Abstracts

AZT

AZT, Folic Acid and Vitamin B12

In studying bone marrow cells from 12 patients it was found that folic acid or vitamin B12 deficient cells had impaired DNA synthesis and were more susceptible to AZT toxicity. It is not known whether folic acid or B12 supplementation can overcome this "AZT inhibition" of DNA synthesis and whether the benefit of such therapy exceeds the risk. Low levels of serum vitamin B12 are a predictor of bone marrow toxicity from AZT. Some of the toxic effects of AZT may be in fact due to vitamin B12 deficiency. It is noted that approximately 2/3 of AIDS patients may be in negative vitamin B12 or folate balance. 6487

"Synergy of Inhibition of DNA Synthesis in Human Bone Marrow by Azidothymidine Plus Deficiency of Folate and/or vitamin B12?"

Cardiac Selenium

Cardiac Selenium

Cardiac status was evaluated on autopsy in eight AIDS patients and it was found that there was a significant reduction in tissue selenium. The authors suggest that cardiomyopathy found in AIDS patients may be due to selenium deficiency which has been associated with dilated congestive cardiomyopathies in China called Keshan disease. In addition to these findings cardiomyopathy has been described in patients on long-term parenteral nutrition who have become selenium deficient, and in a recent uncontrolled study six of eight AIDS patients showed improvement in left ventricular function when oral selenium supplementation was given because of reduced plasma selenium levels. Not only are blood selenium levels low in may AIDS patients but glutathione peroxidase activity as well.

"Reduced Cardiac Selenium Content in Acquired Immunodeficiency Syndrome", Dworkin, Brad M et al, Journal of Parenteral and Enteral Nutrition, November/December 1989;13(6):644-647.

Cofactors

Cofactors - Mycoplasma

Luc Montagnier, M.D. and Robert Gallo, M.D. the "co-discoverers" of AIDS were in Los Angeles, California receiving awards from The American Association of Blood Banks.

Dr. Gallo feels strongly that HIV alone causes AIDS while Dr. Montagnier, from the Pasteur Institute in Paris, France, states that "HIV is necessary but may not be sufficient to cause AIDS" by itself. Cofactors may be needed. Gallo states that a coinfection with the herpes type VI virus or the human T-cell leukemia virus may speed up the progression of HIV to full blown immunosuppression. He states that without the HIV virus, AIDS as a disease would disappear. Montagnier states that antiviral therapies are not curing AIDS and how HIV causes AIDS has never been explained. Mycoplasma pirum may be a driving cofactor in causing immune disintegration according to Montagnier. Montagnier states that possibly a triple approach of antimycoplasma and antibacterial medications, along with antiviral agents and therapies to restore the immune system may be needed. Three mycoplasma species have been found in AIDS patients; mycoplasma fermentans, mycoplasma pirum and mycoplasma genitalium.

The latter two have become very resistant to antibiotics. Four to six kGy of gamma radiation reduces viral replication in T4 lymphocytes with inactivation of mycoplasma. Further studies are needed comparing HIV positive individuals who are asymptomatic with those who have the full blown disease for cofactors. Assays are being developed. 11216

"Cofactor Question Divides Co-Discoverers of HIV", Cotton, Paul, JAMA, December 26, 1990;264(24):3111-3112.

Compound Q

Compound Q

Sixty HIV patients have shown remarkable improvement in CD4 lymphocytes after treatment with compound Q, an underground drug derived from the Chinese cucumber root. The drug is now in phase I clinical trials in five different sites. The 63 patients received monthly infusions of compound Q for about four months. These patients had been taking AZT prior and were followed for a year before compound Q was administered. Originally they had an average daily decline of .35 CD 4 cells daily. In the follow-up after compound Q therapy, they had a daily increase of .67 CD4 cells daily. The dosage was 16-20 mcgs/kg of compound Q monthly. Higher dosages are being used at the 5 sites up to 36 mcg/kg. The cost is $280.00 a month for the drug and the infusion after an initial work-up of $600.00 to $1200.00. Dr. Larry Waites, M.D., a family physician, and Dr. Allen Levin, M.D. an immunologist in San Francisco, are the physicians who have spearheaded the original study. 8971

"Patients Show Significant Improvement With Compound Q", Staver, Sari, American Medical News, June 29, 1990;7.

Photophoresis

Extracorporeal Photopheresis and AIDS Related Complex (ARC)

Five patients with AIDS Related Complex, three homosexual men and one woman and one man with a history of intravenous drug use, were given monthly treatments with extracorporeal photopheresis. Symptoms resolved in four patients and lymphadenopathy disappeared in all five patients. Improvement in four patients in delayed hypersensitivity reactions to skin testing was noted. There were increases in p24 and gp120 antibody levels. CD4-cell percentages increased in four patients and declined in one patient after a six month period. Absolute CD4 counts decreased in two patients. After three months the CD4 percentages increased or remained the same in three patients and decreased in one patient. All were culture positive for HIV before treatment and one patient had a negative viral culture after five months of the treatment. Two others became HIV culture negative at 14 and 15 months respectively.

