Immunocompromised persons are more susceptible to serious food-borne and water-borne illnesses than are persons with stronger immune systems. These secondary infections contribute significantly to the morbidity and mortality of HIV-infected persons. Food plays an active role in disease transmission by supporting the growth of the etiologic agent or toxin production, or a passive role where the food does not support growth but serves as a means of transmission.
Food- and water-borne diseases cause nausea, vomiting, and/or diarrhea with or without additional symptoms of fever, chills, headache and fatigue. Chronic diseases that may result from food-borne diseases include arthropathies, chronic gastroenteritis, organ compromise, and nutritional and other malabsorptive disorders, possibly resulting in death. Cryptosporidium, Microsporidium, Salmonella and cytomegalovirus are the main pathogens resulting in AIDS-related diarrhea. Diarrhea in immunocompromised patients is a challenge for the treatment and prevention of wasting. Fifty percent to 90 percent of persons with AIDS have serious episodes of diarrhea that can be life-threatening.
To prevent or minimize food- and water-borne diseases, the following precautions are recommended in the fifth edition of "Nutrition and Your Health: Dietary Guidelines for Americans," published by the Department of Health and Human Services and the Department of Agriculture.
- Do not eat raw or undercooked meat, poultry, fish or shellfish. Whole poultry should be cooked to 180°F; poultry breast and well-done meats to 170°F; and medium-rare beefsteaks, roasts, veal and lamb to 140°F.
- Reheat sauces, soups, marinades and gravies to a boil. Reheat leftovers to at least 165°F. Use a food thermometer. In a microwave, cover the container and turn or stir the food to make sure it is evenly heated throughout.
- Do not eat raw or partially cooked eggs; foods containing raw eggs; raw (unpasteurized) milk; or cheeses made with raw milk. Cook eggs until whites and yolks are firm.
- Undercooked hamburger and raw fish (including sushi), clams and oysters are high-risk for contamination. Cook fish and shellfish until it is opaque; fish should flake easily with a fork. When dining out, order foods that have been thoroughly cooked and be sure they are served piping hot.
- When cooking, keep hot foods at 140°F or above, and cold foods at 40°F or below. In the danger zone between these temperatures, harmful bacteria can grow rapidly. Whether cooked or raw, never leave meat, poultry, eggs, fish or shellfish out at room temperature for more than two hours (or more than one hour if the temperature is 90°F or greater). Chill leftovers as soon as possible, and use within three to four days.
- Freeze fresh meat, poultry, fish and shellfish that cannot be used in a few days. Thaw these frozen items in the refrigerator, microwave, or cold water changed every 30 minutes. Cook foods immediately after thawing.
- Uncooked meats should not come in contact with other foods. Hands and all utensils and surfaces should be washed thoroughly after contact with uncooked foods.
- Listeriosis is a serious disease that occurs frequently among severely immunocompromised HIV-infected persons. Some soft cheeses and some ready-to-eat foods (such as hot dogs and cold cuts from deli counters) have been known to cause listeriosis. Reheating these foods until they are steaming can prevent listeriosis.
- Because of the risk of cryptosporidiosis and giardiasis, HIV-infected persons should not drink water directly from lakes or rivers; should avoid swimming in water that may be contaminated with human or animal waste; and should avoid swallowing water while swimming.
- Boiling water for one minute will eliminate the risk of acquiring cryptosporidiosis infection. Using submicron, personal-use water filters or drinking bottled water may also reduce the risk. Current data are inadequate to support a recommendation that all HIV-infected persons boil or otherwise avoid drinking tap water in nonoutbreak settings. Those who choose a personal-use filter or bottled water should be aware of the complexities involved in selecting the appropriate products, and the lack of enforceable standards for destruction or removal of oocysts, the cost of the products, and the difficulty of using the products consistently.
- Nationally distributed brands of bottled or canned carbonated soft drinks are safe to drink. Also safe are commercially packaged noncarbonated soft drinks or fruit juices that do not require refrigeration until after opening. Nationally distributed brands of frozen fruit juice concentrate are safe if they are reconstituted with water from a safe source. Only juice labeled as pasteurized should be considered free of Cryptosporidium risk. Other pasteurized beverages and beers are considered safe to drink. No data are available concerning survival of Cryptosporidium oocysts in wine.
"Knowledge of safe food- and water-handling techniques is essential for persons living with HIV and AIDS, their caretakers, and for health care providers to prevent the potentially life-threatening nature of such infections," the authors concluded. "To decrease the risk of infection from enteric pathogens, emphasis should be placed on proper storage of perishable foods, adequate cooking of animal foods, avoiding cross-contamination of raw and cooked foods, ensuring appropriate sanitation in the kitchen, ensuring personal hygiene, and using water from safe sources."
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