The different drugs can have different side effects, and it's worthwhile to seek out information on these, especially if an extensive list (more than 3 or 4) of the antiviral drugs is recommended by your doctor. Stress on the liver is a primary concern since the liver clears the drugs from the body along with all the usual materials it already deals with. Some websites to check out for more information on this include www.tthhivclinic.com, hivinsite.ucsf.edu, www.critpath.org, www.catie.ca, and aids.org.

Make sure you're giving your body its best chance to survive. Good nutrition is important. Calories are important, but without enough vitamins and minerals, the body cannot appropriately use its calories. In HIV disease this has been a major problem. Supplementation should be considered. Be careful of relying on dietary assessments that indicate you're getting levels that would be okay for a person without HIV, but that don't take into consideration the specifics of HIV and its unusual effects and demands on the body's vitamins and minerals. A good quality mulitivitamin may be a starting place. Selenium, the B vitamins, vitamins C and E are a few that studies indicate are particularly important micronutrients not to let become too low. Charlie Smigelski, an HIV-savvy Registered Dietitian, who is another member of the Virtual Faculty, offers a list of supplements specifically aimed at liver support. See his recommendations under the Q&A on Lipodystrophy. Also, the DAAIR crosslink at the previously mentioned aids.org and at www.bgladco.com both provide extensive coverage of these issues.

A: Barbara J. Scott, MPH, RD responds:

In our clinic, we are urging clients and providers to use an initial nutrition assessment (body comp, weight change history, usual diet, etc) to determine nutrition risk and to make arrangements for a nutrition "rehab" period of one to two weeks prior to starting medications that are likely to have major nutrition-related side effects like diarrhea or nausea. We also try to give clients the information they need to be prepared to handle these problems in case they do occur. For example, we go over information on hydration, rehydration, foods to include more of/less of with diarrhea so they know what they might want to have on hand at home and know when to be concerned. We do anticipatory counseling on including plenty of protein, using supplements, etc. so they can try to have their bodies be as prepared as possible to utilize the meds. You might benefit from such advice and be able to request nutrition services sooner rather than later!