These results suggest that extracorporeal photopheresis deserves further study as a potential therapy for AIDS-related complex.

"Extracorporeal Photopheresis in the Treatment of AIDS-Related Complex: A Pilot Study", Bisaccia, Emil, M.D., et al, Annals of Internal Medicine, August 15, 1990;113:4:270-275.

Fibrinogen

Fifty-one asymptomatic HIV-1 seropositive individuals, mean age of 31, were evaluated for fibrinogen levels and a negative correlation was found between plasma fibrinogen concentrations and CD4 lymphocyte counts. The authors conclude that high plasma fibrinogen concentrations are correlated with low CD4 lymphocyte counts in HIV-infected individuals.

"Fibrinogen Concentration in Asymptomatic HIV-Infected Individuals", Lefrere, Jean-Jacques, et al, AIDS, 1990;4:1033-1042.

Vitamin Supplements

Contents:
Beta-Carotene
Folate and Vitamin B12
Vitamin B12
Vitamin C
Vitamin D
Vitamins (2)

Folate and Vitamin B12

During a nine month period 74 HIV infected patients between 17-68 years of age were evaluated for folate and vitamin B12. For those not supplemented with folic or folinic acid or taking antifolate drugs, serum and erythrocyte folic acid levels were significantly decreased. Over 50% of the HIV infected patients were deficient in serum and/or erythrocyte folate. For those not supplemented with vitamin B12 the serum plasma vitamin B12 level was significantly reduced. Vitamin B12 deficiency, evidenced by decreased plasma vitamin levels, was present in only 10% of patients. The researchers only found elevated folate levels in vitamin supplemented patients. Folate deficiency in early HIV patients may be due to the fact that neopterin, which is raised in HIV infection from chronic macrophage stimulation, inhibits folate metabolism. Some drugs used in AIDS have antifolate effects. Demyelination can be the result of folate and/or B12 deficiency which may be a cause of the neurologic damage of HIV infection.
Though vitamin B12 deficiency was seen in AIDS patients it was less striking as compared to folate. The authors encourage serum vitamin B12 analysis in HIV infected patients.

"Folate, Vitamin B12, and HIV Infection", Boudes, Pol, et al, The Lancet, June 9, 1990;335:1401-1402.
Neuropsychiatric Disorder and Vitamin B12

Vitamin B12 deficiency may be a cofactor in subtle cognitive changes in HIV-1 infection. Neurologic damage from vitamin B12 deficiency may be due to a methyl group deficiency as a result of the inability to synthesize methionine and S-adenosylmethionine or to homocysteine pileup being toxic to the brain.

Herbert, V: "Vitamin B12 Deficiency Neuropsychiatric Damage in Acquired Immunodeficiency Syndrome." Archives of Neurology, June 1993;50:569.

Herbert, V: "Low Holotranscobalamin II is The Earliest Serum Marker For Subnormal Vitamin B12 (Cobalamin) Absorption in Patients With AIDS. American Journal of Hematology, 1990;34:132-139.

Vitamins (1)

Acquired immune deficiency syndrome (AIDS) is a clinical disorder caused by a retrovirus infection and represents the end point in a progressive sequence of immunosuppressive changes. Vitamins can enhance disease resistance in animals and humans.

This article summarizes the immunological and nutritional modifications caused by AIDS. The effects of murine and human retrovirus infection on vitamin status are analyzed as co-factors in the development of severe immune dysfunction, AIDS.

The properties of immunoenhancing antioxidative vitamins, vitamin A, B6, B12, C, E, and beta-carotene, which are frequently low in AIDS patients, are evaluated relative to the development of immunodeficiency during retrovirus infection. Vitamin A, E, and B12 deficiency accelerated the development of AIDS with low T cells, whereas their normalization retarded the development of immune dysfunction.

The interactions between these vitamins and the immune system in human AIDS patients and animal models of AIDS are reviewed. Our purpose is to provide data on how retrovirus infection can cause nutritional deficiencies that accentuate immune damage and to evaluate the potential therapeutic role of vitamins in the treatment of immune dysfunctions in AIDS patients.

Liang B et al., Vitamins and immunomodulation in AIDS. Nutrition, 1996 Jan, 12:1, 1-7.

Vitamins (2)

A study following 296 well-nourished HIV positive men for 6 years found that less of the people who took the multivitamin supplements developed AIDS compared to those who did not. Iron and vitamin E were particularly protective. Daily use of multivitamins was associated with a 40% reduction in risk of declining CD4 counts. This research was done at the University of California at Berkeley. 18987

Ince, S: "Vitamin Supplements May Help Delay Onset of AIDS." Medical Tribune, September 9, 1993;18.

