Food

PrEP, TasP and nutrition: A practical guide

Nutrition tips to navigate side effects

Emiliano Pena

11 Oct 2025 • 8 min read

Pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) changed the script: fewer new infections, more freedom, more confidence.

Not always smooth. Some side effects include nausea, bloating, diarrhoea, headaches or appetite changes. Most effects are mild and settle within days to weeks. Later, routine monitoring may focus on regular check‑ups, as some of these medicines could impact bone and kidney health as well as blood lipids. This is manageable, with your healthcare team in the lead.

And there is more. Food and drinks can make day‑to‑day easier while supporting your bones, kidneys, heart, gut and overall health.

Protein: steady support

Protein supports muscle maintenance, recovery and immune function, as well as satiety. This can help if appetite and/or weight fluctuate.

Include a protein source at meals and snacks (e.g., yoghurt, eggs, tofu/tempeh, lean cuts, fish, chicken, beans, lentils).

Bones: quiet work, big payoff

Calcium is vital to support your bones. A yoghurt, a piece of cheese roughly the size of your middle and ring fingers together, or a block of calcium‑set tofu: easy anchors towards the UK’s daily 700 mg for adults.

If you avoid dairy or are looking for variety, choose plant drinks and tofu with added calcium, fortified cereals, or leafy greens like kale and collard greens.

And then there is vitamin D, which supports calcium absorption. Some foods provide modest amounts of vitamin D (eggs, fortified products, UV‑exposed mushrooms), while your body normally produces it when your skin is exposed to sunlight, but a 10 µg (400 IU) daily supplement is advised in autumn and winter for adults in the UK. Some people may benefit from year‑round vitamin D supplementation (e.g. people who are rarely exposed to sunlight); your GP, healthcare team or dietitian can advise.

Kidneys: keep it flowing

Hydration helps: water, tea, soups, fruit and vegetables all count. About 6–8 glasses per day is a good start. Aim for pale‑yellow urine when you go to the loo and adjust accordingly. A refillable bottle is a simple nudge if you tend to forget to drink.

Too much salt (over 6 g per day or 2.4 g of sodium for adults in the UK) can raise blood pressure and, in the long run, stress your kidneys. Check salt or sodium on food labels. Try adding flavour with herbs, spices, citrus and vinegars, and taste before adding extra salt.

Cholesterol: a gentle tilt

No perfection required, just a shift. As some saturated fats can contribute to LDL (bad cholesterol) increases, UK recommendations advise staying within the daily limit of 20g for adults. Ways to reduce saturated fat intake include using more olive oil and less butter, as well as eating nuts, seeds and avocado instead of fatty meats or pastries.

Other strategies that can help with blood cholesterol levels: if you have breakfast, build in oats - around 40g daily can contribute to lowering LDL modestly. Rotate beans or lentils through the week and add vegetables to your plate for extra fibre, vitamins and minerals.

If LDL is high, plant sterols/stanols may help: 2g per day can contribute to reducing LDL. Check with your GP, healthcare team, pharmacist or dietitian.

Omega-3s can also support healthy blood lipid profiles. Aim for oily fish 1–2 times a week (e.g., salmon, sardines). If not eating fish, consider an algal omega‑3 supplement. Plant options like flaxseed, walnuts and chia also contribute to your omega-3 intake.

Weight changes

Some antiretroviral regimens have been associated with weight gain in some people. Staying on effective HIV prevention or treatment remains the priority.

Aim for meals built around vegetables, a source of protein, and wholegrains/starchy vegetables (roughly half the plate vegetables, a quarter protein, a quarter wholegrains/starchy vegetables). If possible, use olive oil for cooking, and keep sugary drinks and alcohol occasional.

Helpful snack ideas include fruit with yoghurt or skyr, hummus with vegetables, edamame, boiled eggs or a small handful of nuts. The UK Eatwell Guide is a great resource to help you start planning.

Try to be active most days and add two to three short resistance sessions each week to support muscle and metabolic health. If weight changes quickly or occurs alongside raised lipids or glucose, speak with your healthcare team so they can review your regimen and tests.

Gut: comfort first, colour next

Some people may get a queasy stomach in the first weeks of treatment. During this phase, smaller, more frequent meals can be kinder on your stomach. Soft textures also tend to sit well: porridge, ripe bananas, cooked vegetables, yoghurt or kefir if tolerated. Ginger or peppermint may help.

Gentle protein source ideas include scrambled eggs, skyr/yoghurt, silken tofu, soft fish, dhal or lentil soup.

If you have diarrhoea, small sips of fluids, oral rehydration solutions, low‑fat foods, and soluble fibre (oats, bananas) can help. If you are constipated, stay hydrated, increase fibre gradually, and add movement. Once things settle, return to colour and variety.

Gut microbiome research is evolving: evidence suggests that diverse, fibre‑rich plates may support a varied microbiome.

Food safety: when CD4 counts are low

If your CD4+ T‑cell count is very low (severe immunosuppression), your healthcare team may advise stricter food‑safety measures to reduce infection risk.

Examples could include avoiding raw or undercooked meat, poultry, fish and eggs; unpasteurised milk/cheeses; refrigerated smoked fish; pâté; unwashed sprouts and deli meats unless reheated until steaming hot. Fruit and vegetables remain valuable: wash thoroughly and, if advised, peel if eaten raw; choose pasteurised juices. Fermented foods and probiotic supplements may be paused during severe immunosuppression or acute illness; follow your healthcare team’s advice. And if you are not sure about any food, always talk to your healthcare team.

As CD4 counts improve, reintroduce foods as indicated by your healthcare team.

Timing with minerals and antacids

Calcium, iron, magnesium, zinc, multivitamins with minerals and some antacids can reduce the absorption of certain PrEP/TasP medicines. Leave at least a 2-hour gap between them.

Some people find that taking PrEP/TasP at breakfast and supplements at lunch works for them.

People who take PrEP/TasP at night could consider taking supplements in the afternoon to maintain the gap.

Confirm with your healthcare team according to what works best for you.

Supplements and interactions

Some herbal and over‑the‑counter products can interact with PrEP/TasP medicines.

Avoid St John’s wort, which can reduce the effectiveness of prescribed medicines. Other common supplements like ginseng and ginkgo biloba could also impact how these medicines work. Be mindful of high‑dose garlic or turmeric supplements; food forms are fine.

Always check with your GP, healthcare team or pharmacist before starting any new supplement, herbal product, or over‑the‑counter medicine. If unsure, show them the product.

When to check in

If side-effects continue beyond a few weeks, worsen, or you notice swelling, reduced urine, chest pain, shortness of breath or significant fatigue, speak with your healthcare team. Also, check in if you are unsure about supplement timing.

Your healthcare team will likely contact you if your lab results flag bone, kidney or lipid changes. Routine checks are typically every 3–6 months (including renal function, blood lipids, and bone markers) to monitor your health and potential side effects.

Do not change or stop taking prescribed medicines without medical advice.

The big picture

PrEP and TasP work. Side effects may happen. Let nutrition be on your side.

Aim for a colourful plate that includes protein to support your muscles and immune health. If feeling queasy, opt for smaller, more frequent meals and start with softer textures, then gradually return to wholegrains and fibre. Add healthy fats to your mix, keep your fluid intake steady, ensure timing works around your medications and keep in touch with your healthcare team.

All while you continue enjoying the glamour of life.

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