Antiretroviral drug therapy is just one way to help keep the immune system in check for people living with HIV. Other factors like stress reduction and good nutrition can help strengthen your body's own defenses against disease and some of those side effects of medication. Eating healthy, managing stress, exercise and integrating natural or alternative therapies are all important additions to the prescription drugs that your doctor may prescribe for you. Because HIV speeds up your body's metabolism, you need more vitamins and minerals than food can provide even when you are eating well. We have to be very careful that these vitamin supplements or meal replacements do not interfere with the way the pharmaceutical drugs work. The goal is to get the most of the food you eat while achieving proper levels of the medication that are prescribed. If you are a regular reader of this column, you already know about the importance of adherence to the drug cocktails and treatment success.

Alternative therapies, like herbal products and vitamins, can be an effective way to give your body a little extra boost. Unfortunately, natural vitamins and supplements do not have to be tested or studied as pharmaceutical agents do. We don't know how these agents interact with prescription drugs. There can be a large variation in the potency of natural products from batch to batch and between manufacturers. Because of these reasons, extra caution must be used when adding any supplements to your daily food and drug regimen. Something else to remember is the cost of supplements. The price has to be weighed against the benefit of the product. It is not uncommon to hear a patient spent hundreds of dollars on pretty brown bottles of vitamins and natural "immune system boosters." Spending that money on a good, balanced diet may be cheaper and better for you in the long run.

Certain foods themselves can interact with the drugs that are prescribed by physicians. To avoid upsetting your stomach, some prescription drugs can be taken with food. It is not that simple with the drugs used to treat HIV infection. The presence of food, in the case of Videx, can cause the drug to be destroyed by the acidity in the stomach. Other drugs like Fortovase require food to be resent in order to achieve proper absorption. The effect that food or alternative therapies can make on the blood levels of the HIV drugs can mean the difference between success and failure of the drug combo.

Here are a few tips to remember when planning your medication regimen. However, please be advised that this is just a sample list, it is not an all-inclusive list.

Food-drug interactions:

  • Grapefruit juice - increases absorption of non-nukes and PIs

  • Caffeine - Crixivan (may increase dehydration and kidney stones)

  • Alcohol - Crixivan (may increase dehydration and kidney stones)

Supplement-drug interactions:

  • Garlic - decreases Fortovase levels

  • St. Johns wort - decreases absorption of Crixivan and other protease inhibitors

  • Vitamin E - high levels already included in Agenerase (amprenavir)

Drugs that need to be taken WITH FOOD:

  • Norvir (ritonavir)

  • Kaletra (lopinavir/ritonavir)

  • Viracept (nelfinavir)

  • Crixivan/Norvir (when dosed together)

  • Fortovase (saquinavir) and Fortovase/Norvir (when dosed together)

  • Viread (tenofovir)

Drugs that need to be taken on an EMPTY STOMACH:

  • Videx (didanosine, ddI) all formulations should be taken 30 minutes before or 2 hours after meals

  • Crixivan (indinavir) can be taken with a light, low-fat snack

  • Sustiva (efavirenz) 200 mg capsules or 600 mg tablets (new formulation); food can increase blood levels, side effects

Drugs that can be taken WITH OR WITHOUT FOOD:

  • Epivir (lamivudine, 3TC)

  • Retrovir (zidovudine, AZT)

  • Combivir (lamivudine/zidovudine)

  • Ziagen (abacavir sulfate)

  • Trizivir (abacavir/lamivudine/zidovudine)

  • Zerit (stavudine, d4T)

  • Viramune (nevirapine)

  • Rescriptor (delavirdine)

Prescription drugs can cause side effects that change your appetite and digestion. Speak to your health care provider or pharmacist about tips that may help avoid these unwanted side effects. HIV disease or opportunistic infections can also interfere with eating or absorbing the nutrients you do get. Sometimes, thrush can cause a problem eating and enjoying food. Try rinsing your mouth or brushing your teeth before eating. Smoking and alcohol use can irritate the inside of your mouth. Hard candy and being well hydrated can help when you have a dry mouth.

Some of the most common questions I get as a pharmacist involve the use of herbal supplements and natural products. In general, it is always best to speak with your health care provider or pharmacist about using these products along with your prescription drugs. Make a list of all the items you take including over-the-counter drugs, vitamins, sports drinks, as well as all of the prescription drugs. Your health care provider can make a complete evaluation of any potential problems that may exist. When you are ready to buy, always make sure you purchase high quality products from reputable stores or buying clubs, but don't waste your money on "miracle cures" or high-pressure sales people. If it sounds too good to be true, it probably is.

Glen Pietrandoni is director of Clinical Pharmacy Services for the Walgreen Specialty Pharmacy, focusing on HIV, located in the Howard Brown Health Center of Chicago. Contact:

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