Vitamin B12, Malabsorption, Intrinsic Factor *

In AIDS patients, low intrinsic factor secretion is common and can contribute to vitamin B12 malabsorption. Regular vitamin B12 supplementation may be warranted in patients with HIV infection.

Herzlich, B. C. et al: "Decreased Intrinsic Factor Secretion in Aids: Relation to Parietal Cell Acid Secretory Capacity and Vitamin B12 Malabsorption." The American Journal of Gastroenterology, 1992; 87(12):1781-1788.

Megadose Vitamin C (50 to 200 gms per day)

The dosages were administered both orally and intravenously. Ascorbate works as a free radical scavenger, destroying free radicals released in the disease state. Dr. Robert Cathcart states if enough ascorbate is given to "neutralize the toxicity" of AIDS, and if secondary infections are treated, the condition will go into remission.

Subjectively, symptoms decrease and increase inversely depending on how closely the patient titrates the vitamin C dosage to bowel tolerance. The ascorbate mixture utilized consisted of 25% buffered ascorbate salts (calcium, magnesium and potassium ascorbate) and 75% ascorbic acid. The mixture was dissolved in a small amount of water and consumed at least every hour. Initially, the usual tolerated amount was 40 to 100 gms per day.

Dosages in excess of 100 gms per day may be necessary with secondary bacterial and viral infections. Intravenous sodium ascorbate buffered to a pH of 7.4 and without preservatives was added to sterile water in a concentration of 60 gms per 500 cc.

If the toxicity of the condition exceeds the ability to take adequate amounts of ascorbate, it may be necessary to scavenge all free radicals created by AIDS and secondary conditions. Patients with small veins may need solutions of 60 gms per liter. This infusion should be given over at least a 3-hour period, but preferably longer. As many as 3 bottles or 180 gms per day may be necessary in acutely ill patients. Dr. Cathcart notes even though patients are receiving intravenous ascorbate they should not discontinue their oral bowel tolerance dosages. Intestinal parasites such as Giardia lamblia and Entamoeba histolytica, candida and food and chemical sensitivities are common among AIDS patients.

Vitamin C reduces AIDS to a significant degree. He emphasizes the absolute necessity of massive doses and the avoidance and treatment of opportunistic infection. Multiple infections, lack of understanding in the use of vitamin C or the inability to tolerate the doses prescribed can result in a poor prognosis. The success of vitamin C treatment depends on the consistent administration of enough vitamin C to neutralize free radicals produced by the various disease states.

"Vitamin C in the Treatment of Acquired Immune Deficiency Syndrome (AIDS)", Cathcart, Robert F., III, Medical Hypotheses, 1984;14:423-433.

Vitamin D

Determined Vitamin D metabolites, immunologic, virologic, clinical parameters and survival time.

Significantly lower serum levels of 1,25-vitamin D (1,25D) were found in symptomatic patients (median, 34 pg/mL; 25th-75th percentile, 21-45) compared with controls (49 pg/mL; 39-59) and asymptomatic patients (45 pg/mL; 42-50).

Subnormal serum concentration of 1,25-vitamin D in human immunodeficiency virus infection: correlation with degree of immune deficiency and survival. Haug-C; Muller-F; Aukrust-P; Froland-SS. J-Infect-Dis. 1994 Apr; 169(4): 889-93.

Garlic

Ten AIDS patients with decreased natural killer cells were given five gm/d of garlic extract for six weeks and for the subsequent six weeks 10 gm/d. Three patients dropped out of the study due to side effects. three patients died within the experimental period. After six weeks 6 of 7 patients had normalized natural killer cell activity and 4 of 7 had improved helper/suppressor ratios.

Associated symptoms of diarrhea, genital herpes, candidiasis and pansinusitis with recurrent fever improved. The pathogen that was believed to be the cause of the diarrhea was cryptosporidia. The patient with pansinusitis had been on antibiotics for over a year without response. One patient's platelet count increased from 103,000 to 280,000 after four months.

Garlic includes germanium, magnesium, selenium, amino acids, sulfur compounds, vitamin A, B1 and C. Further study is encouraged on garlic's immune enhancing effects.

"Enhancement of Natural Killer Cell Activity in AIDS With Garlic", Abdullah, T.H., et al, Deutsche Zeitschrift Fur Onkologie, 1989; 21:52-53.

Gluten

Gluten-Free Diet For Enteropathy

AIDS associated enteropathy is related to infection and the occurrence of profound diarrhea for 30 or more days resulting in villous atrophy, cryptic changes, reduced mitoses and malabsorption. These histologic changes are similar to those in celiac disease. One case study of an individual who was treated on a gluten-free diet resulted in a dramatic reduction in bowel movements from 11 or 12 to 2 or 3 per day. This finding was followed up by 9 more patients with AIDS-associated enteropathy who were placed on a gluten-free diet. There was a remarkable decrease in abdominal cramping and frequency of bowel movements without antidiarrheal agents. The authors' experiences extended to 30 patients. 93% of these had beneficial effects on the gluten-free diet. There is a suggestion that some viruses may be involved in certain steps of the pathogenesis of celiac disease.

