Living With HIV

What are dietary supplements?

Dietary supplements are manufactured products that are typically used to improve some aspect of health. Depending on the main ingredient, dietary supplements can come in different forms, including tablets, capsules, gels, liquids, powders, and gummies.

Dietary supplements are often found in the foods that we eat. However, supplements can sometimes be more convenient to consume to avoid any concerns related to preparing foods, planning meals, eating certain foods often enough, or worrying about food spoiling. Types of dietary supplements include vitamins, minerals, botanicals/herbs, botanical compounds, microbials, and amino acids. Some examples include:

• Vitamins: Vitamin A, vitamin C, vitamin E
• Minerals: Calcium, zinc, iron
• Botanicals/Herbs: Echinacea, oregano, turmeric
• Botanical Compounds: Caffeine, CoQ10, curcumin
• Live Microbials: Probiotics
• Amino Acids: Branched chain amino acids, essential amino acids, glutamine, leucine

Most people take dietary supplements based on the proposed benefits of that specific supplement. For example, calcium supplements are often used to help build strong bones. However, some supplements may not be as effective as they are claimed to be. The NIH Dietary Supplement Fact Sheets can help provide information on supplements to see if they are worth taking.

Note: While the U.S. Food and Drug Administration (FDA) helps regulate dietary supplements, it does not review and approve these products for safety or effectiveness before they become available to consumers. Due to the lack of regulatory requirements needed for dietary supplements to get approved for purchase, additional steps may be necessary to help reduce the risks associated with unsafe products.

To help choose safe and reliable dietary supplements, consumers should look for supplements with a seal from a third-party organization like the National Sanitation Foundation or The United States Pharmacopeial Convention, which test products to confirm the legitimacy of the contents. Because the FDA helps regulate dietary supplements only after they are available for purchase, choosing products or brands with a proven history is also a good idea.

What dietary supplements should you take if you have HIV?

Dietary supplements should generally be used to supplement a lack of certain nutrients in your diet or to accommodate your specific health needs. This means that the need for any dietary supplements should be determined on a case-by-case basis and in consultation with your health care provider, regardless of your HIV status.

However, if you have HIV, you may be more likely to experience certain symptoms or side effects related to HIV infection or HIV medicines. Examples of symptoms or side effects include rash, diarrhea, fatigue, and depression. In addition, if you are pregnant and have HIV, you may be more likely to experience preterm delivery and low infant birth weight.

Some dietary supplements have been researched specifically on people with HIV, including the following:

• Curcumin: May reduce some symptoms (such as diarrhea)
• Folate: May reduce the chances of having a preterm birth
• N-acetylcysteine and Glutathione: Unlikely to make big changes to HIV-related outcomes
• Selenium: May reduce the risk of preterm delivery during pregnancy
• Vitamin A: May reduce some symptoms (such as diarrhea) and improve survival of infants with HIV; may reduce the risk of serious illness during pregnancy
• Vitamin D: Unlikely to make big changes to HIV-related outcomes
• Zinc: Can possibly improve general health and reduce the risk of some symptoms (such as diarrhea), but results are inconclusive

While specific research on people with HIV may not be available, some research supports the use of dietary supplements for health concerns that can be more common if you have HIV. Examples include:

• Reduced bone density: Calcium, vitamin D
• Skin rash: Omega-3 oils (fish oils), vitamin E
• Stomach discomfort: Probiotics
• Weight gain: Caffeine
• Weight loss: Protein and/or amino acids

While it is possible that a dietary supplement may help if you are experiencing these symptoms or side effects, it is important to consult with a health care provider before taking any dietary supplements because some products may interact with HIV medicines.

How are dietary supplements different if you have HIV?

If you have HIV, dietary supplements may help with specific health concerns caused by HIV infection or HIV medicines. These supplements can potentially reduce the frequency or severity of issues like weakened immune function, weaker bones, liver or kidney problems, digestive problems, mental health challenges, and some nutrient deficiencies that are caused by HIV or HIV medicines.

Although dietary supplements can sometimes improve HIV-related symptoms, some HIV medicines can cause or amplify certain health issues. For example, tenofovir disoproxil fumarate (TDF) has been linked to bone and kidney issues, and HIV medicines in the integrase strand transfer inhibitor (INSTI) class may cause issues with the absorption of cations like calcium and iron.

In addition, if you have HIV and also take medicines for other health concerns (such as heart disease), the combination of medicines can further complicate how dietary supplements affect the body. Because some dietary supplements can cause drug interactions with HIV medicines or other medicines, it is important to consult with a health care provider before taking a new supplement.

What dietary supplements should you avoid if you have HIV?

The dietary supplements you need vary based on your unique circumstances, including factors like overall health, HIV medicines, other medicines, and diet. These factors can influence which dietary supplements are safe and which should be avoided.

Even so, some dietary supplements have documented interactions with HIV medicines and should be avoided. Some dietary supplements that may be worth avoiding to prevent serious drug interactions include:

• Cations (such as calcium, magnesium, aluminum): May reduce the effectiveness of HIV medicines in the INSTI drug class
• Probiotics: May cause gastrointestinal issues
• St John’s Wort: May interact with HIV medicines in the protease inhibitor and non-nucleoside reverse transcriptase inhibitor drug classes
• Vitamin A: May cause liver problems when combined with some medicines or in high doses

It is important to consider that some supplements may include these ingredients, although they aren’t explicitly listed on the front label.

For example, some “super green” supplements contain high levels of vitamin A, and some antacids (such as Tums) include high levels of cations. See the HIVinfo What is a Drug Interaction? fact sheet for more information about drug interactions.

What are some tips for taking dietary supplements if you have HIV?

Dietary supplements may help improve certain aspects of your health when taken as intended. If you have HIV, the first step to take before taking a dietary supplement should be to consult with a health care provider to make sure it is safe based on your personal situation.

Otherwise, to get the most out of a dietary supplement, it is important to be mindful of how the supplement is taken. Some tips for taking dietary supplements include:

• Reading labels: Some supplements may have additional instructions or information (such as allergens) that could be important to know.
• Planning around meals: Some supplements may need to be taken with food, while others should be taken on an empty stomach.
• Scheduling intake: Taking a supplement too frequently or infrequently can impact the effectiveness or safety.
• Taking recommended doses: Doses that are too big or small can impact the effectiveness or safety.
• Monitoring effects: Being aware of a supplement’s effects on the body after taking it can help prevent long-term problems.

If you have HIV and plan to take a dietary supplement, being mindful of these tips can help to make sure a supplement is both safe and effective. 

This fact sheet is based on information from the following sources:

From the U.S. Food and Drug Administration:

• FDA 101: Dietary Supplements
• Mixing Medications and Dietary Supplements Can Endanger Your Health

From the NIH Office of Dietary Supplements:

• Dietary Supplements for Immune Function and Infectious Diseases
• Dietary Supplements: What You Need to Know
• Dietary Supplement Fact Sheets

From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:

• Guidelines for the Use of Antiretrovirals in Adults and Adolescents With HIV:
  • Adverse Effects of Antiretroviral Agents
  • Drug-Drug Interactions

Also see the HIV Source collection of HIV links and resources.