Colorado State University Extension
SafeFood Rapid Response Network
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Food Safety Issues for Persons Living with HIV/AIDS
Edited by: Mary Schroeder, M.S., R.D. & Pat Kendall, Ph.D., R.D., Colorado State - Fall 2004
Since Human Immunodeficiency Virus (HIV) was first recognized in 1981, it has spread around the globe, affecting more than 60 million worldwide, one-third of whom have died. In the U.S., there are more than 800,000 people currently living with HIV and some 40,000 who become newly infected each year.
HIV is transferred via body fluids (blood, semen, vaginal fluid and breast milk) from an infected person to an uninfected one. The virus is carried in infected CD4 T cells, macrophages and as free virus in blood, semen, vaginal fluid and breast milk. With the exception of breast milk, HIV is not transmitted by food. Following initial infection with HIV, the number of circulating CD4 T cells drop and the person may show signs of a flu-like illness, lasting from 2 to 6 weeks. During this time the body is vulnerable to opportunistic infections.
Eventually, the body's immune system responds, producing CD8 T cells, which destroy HIV-infected cells. This leads to a lengthy asymptomatic phase, during which the level of free HIV virus in the body fluids remains low but continues to replicate. This phase can last for years, thanks in part to the development of more than 20 FDA-approved drugs that block HIV replication, thus delaying the progression of the infection to AIDS.
When the CD4 T cell count reaches half of normal, HIV enters the symptomatic phase, leading to a loss of cell-mediated immunity and increased vulnerability to opportunistic infections. Once the CD4 count drops to less than 200 cells/microliter, the persons is considered to have developed AIDS (Acquired Immune Deficiency Syndrome), the term used for advanced HIV infection.
Pathogens of Concern for HIV/AIDS
Within a few years of the discovery of HIV, research studies began to document the increased rates of foodborne infections among persons with AIDS. A 1997 review of these studies found persons with AIDS to have a 20 to 100 times higher risk of infection with Salmonella than the general population. Other bacterial pathogens have not been so intensely studied, but one study reported a 35-fold increase in infections caused by Campylobacter jejuni among persons with AIDS. A review of all foodborne illness data collected in Denmark between 1991 and 1999 found persons with AIDS to be 10 times more likely to be diagnosed with Salmonella, Campylobacter and Shigella infections than the general population.
Some studies suggest that persons with AIDS have a greatly increased risk of listeriosis, caused by the pathogen Listeria monocytogenes, due to the fact that a large majority of documented listeriosis infections occur in people with depressed T-cell mediated immunity. Another pathogen of concern for AIDS patients is Crytosporidium parvum, a microorganism spread easily via human and animal feces and food or water contaminated with feces. Fortunately, improvements in the medical management of AIDS have helped to minimize the occurrence of life-threatening diarrhea caused by Cryptosporidium infections.
Toxoplasma gondii is another opportunistic pathogen of concern for those with HIV/AIDS. When healthy persons are exposed to the parasite, they develop protective immunity (become seropositive). However, HIV-infected persons who are seropositive for Toxoplasma gondii may experience a reactivation of the tissue cysts if their CD4 count drops below 100. HIV-infected individuals are usually tested for antibodies to Toxoplasma soon after diagnosis. If they are seropositive, they are put on prophylactic drug treatment to help prevent reactivation of the Toxoplasma cysts. If individuals test seronegative (no prior exposure to T. gondii), it is important to avoid consumption of raw or undercooked meats and unwashed raw vegetables and to avoid contact with cat feces - all common sources of T. gondii. A treatment option called HAART is proving to be highly effective in helping boost immune function in HIV-infected persons, thereby greatly minimizing the risk of opportunistic infections.
Food Safety Recommendations
Food safety recommendations for persons with HIV/AIDS are similar to those for pregnant women and the elderly discussed in previous newsletters. Key recommendations include:
- Practice personal hygiene.
- Wash hands well with soap and warm water before handling food, after using the toilet, after changing a baby's diaper, coughing or sneezing, and after touching animals.
- Cook foods adequately.
- Use a food thermometer to make sure meat and poultry (including ground) are cooked to safe temperatures.
- Use a thermometer to make sure leftovers are reheated to 165°F.
- Cook shellfish until the shell opens and the flesh is fully cooked. Cook fish until the flesh is firm and flakes easily with a fork.
- Cook eggs until both the yolk and white are firm.
- Avoid cross-contamination.
- Wash knives, cutting boards, and food preparation areas with hot, soapy water after touching poultry, meat and seafood.
- Wash hands with soap and warm water after handling foods
- Thoroughly rinse fresh fruits and vegetables under running water before eating.
- Keep cooked and ready-to-eat foods separate from raw meat, poultry, seafood and their juices.
- Keep foods at safe temperatures.
- Keep your refrigerator below 40°F.
- Store all perishable foods such as eggs, meat, and dairy at or below 40°F.
- Throw away perishable ready-to-eat or leftover foods after 4 days.
- Thaw foods in the refrigerator or under cold running water.
- Do not prepare food more than 2 hours before serving without plans for proper cooling.
- Take only foods that can be kept at safe temperatures in carried meals such as lunch boxes, picnics and potluck dinners.
- Avoid risky foods. These include:
- Raw or undercooked meat, poultry, eggs, fish, and shellfish,
- Unpasteurized milk and chilled fruit juices,
- Raw sprouts (like alfalfa),
- Soft cheeses made with raw milk,
- Hot dogs and luncheon meats that have not been reheated to steaming hot,
- Refrigerated pates and meat spreads,
- Refrigerated smoked fish and pre-cooked seafood, such as shrimp and crab.
Education Materials
Food safety education materials designed specifically for persons with HIV/AIDS can be found on the Colorado State University SafeFood website. Go to www.colostate.edu/orgs/safefood and click on Food Safety for High Risk Groups.
Sources:- Online continuing education course: Food Safety for High Risk Populations; Pilot Oct. 2004. Available at http://www.hec.osu.edu/highriskfoodsafety/. Presenter: Hillers, V. Professor, Extension Specialist. Washington State University.
- Smith, JL. Long Term consequences of foodborne toxoplasmosis: Effects on the unborn, the immunocompromised, the elderly, and the immunocompetent. J Food Prot. 1997;60:1595-1611.