The authors feel that HIV-I infection of the enterocytes, or the immune responses to the virus, may be a triggering mechanism for the expression of celiac disease. The authors encourage a trial of a gluten-free diet in AIDS related diarrhea.

"Gluten-Free Diet For AIDS-Associated Enteropathy", Ruiz-Arguelles, Guillermo J., M.D., et al, Annals of Internal Medicine, November 15, 1990;113(10):806.

Condom

HIV and Condom Use

This article states there is no proof that condom use protects against sexually transmitted diseases. Recent studies on HIV prevention have shown that condom use, as a reliable protective agent against HIV, is a dangerous illusion. Risk in these studies were 13% and 27%. 9369

"Condoms Against HIV Infection", April, K. and Schreiner, W., Schweiz. Med. Wschr., 1990;120(26):972-978.

Kemron

One in 14 individuals in Kinshasas, Zaire, Africa has AIDS. Health professionals in Africa are becoming more outspoken about the seriousness of the AIDS issue. Kenyan researchers state that a cheap form of oral interferon (Kemron) has been used with evidence of "deseroconvertion".

U.S. officials are skeptical regarding trials at the Kenya Medical Research Institute in Nairobi of 204 HIV-positive patients. Most patients were reported to have an increased elevations of CD4 lymphocytes and 18 patients have deseroconverted. In another potentially startling discovery, Robert Gallo from the NCI reported that Giardia lamblia may be an intestinal parasite capable of transmitting HIV in the laboratory. If this were the case, the AIDS virus could actually be transmitted through drinking water. 10826

"Zaire's Doctors Take The Initiative on AIDS", Brown, Phyllida, New Scientist, October 27, 1990;16.

Mycoplasm

Mycoplasma Cofactors

This work showed the progression of HIV on cell lines could be reduced with antibiotics such as tetracyclines or fluoroquinolones which have activity against mycoplasma contamination of these cells. This finding has provoked the possibility that there is a cofactor(s) in the pathogenesis of AIDS. These researchers have isolated mycoplasma pirum, fermentans and genitalium from AIDS patients. Viral replication could be inhibited by an antiserum to M. genitalium binding site. The preimmune rabbit serum had no effect. The authors conclude that some mycoplasma species may have an important role in HIV replication and pathogenicity.

"Inhibition of HIV Prototype Strains Infectivity by Antibodies Directed Against a Peptidic Sequence of Mycoplasma", Montagnier, Luc, et al, C.R. Acad. Sci. Paris, 1990;311(3):425-430.

Nutrition & AIDS

Contents:
Arginine
Nutritional benefits
Nutritional Deficiency
Nutritional intervention (2)
Nutritional support (2)
Pentamidine and Hypomagnesemia

Arginine

Large doses of L-arginine have improved immune function both in-vivo and in-vitro. However, large doses do not increase HIV gene expression in-vitro. With its very low toxicity, it may be a good new therapeutic approach to HIV infection

Arginine, up to 30 gms per day, has been given to humans without side effects. It is also noted that L-arginine is inexpensive, stable and easy to administer. L-arginine can be used alone or, in combination, with anti-retroviral nucleoside analogues in HIV.

Wrightham, M.N., et al: "L-Arginine: A Therapeutic Option For AIDS/HIV Infection?" Medical Hypothesis, 1992;38:236-239.

Nutritional benefits

Patients with ARC and AIDS develop a variety of symptoms that significantly affect their nutritional status. Podiatrists, although not directly involved with the intricacies of the nutritional management of people with AIDS, should be aware of the effect of the virus on the human body.

Investigators are predicting that almost 100% of the estimated 12 million HIV-positive persons in the world will develop AIDS. By giving people with AIDS nutritional education, not only may there be a beneficial response in respect to treatment but it may enhance an individual's quality of life and positive self-image.

Solomon NS & Lyden CR: Nutrition for the patient with acquired immunodeficiency syndrome. Clin Podiatr Med Surg, 1992 Oct, 9:4, 873-81.

Nutritional Deficiency

Low levels of zinc have been suggested as a marker for progression of HIV infection. B6 supplementation in cases of frank deficiency may raise CD4 levels. Borderline deficiencies of vitamins B6 and B12 have been seen in asymptomatic HIV seropositive patients. Other nutrients which have been found to be deficient are vitamins A and B1 in AIDS or ARC patients. Another study showed 25% of HIV infected patients had deficiencies of either ascorbate (vitamin C), carotenes, choline or zinc with over 10% having deficiencies in vitamin A, B6 and E. The author states physicians caring for HIV infected patients should look for vitamin deficiencies, especially from vitamins B6 and B12. Further research in the area is recommended.

