Loss of appetite has several possible causes. One cause can be HIV itself, which somehow causes an altered sense of taste: food just doesn’t seem to taste good. Other causes are depression, drugs, opportunistic infections, or infections of the mouth.
Treatment depends on the exact cause. When the cause is HIV and an altered sense of taste, the best treatment is to learn your preferences and eat accordingly. A person with an altered sense of taste often has a particular problem with protein-rich foods, particularly with red meat. The solution in that case is to find other sources of protein: poultry, fish, eggs, and cheese are all excellent sources of protein. So are dried beans and rice. A person with an altered sense of taste also seems to have the best appetite in the morning: try to eat large, nutritious breakfasts. If you have a preference for foods at different temperatures, indulge your preference. Try eating foods that smell good: the senses of smell and taste are closely connected. Try adding herbs, bacon, garlic, olives, cheese—anything that livens up the flavor of the food and “doesn’t disagree with you.
Some opportunistic infections of the mouth (thrush, herpes, aphthous ulcers, and Kaposi’s sarcoma), discussed in the preceding section, cause pain with eating. When eating hurts, people often lose their appetites. In this case, avoid foods that cause pain. Stay away from salt and seasoned salts; from hot spices like pepper, chili pepper, and paprika; and from acidic foods like vinegar, citrus fruits and juices, tomatoes, pineapple, and pickles. Try food at moderate or cool temperatures. Try foods that are soft and won’t irritate the mouth: mild cheeses, cottage cheese, yogurt, cooked eggs, cream soups, ice cream, puddings, popsicles, ground meats, baked fish, bread, noodles and pastas, and cooked or canned fruits.
Another cause of appetite loss is the emotional reaction to having HIV infection. At times, people become anxious or depressed and lose interest in eating. Both anxiety and depression can occur at any stage of this infection, but they are especially common at the time the person first learns of a positive blood test, and at the time of the first opportunistic infection. One way to fight this might be to make eating a special event: put on some music, prepare the food so it looks attractive, think of a meal as a break from your worries, relax, take your time with the meal. Eat your favorite foods. Keep snacks around: ice cream, cheeses, canned fruit, crackers, peanut butter. Small meals are less filling; try several small meals a day. Eating is often a social event, and many people enjoy food best in someone else’s company.
Still another cause of loss of appetite is fatigue: people are simply too tired to eat. Fatigue can also interfere with their ability to prepare a meal if they live alone. If you eat less because you are tired, be careful to eat meals especially high in calories and protein, so that even if you eat less, you get the same level of nutrition. Try milkshakes, dried fruits, peanut butter, ice cream, cheese, sour cream, hot chocolate, custard, cream soups, scrambled eggs or an omelet with cream cheese, noodles with cheese and cream. Preparing main courses that are high in protein and calories and then freezing them also saves energy: spaghetti sauce, chili, pot roasts, beef or chicken or lamb stews, and soups all taste good made in large amounts, frozen, and reheated; they freeze well. High-protein main courses are also sold prepared and frozen in grocery stores. In either case, frozen food can be reheated on the stove or in a microwave oven. Keep
ready-to-eat and nutritious snacks on hand. Many communities also have organizations that will prepare or deliver meals.
Drugs can also be the cause of an altered appetite. Virtually any of the drugs listed below as causes of nausea and vomiting can reduce the appetite, and the list is certainly incomplete.
In general, the treatment for appetite loss depends on the situation: if you have a sore mouth, get treatment for the sores; if drugs are responsible, consider alternatives to those drugs; tailor meals to your own tastes; and accommodate meals to fatigue. When appetite loss is temporary, try to get in as many calories as possible without regard to the nutritional value: you simply are not going to become malnourished in a few days. Try fortifying foods with oil, butter, mayonnaise, a little dried milk, grated cheese, cream. Try making shakes out of combinations of different foods: milk, ice cream, instant breakfast, buttermilk, bananas or strawberries or peaches or apricots or pears, fruit juice, yogurt, honey, cocoa, chocolate syrup, peach or pear or apricot nectars, ginger ale, brown sugar.
Most important is drinking enough fluids: healthy people can survive over one hundred days without food, but no one can survive more than a few days without fluid. Drink fluids that are high in calories and protein—milk, shakes—instead of diet drinks, coffee, or tea. Routinely stir some dried milk into your milk.
If people with HIV infection eat poorly for weeks or months, a physician should be consulted. In some cases, the physician may prescribe an appetite stimulant such as Megace. In extreme cases, the physician may use a feeding tube—a tube placed through the mouth and into the
stomach, or through the abdomen and directly into the stomach—so nutrition is maintained despite the inability to eat. An alternative, discussed in a later section on wasting, is to feed people intravenously.