DR. MJ Bazos MD, Patient Handout
HIV: How to Avoid Infections If You're HIV Positive

Take care of yourself

Take care of yourself. If you are HIV-positive, you need to take very good care of yourself. Be sure to eat a balanced diet, exercise if your doctor says you can, and get plenty of rest. You can also take steps to keep yourself from getting infections or diseases that are more common in people with HIV.

Practice "safer sex"

Use a condom every time you have sex. A latex condom will help protect you and your partner and will reduce your risk of getting herpes, papillomavirus, or a new strain of HIV, which might be resistant to antiretroviral drugs. The female condom hasn't been studied much yet, so it isn't known how effective it is, but it probably does lower your risk. To reduce your risk of acquiring intestinal infections, avoid sex that results in oral exposure to feces (oral-anal contact).

Work and play safe

Certain activities or jobs, such as working in homeless shelters, hospitals, clinics, nursing homes or prisons, can increase your risk of exposure to tuberculosis (TB). Talk with your doctor about where you work. Your doctor can decide how often you should be tested for TB.
Parents of children in day care and people who provide child care are at increased risk of getting cytomegalovirus (CMV) infection, cryptosporidiosis, hepatitis A and giardiasis from the children. The risk can be reduced by good hygiene practices, such as always washing your hands after changing diapers and after touching urine or saliva. If your child has HIV, you should tell the people who help care for your child.
If you work with animals (veterinary work or working at a pet store, farm or slaughterhouse), you may be at higher risk for infections like cryptosporidiosis, toxoplasmosis, salmonellosis, campylobacteriosis or Bartonella infection. The risk of getting these infections probably isn't high enough for you to give up your job. But you should take some special precautions:
Pet precautions
Although owning a pet may have risks for people with HIV, many of the risks can be avoided. Pets provide emotional benefits, so don't be hasty about deciding to give up your pet. Here are some steps to keep you and your pet healthier:
  • Take your pet to the vet right away if it gets diarrhea. Your vet will want to check to see if the diarrhea is caused by a germ that might be harmful to you. If possible, have a friend take care of your pet when it has diarrhea.
  • Always wash your hands after handling your pet, especially before you eat. Avoid contact with your pet's feces. If your child has HIV, make sure your child washes his or her hands after playing with the pet.
  • If you want to get a new dog or cat, to reduce your risk of cryptosporidiosis the animal should be at least 6 months old and it shouldn't have diarrhea.
  • Be careful about where you get your pet. Some pet-breeding facilities, animal shelters or pet stores have better hygiene than others.
  • Avoid stray animals. If you decide to adopt a puppy or kitten, your vet should check the pet you get to be sure it doesn't have a germ that you could get.
  • If you have a cat, the litter box should be cleaned every day, preferably by someone who doesn't have HIV and isn't pregnant. Keep your cat inside, and don't let it hunt. Don't feed it raw or undercooked meat.
  • Avoid the kind of play that may result in cat scratches or bites. If you do get bitten or scratched, wash the site right away. Never let your cat lick an open scratch or wound on your body. Flea control is also an effective way to help keep your cat and yourself healthy.
  • Limit your contact with reptiles (snakes, lizards, iguanas, turtles) to reduce your risk of salmonellosis. Wear rubber gloves if you must clean an aquarium. Avoid contact with exotic pets such as monkeys.


Food and water precautions
There are some things that you can do to help avoid getting sick because of foods or drinking water:
  • Avoid eating or tasting raw or undercooked eggs (including foods that may contain raw eggs, like some preparations of hollandaise sauce, Caesar salad dressing and mayonnaise).
  • Avoid raw or undercooked poultry, meat and seafood, and dairy products that haven't been pasteurized. Cook poultry and meat until it isn't pink in the middle. The internal temperature of cooked beef should be at least 170°F; 180°F for poultry.
  • Wash fruits and vegetables carefully before you eat them.
  • Wash your hands, cutting boards, counters and knives with soap and water after they come in contact with uncooked foods, especially uncooked meat.
  • If you are severely immunosuppressed and want to reduce your risk of listeriosis (an uncommon disease), be careful about soft cheeses and ready-to-eat foods, like hot dogs and cold cuts from the deli. Reheat hot dogs and cold cuts until they are steaming before you eat them.
  • Never drink water directly from lakes and rivers. Avoid swimming in water that might have human or animal feces in it. Avoid swallowing water while swimming or during other recreational water activities.
  • If your city has an outbreak of waterborne disease, or some other reason for a "boil water" advisory, boil your water for one minute before you use it for drinking or brushing your teeth. Risk may be reduced by using personal-use water filters or bottled water.
  • It isn't necessary to boil tap water if there is no "boil water" advisory in effect, although you may want to. Talk with your doctor about this, since avoiding tap water completely may be inconvenient and expensive.
  • If you choose to avoid tap water completely, you should know that ice made from contaminated water may also cause infection, as can fountain beverages served in public places.
  • Bottled or canned carbonated soft drinks are safe to drink. Noncarbonated soft drinks and fruit juices that do not require refrigeration until after they are opened (those that can be stored unrefrigerated on grocery shelves) also are safe. Frozen fruit juice concentrate is safe if you reconstitute it with water from a safe source.
  • If you drink fruit juice that is sold refrigerated, not frozen, drink only juices that are labeled "pasteurized." Make sure you keep them refrigerated, too. Other pasteurized beverages and beers are also considered safe to drink, although no data are available about the safety of wine.


Travel tips
Travel may be riskier for HIV-infected people, especially if their immunosuppression is severe. Travel to developing countries may put you at higher risk of foodborne and waterborne illnesses than traveling in the United States. Talk with your doctor before you travel.
  • Remember to be very careful with food and drinks. Avoid ice, raw vegetables and fruits, tap water, raw or undercooked seafood or meat, milk and dairy products and food bought from street vendors.
  • Items that are generally safe include steaming-hot foods, fruits that you peel yourself, bottled (especially carbonated) beverages, hot coffee or tea, beer, and water that has been boiled for one minute.
  • Treating water with iodine or chlorine may not be as effective as boiling it, but it may help, perhaps with filtration, when boiling isn't practical.
Although some studies have shown that medicine to prevent traveler's diarrhea may reduce the risk, none of the studies have specifically included HIV-positive patients.
It isn't generally recommended that you take medicine to prevent an upset stomach or diarrhea before traveling, but you may want to talk with your doctor about this. You should bring an antibiotic with you to take if you do get diarrhea.
See a doctor right away if your diarrhea is severe and doesn't get better with medicine, if you have blood in your stool, if you get dehydrated, or if you have a fever (with or without chills).
Avoid direct skin contact with soil or sand, especially if it's likely the soil may be contaminated with animal feces. Wear shoes and protective clothes. Sit on towels if you go to a beach.
Talk with your doctor about the vaccinations you need. Many vaccinations are okay for people with HIV, but some common vaccinations shouldn't be used in people with HIV. If you can't have certain vaccinations, your doctor may need to give you special instructions. Your doctor will also want to talk with you about avoiding exposure to fungal infections and protozoal infections, depending on where you want to travel.