"Nutritional Deficiency and AIDS", Letter to the Editor, Coodley, Gregg, M.D., Annals of Internal Medicine, November 15, 1990;113 (10):807.

Nutritional intervention (1)

Nutrition is a fundamental intervention in the early and ongoing treatment of human immunodeficiency virus (HIV) disease.

Nutrition therapy, in coordination with other medical interventions, can extend and improve the quality and quantity of life in individuals infected with HIV and living with acquired immune deficiency syndrome (AIDS). The current literature and practice for nutrition use in the treatment of patients with HIV and AIDS is reviewed.

Elbein RC: Nutrition and HIV infection. A continuum of care. J Am Podiatr Med Assoc, 1995 Aug, 85:8, 434-8.

Nutrition intervention (2)

The goals of medical nutrition therapy in HIV disease include early assessment and treatment of nutrient deficiencies, maintenance and restoration of lean body mass, and support for activities of daily living and quality of life. The maintenance and restoration of nutritional stores are closely interrelated and interdependent with each of the other recommended medical therapies. Therefore, it is vital to the health of persons with HIV/AIDS to have access to the services of a registered dietitian, who is the essential member of the health care team for providing medical nutrition, therapy.

The registered dietitian should take an active role in developing nutrition care protocols for HIV/AIDS in their practice setting. Dietetics professionals must take responsibility for obtaining and maintaining current knowledge in this area and should take the lead in translating current knowledge and research into practical and realistic nutrition guidelines for persons with HIV/AIDS.

Further research is needed in the area of HIV/AIDS and nutrition.

Anonymous: Position of the American Dietetic Association and the Canadian Dietetic Association: nutrition intervention in the care of persons with human immunodeficiency virus infection [published erratum appears in J Am Diet Assoc 1994 Nov;94(11):1254]. J Am Diet Assoc, 1994 Sep, 94:9, 1042-5.

Nutritional support

The acquired immunodeficiency syndrome and (human immunodeficiency virus) infection loom as our major public health priorities for at least the next two decades. Despite the recent exciting early development of vaccines and newer drug therapies, we are all faced with a reservoir of almost one-quarter million cases in the United States and several times that worldwide.

Since the vast majority of HIV-infected patients develop AIDS, which is a chronic progressive disease that produces gastrointestinal dysfunction and wasting, development of rational strategies for nutritional support of these patients should also be a high priority.

Aron JM: Toward rational nutritional support of the human immunodeficiency virus-infected patient [editorial]. JPEN J Parenter Enteral Nutr, 1991 Mar-Apr, 15:2, 121-2.

Nutrition support (2)

A series of 55 patients with AIDS and opportunistic infections were admitted a total of 75 times to Robert Wood Johnson University Hospital over a 4-year period, and supplemental nutrition support--intravenous (IV), enteral, or both--was given during 32 of these admissions. Use of nutrition support was correlated retrospectively with pretreatment nutritional status, length of hospital stay (LOS), and survival and was found to be positively correlated with weight loss greater than or equal to 10% or weight less than or equal to 90% of ideal body weight (p less than 0.001), admission hemoglobin less than or equal to 10g (p less than 0.001), and LOS less than or equal to 21 days (p less than or equal to 0.003).

Nutrition support intervention did not correlate with survival, admission total lymphocyte count (TLC), or serum albumin level.

Survival was negatively correlated with LOS and continuous daily fever for greater than or equal to 6 days.

Survival was also significantly lower in patients who received IV rather than enteral nutrition support. Weight loss, admission TLC, albumin, and hemoglobin levels did not correlate with survival.

These results suggest that nutrition support generally was given to the sickest patients with AIDS. There was no measurable benefit associated with use of supplemental nutritional support in this series. Properly designed trials will be necessary to define the optimum route, timing, and type of nutritional support for patients with AIDS.

Brolin RE et al., Use of nutrition support in patients with AIDS: a four-year retrospective review. Nutrition, 1991 Jan-Feb, 7:1, 19-22.

Nutrients

Recent studies indicate that multiple nutritional abnormalities occur relatively early in the course of human immunodeficiency virus (HIV-1) infection. Decreased plasma levels of vitamins B6, B12, A, and E and zinc have been correlated with dietary intake and associated with significant alterations in immune response and cognitive function.

To achieve normal plasma nutrient values, the HIV+ men appeared to require intake in multiples of the recommended dietary allowance (RDA) for vitamins A, E, B6, and B12 and zinc. For the HIV+ men, a relatively high proportion of biochemical deficiency was associated with consumption of vitamin B6 and zinc at the RDA level.

Inadequate dietary intake and altered nutrition status in early HIV-1 infection. Baum-M et al., Nutrition. 1994 Jan-Feb; 10(1): 16-20.

