Eating out seduces: The low lights of a restaurant, soft music, the hum of conversation punctuated by bursts of laughter, the titillation of the palate. And the magic: The food materializes as if out of thin air; the dirty dishes disappear. Eating out -- especially for people with HIV who have a diminished interest in food or a sense of taste altered by medications or who simply get too tired to cook interesting meals -- is a ready cure for that aspect of what ails you.
But what we don't see can be harmful. Many foods hold hidden dangers for people with damaged immune systems. As a connoisseur of fine food, I never thought beyond the longing of my taste buds when I ate out -- until I got a three-month bout of Giardia that almost killed me. A water-borne microorganism usually found in streams or wells, my little bug was living in a decidedly urban setting: A restaurant's ice machine. After my near-death experience, I began to consider the blurry line between the benign and the malign for the immune-compromised.
The reasons are simple. In people with healthy immune systems, antibodies in the blood and gut signal immune cells to destroy food-borne bacteria, parasites or other microbes. But in people whose immune systems are besieged, this antibody/immune-cell communication breaks down, leaving the body open to culinary catastrophe. To avoid getting sick, view food you don't prepare yourself like sex with a stranger: Take precautions, then have a wonderful time. People with CD4 counts below 200 are most at risk.
"I adored sushi," says Joel Elkins, a 28-year-old HIV positive Chicago investment counselor. "I really could have eaten it every day. You know how you get hooked on something? For some people it's pasta, for others it's Tex-Mex. For me it was anything raw, riced or rolled." When Elkins landed in the hospital with a fever of 105 degrees and diarrhea, vomiting and other miseries, it never occurred to him that sushi was the culprit. "Who knew you could get amoebic dysentery from food made in America?" he asks.
Eleni Melitas was equally surprised when food from one of her regular hangouts landed her in the hospital for a month. "I'm Greek, my lover is Greek, most of our friends are Greek, we eat Greek," says the 34-year-old HIV positive San Francisco -- based artist. "I could not believe something I had eaten all my life practically killed me." Feta cheese and olive salata turned out to be the source of her Salmonella, a fast-multiplying bacteria that is 20 times more likely to cause disease in people with AIDS than in those with healthy immune systems.
Dr. John Turner, an AIDS specialist at Graduate Hospital in Philadelphia, reports a sharp increase recently in food- and water-borne diseases among his patients with HIV. "Restaurants are regulated by health departments, but that system is far from perfect," he says. "The kitchen at the Four Seasons may be so clean you could do surgery on the counters, but it can still transmit parasites in the water used to prepare raw foods. All it takes is one employee's failure to wash his or her hands." Turner suggests asking questions: "Find out if the food is fresh that day. And use common sense -- if food is sitting out, don't eat it."
Ask this about everything you eat: Where does it come from? Avoid the obvious vectors for microbes such as Shigella, E. coli, Salmonella and the hepatitis viruses. Shellfish is out -- they have been the source of several cholera outbreaks in the Gulf states. Steer clear of anything raw: Steak tartar (raw meat), fresh Caesar salad (raw egg), sushi or seviche (raw fish). Vegetable makis, tempura, flying-fish eggs, shrimp dumpling or grilled eel will quench that desire for Japanese food. Most Italian food is cooked for hours and is safe. But beware desserts: Enjoy a gelato, not tiramisu -- mascarpone cheese has a shady history involving botulism. Always order meat, including chicken and pork, well-done. And of course, the tap water in the tumbler can carry Cryptosporidium.
Excitement for your palate abounds -- within limits. Don't feel you have to deprive yourself while others gorge. Food is one of our most accessible pleasures. Dig into Cajun catfish, spicy paella, steak au poivre. Savor curry, polenta, quiche. Indulge yourself with mud pie, a praline sundae, fresh-fruit cobbler. Think first, then eat. Bon appetit!