Smoking, lack of exercise, eating a lot of fatty foods and drinking a lot of alcohol can cause changes to blood fats and to the way your body processes sugar. Some anti-HIV drugs can also contribute to these issues, which are sometimes referred to as metabolic changes.

These can include:

• changes to blood fats (also called lipids), such as having too much low-density (LDL, or ‘bad’) cholesterol; having too little high-density (HDL, or ‘good’) cholesterol; or having high triglycerides
• a change in the way the body processes sugar, known as insulin resistance.

These changes are associated with an increased risk of diabetes and cardiovascular (heart) disease.

People can have any one of these changes on its own, but there is often a link between them. For example, insulin resistance can lead to diabetes, and both diabetes and weight gain are associated with an increased risk of cardiovascular disease.

You will be monitored for metabolic changes as part of your routine HIV care. If you develop any of these problems, you can talk to your healthcare team about the sort of changes you may need to make to your eating habits and lifestyle to deal with them.

If you have high cholesterol, it is recommended that you cut down on saturated fats. These come from animal products such as red meat, dairy products such as butter, cream, whole milk, cheese and full-fat yoghurt, and the vegetable fats palm oil and coconut cream or oil (See Healthy eating for more information on a healthy, balanced diet).

Everyone is recommended to eat at least five portions of fruit and vegetables a day, and having plenty of fresh fruit and vegetables is especially important if you need to reduce your weight or high lipid (blood fat) levels.

To help prevent blood clots and reduce triglyceride levels, it’s a good idea to increase your intake of a type of polyunsaturated fat called omega-3 fats. These are found in oily fish like mackerel, herring, salmon and sardines. Non-animal sources of omega-3 can be found in flaxseed oil, soya-based foods and are available as supplements.

Regular exercise can also help reduce levels of blood fats. Resistance training (using muscle strength, such as lifting weights) and aerobic exercise (activities that increase your heart rate and make you breathe faster, such as running, walking, swimming and cycling) are particularly effective.

The glycaemic index (GI) is a way of rating foods by how fast they cause a rise in your blood sugar levels. High GI food will produce a sudden rush, while low GI food keeps blood sugar levels more stable, and leave you feeling fuller for longer. If you are experiencing these metabolic changes, you may be advised to follow a low GI diet. A dietitian can help you with this.

With the right treatment and care, people with HIV can expect to live well into old age. In fact, some doctors think that the life expectancy of many people more recently diagnosed with HIV is now near normal.

Nutrition has an important part to play in helping you to live a long and healthy life.