Pentamidine and Hypomagnesemia

Pentamidine isethionate treats several infections, including pneumocystis carinii pneumonia, which is important for AIDS patients. This was a case study of a 26 year old homosexual AIDS patient admitted for fevers and night sweats, who had already been treated for a multitude of infectious diseases, and was found to have pneumocystis carinii. He was started on pentamidine 4 mg/kg/day intravenously for 10 days with a total dose of 2.8 gm. He also received clindamycin, pyrimethamine and leucovorin. On the 10th day of treatment the patient developed a sudden onset of muscle weakness with positive Chostvok's and Trousseau's signs and was found to have a serum calcium of 5.3 mg/dl and magnesium at .5 mg/dl. The patient received 2 gm of calcium gluconate and 10 gm of magnesium sulfate intravenously with symptomatic relief.

Additional oral supplementation of calcium carbonate at 1 to 2.6 gm/d was given and the patient continued with large doses of magnesium sulfate 3 to 10 gm daily for the next two weeks. The pentamidine therapy was discontinued after ten days because of acute renal failure. The hypomagnesemia appeared to be from renal wasting. The author concludes patients with AIDS may be susceptible to magnesium depletion due to malnutrition, gastrointestinal magnesium loss and, with the addition of pentamidine, the risk of hypomagnesemia is great. They also suggest patients on pentamidine be monitored for hypomagnesemia and hypalcemia.

"Symptomatic Hypocalcemia and Hypomagnesemia With Renal Magnesium Wasting Associated with Pentamidine Therapy in a Patient With AIDS", Shah, Gaurang M., M.D., et al, The American Journal of Medicine, September 1990;89:380-382.

Smoking

Cigarette smoking may speed the progression to AIDS in some HIV infected people according to scientists from Harvard and U.C. Berkeley studying 387 HIV-infected men, some who were asymptomatic and some who had ARC. In this 56 month observation period cigarette smokers had twice the likelihood of developing AIDS than nonsmokers. Smokers with HIV infection suffer a more rapid depletion of CD4 cells than do infected nonsmokers. 9154

"Smoking May Hasten AIDS Development", New Scientist, July 7, 1990;15.

Sports Injury

Sports Injury Transmission

This is a case study of the alleged transmission of the AIDS virus from a 25 year old man who collided with a player during a football match who was a drug abuser and HIV-1 seropositive. There were severe skin wounds of the eyebrows with profuse bleeding. One month later this person who was seronegative one year earlier developed mononucleosis-like symptoms and one month later HIV-1 antibodies were found. He had no risk factors. Because of the absence of other risk factors this case suggests HIV-1 infection may be passed on by traumatic contact from a seropositive man.

"Transmission of HIV-1 Infection Via Sports Injury", Torrie, Donato, et al, The Lancet, May 5, 1990;1105. (Address: Donato Torrie, Division of Infectious Diseases, Regional Hospital, E. and S. Macchi Foundation, 2100 Varese, Italy)

Antioxidants & AIDS

Antioxidants and N-Acetylcysteine

Reports at the ninth International Conference on AIDS in Berlin, Germany, found early AZT confers no clear survival benefit. Dr. Luc Montagnier, of the Pasteur Institute, states mycoplasma may play a role in signaling lymph nodes to start the integration of the virus into cells where they can then replicate. Dr. Anthony Fauci, director of The National Institute of Allergy and Infectious Disease, states HIV is a multifactorial process in which various phases overlap. The virus load in the lymph nodes seems to be a critical factor in the evolution of the disease. Dr. Montagnier encourages looking for mycoplasma in organs other than the lymph nodes. Stronger antibiotics or combinations of antibiotics may be needed to inhibit the infectious process. Antioxidants such as N-acetylcysteine can prevent apoptosis, which programs cell death. Oxidative stress can mediate apoptosis. In HIV infection, apoptosis is a permanent and chronic situation.

Dr. Montagnier is planning trials with other antioxidants to see if they help prevent apoptosis when combined with antiretroviral drugs. He stated it would not be a bad idea in HIV infected patients to take antioxidants.

"HIV Pioneer Eyes Antioxidants", McKeown, L.A., Medical Tribune, June 24, 1993;34(12):1,8.


Antioxidants, Phytopharmaceuticals and Reactive Oxygen Species

Reactive oxygen species are known to be involved in the disease process of AIDS (as well as: inflammatory disease, degenerative neurologic disease, atherosclerosis, myocardial damage, ageing and chronic respiratory disease). It can result from radiation and chemotherapy.

The immune response resulting in the release of the tumor necrosis factor can cause macrophages to increase their release of oxygen free radicals. In HIV infection, the altered immune system has difficulty reacting to the increased free radical oxygen release. There is an overall antioxidant deficiency in HIV infection due to impaired scavenging systems and altered structure and function of the alimentary tract (e.g. achlorhydria, malabsorption, loss of mucosal integrity and loss of appetite secondary to chronic nutritional deficiencies.

