start it.

PVL tests can detect HIV faster than other tests. This is why they’re used to test newborn babies whose mothers have been diagnosed with HIV or AIDS. If test results show that HIV is present in the baby’s blood sample, doctors can start treatment sooner.

Pregnant women who may have had a recent exposure to HIV can also have a PVL test. This test can help them make informed decisions, such as when to start treatment to avoid infecting their baby with HIV.

PVL tests aren’t designed for people who want to know their HIV status. There are other tests that are cheaper and more reliable for telling whether a person has HIV or not.

What do the results mean?

Results of PVL tests are usually given as “copies per milliliter (mL)” of blood. PVL tests measure how much HIV RNA is in a sample of your blood. RNA is the “blueprint” that HIV uses to make more of the virus. Each virus particle carries 2 copies of RNA. This means that if there are 20,000 HIV RNA copies per mL on your test report, 10,000 virus particles are present in each mL of your blood.

The amount of HIV in your blood may change. Changes in PVL are often called “log changes.” A log change means that your viral load is 10 times more or 10 times less than a previous PVL test result. For example, if a PVL test showed that you had 20,000 HIV RNA copies per mL, a log change would be either an increase to 200,000 copies per mL or a decrease to 2,000 copies per mL. The goal of HIV treatment is to get your PVL results as low as possible.

Most doctors consider a viral load of 500 or fewer HIV RNA copies per mL low, while a viral load of 40,000 or more HIV RNA copies per mL is considered high. Before your doctor makes decisions about your HIV medicines, they may want you to have 2 PVL tests done 2 to 3 weeks apart to monitor changes.

How does a PVL test help my doctor decide when to start HIV medicines?

If you haven’t started taking medicines for HIV infection, your doctor will probably want to test your PVL several times a year to see if the amount of HIV in your blood is changing.

Your doctor might think about starting you on HIV medicines if your PVL is higher than 10,000 to 30,000 copies per mL. This is a complicated decision to make. Your doctor has to think about any other medicines you’re taking and the other health problems you may have. The same PVL test result may lead to different decisions for different people.

Your doctor may also want to check your CD4 lymphocyte cell count. The CD4 cells are white blood cells that help the body fight infection. They are the cells that HIV attacks. The CD4 cell count helps to show how healthy your immune system is. A high CD4 count means a healthy immune system. When the PVL test score goes down, the CD4 cell count usually goes up, although this might take some time. CD4 cell counts can also help you and your doctor decide when to start or change HIV medicines.

How are PVL tests used during HIV treatment?

If you are already taking medicines to treat HIV infection, your doctor will want you to have a PVL test several times a year. This way, he or she can make sure that the medicines are working for you. If your PVL goes up, you and your doctor will have to talk about changing your HIV medicines.

Your doctor might also want you to have a PVL test if you get another infection or if your CD4 cell count goes down.

It’s usually best not to get a PVL test for 3 to 4 weeks after you have an immunization shot or for 1 month after you have an infection. Your PVL could be higher than usual at these times.

How do HIV medicines affect the PVL?

After you start taking HIV medicines or change to different medicines, your PVL should decrease by a lot in the first 1 to 2 months. This means the medicine is working. Your PVL should continue to decrease after that. If the medicines continue to work, your PVL can get so low that after 4 to 6 months of treatment it will be almost impossible to detect the HIV in your body. An undetectable level is good, but it doesn’t mean that you’re cured or that HIV is completely out of your body. It’s important to note that not everyone’s PVL gets this low.

How fast your PVL goes down depends on many things, including:

• How high it was to begin with
• How carefully you’re taking your medicines
• Whether you’ve previously taken other HIV medicines

Things to consider

Special tests show that even people who have undetectable levels of HIV still have very small amounts of the virus in their blood. So even if your HIV level is undetectable, you need to get a PVL test several times a year. And it’s important to remember that you could still infect other people if you have unsafe sex or if you share a needle.

Questions for your doctor

• Do I need a PVL test to help manage my HIV?
• How often should I have a PVL test?
• My PVL is high. Why am I not taking HIV medicine yet?
• My PVL is low. Why am I still taking HIV medicine?

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