In preliminary work, the antioxidants vitamin A and C have shown efficacy in HIV infection. N-acetylcysteine can increase glutathione levels and decrease viral replication. Thiols pretreatment of cell cultures can result in cessation of viral protein production

Phytopharmaceuticals are an important source of antioxidant compounds. Plant elements with antioxidant activity include enzymes like catalases, peroxidases and superoxide dismutase. Carotenoids are some of the most studied plant derived products having antioxidant capability. Vitamin C, glycosides and phospholipids have additional antioxidant protection. These phytopharmaceuticals may have benefit in HIV due to the antioxidant enzyme systems acting directly to alter viral.

"The Role of Reactive Oxygen Species, Antioxidants and Phytopharmaceuticals in Human Immunodeficiency Virus Activity", Greenspan, H.C., Medical Hypotheses, 1993;40:85-92.

Immunity

Malnutrition & AIDS

Contents:
GI problems
Malnutrition (3)
Nutrition and Early HIV
Wasting (4)

GI problems

There is a complex relationship between malnutrition and immune function. Patients with chronic immunological disorders often become malnourished , while, macronutrient deficiencies are associated with the development of immunological deficiencies which reverse on nutritional repletion.

Deficiencies of macronutrients lead to diminished function of T and B lymphocytes in all patients, irrespective of HIV status. Lymphopenia is a characteristic finding in malnourished patients and includes loss of helper lymphocytes (CD4

Because of the complex nature of the human immunodeficiency virus (HIV), a multidisciplinary team approach is essential.

Gastrointestinal problems in patients with AIDS. Winson-G. Nurs-Times. 1994 Jun 22-28; 90(25): 36-9.

Malnutrition (1)

Studies of body composition in acquired immunodeficiency syndrome (AIDS) patients demonstrated body cell mass depletion out of proportion to losses of body weight or fat. The timing of death from wasting was related to the extent rather than the specific cause. However, some patients remain stable for indefinite periods, indicating that wasting is not a constant phenomenon. The development of malnutrition is multifactorial and includes disorders of food intake, nutrient absorption and intermediary metabolism. Nutritional repletion has been demonstrated in several studies.

The effect of treating infections that promote wasting was shown in a study of ganciclovir therapy for cytomegalovirus colitis, in which untreated patients underwent progressive wasting whereas treated patients repleted body mass.

Total parenteral nutrition had a variable effect upon body composition, with repletion occurring in patients with eating disorders or malabsorption syndromes and progressive depletion occurring in patients with serious systemic infections.

Enteral nutrition also can replete body mass in AIDS patients without severe malabsorption. Pharmacologic stimulation of appetite also may lead to weight gain.

Nutritional support can improve nutritional status in properly selected AIDS patients.

Kotler DP: Nutritional effects and support in the patient with acquired immunodeficiency syndrome. J Nutr, 1992 Mar, 122:3 Suppl, 723-7.

Malnutrition (2)

The acquired immunodeficiency syndrome (AIDS) is a complex disease; its manifestations include many opportunistic infections that lead to conditions causing severe malnutrition. Overcoming malnutrition can help AIDS patients increase their weight, improve their self-image, and enhance the quality of their lives.

Thirty-eight dietitians who work with AIDS patients in New York City were surveyed to determine whether their facilities followed 40 suggested guidelines for the assessment and treatment of malnutrition in AIDS. Thirty dietitians (80%) reported that their facilities followed more than half of the suggested guidelines.

Persons with AIDS are at high risk for nutrition-related disorders. Practitioners need to know and apply nutrition care guidelines suggested in the literature to improve the quality of care for this growing population.

Charny A & Ludman EK: Treating malnutrition in AIDS: comparison of dietitians' practices and nutrition care guidelines. J Am Diet Assoc, 1991 Oct, 91:10, 1273-4, 1277.

Malnutrition (3)

Malnutrition is an important consequence of infection with the human immunodeficiency virus (HIV); involuntary weight loss greater than 10% is one criterion that the Centers for Disease Control and Prevention uses for the diagnosis of acquired immunodeficiency syndrome (AIDS). .

(63%) in the intervention group maintained or gained weight compared with 32 subjects (42%), in the nonintervention group.

The results of this study suggest that nutrition intervention in HIV-infected persons can improve nutritional status and may lead to an enhanced ability to fight infection.

Improved body weight status as a result of nutrition intervention in adult, HIV-positive outpatients. McKinley-MJ; Goodman-Block-J; Lesser-ML; Salbe-AD. J-Am-Diet-Assoc. 1994 Sep; 94(9): 1014-7.

Nutrition and Early HIV

Marked malnutrition and wasting have been associated with end-stage AIDS. In both AIDS and protein calorie malnutrition, profound immune dysregulation can affect the CD4 (T4) lymphocytes and their central role in immune regulation. Along with protein energy malnutrition, the most frequently documented nutritional deficiencies in AIDS patients are vitamins B1, B12, folic acid and the minerals selenium and zinc.

Nutrient deficiencies include:

Vitamin A levels were significantly lower in the HIV seropositive subjects than the HIV seronegative subjects.

Water-soluble vitamins: one study showed the nutrients most frequently found to be low in the plasma of HIV positive individuals were vitamin B6 in 53%, vitamin B12 in 23%, and vitamin B2 in 26%.

Among HIV infected subjects, those with vitamin B6 deficiency had significantly poorer functional immunity, documented by impaired response to mitogens and depressed natural killer cell activity. This suggests that vitamin B6 may not be the underlying cause, but may contribute to the degree of immunodeficiency in HIV infected patients.

The water soluble vitamins appear to be crucial for maintenance of neuropsychological capabilities. Vitamin C deficiency: 10%. Twenty-seven percent of HIV seropositive subjects were Vitamin E deficient: 27%.

In review, nutrients most commonly low in HIV infected individuals are: vitamins A, B2, B6, B12, E and the minerals zinc, copper and selenium. There is a need for well defined nutrition intervention trials, evaluating nutritional supplementation's effect on immune function, neuropsychological function and overall disease progression, in HIV infected patients.

Beach, R. S. et al: "N utritional Aspects of Early HIV Infection." Nutrition and Immunology, 1992;2;241-253.

Wasting (1)

Several factors contribute to malnutrition during HIV infection: hypermetabolism, inadequate intake, and malabsorption.

Nutrition interventions for the HIV positive client. Merrill-A. Home-Healthc-Nurse. 1994 Mar-Apr; 12(2): 35-8.

Wasting (2)

Wasting may not be an inevitable consequence of HIV infection but may be a consequence of multiple nutritional insults that are additive without periods of replenishment in between.

Mortality is closely related to weight loss. Malnutrition may be a result of decreased intake, malabsorption, altered metabolism, or any combination of the three. Nutritional supplementation to enhance the immune system or manipulate metabolism may be adjunctive to the above strategies.

Early intervention and attention to nutritional status may have long-term benefits to patients with this disease.

Nutritional aspects of HIV infection. Nerad-JL; Gorbach-SL. Infect-Dis-Clin-North-Am. 1994 Jun; 8(2): 499-515.

Wasting (3)

Malnutrition and wasting are common in patients with HIV infection. Nutritional needs vary with the stage of HIV disease. Severe weight loss is associated with increased mortality in patients with AIDS and is multifactorial in development.

Possible causes of weight loss include decreased food intake due to oral or GI pathology or anorexia, nutrient malabsorption, and systemic infections. The value of nutritional pharmacology with supraphysiological doses of micronutrients has not been established.

Wasting syndrome: nutritional support in HIV infection. Kotler-DP. AIDS-Res-Hum-Retroviruses. 1994 Aug; 10(8): 931-4.

Wasting (4)

Studies demonstrate that poor nutritional status and infection affect the immune system and interact with each other. This leads to opportunistic infections and malignancies, which may result in a diagnosis of acquired immunodeficiency syndrome. Moreover, evidence from our review indicates that nutritional status may play a role in HIV disease progression. We recommend that clinical trials be conducted to evaluate general malnutrition and the efficacy of supplementation with specific nutrients at various stages of HIV disease.

Nutrition: a cofactor in HIV disease. Timbo-BB; Tollefson-L. J-Am-Diet-Assoc. 1994 Sep; 94(9): 1018-22.

Complementary

People with HIV/AIDS are using complementary and alternative medicine (CAM) to improve general health, prevent opportunistic infections, treat symptoms, and reduce side effects from biomedical treatments.

This paper reviews the research and narrative literature on CAM use in people with HIV/AIDS and covers:
(1) nutrition;
(2) exercise;
(3) traditional and ethno-medicine;
(4) miscellaneous products; and
(5) psychosocial interventions.

MacIntyre RC & Holzemer WL: Complementary and alternative medicine and HIV/AIDS. Part II: Selected literature review. J Assoc Nurses AIDS Care, 1997 Mar-Apr, 8:2, 25-38.

Malabsorption

To compare two enteral formulas, differing only in fat source, for product acceptance, tolerance, and effect on fat malabsorption and nutritional status in subjects with acquired immune deficiency syndrome (AIDS).

After 3 days of consuming a controlled, solid food diet containing 100 g fat per day from mixed sources to document fat malabsorption, subjects were randomly assigned to one of two groups. Each group received a liquid formula containing 35% of energy as fat for 12 days. One group received a formula containing 85% medium-chain triglycerides (MCTs) and the control group received a formula containing 100% long-chain triglycerides

Within-group comparisons indicated that subjects fed the MCT formula showed significantly decreased stool fat and stool nitrogen content and increased fat absorption, whereas those fed the control formula did not.

Subjects consuming the MCT formula also tended to have a decreased number of bowel movements and abdominal symptoms, whereas subjects fed the control formula showed no improvement. All subjects maintained their body weights.

There may be advantages to using an MCT-based formula in the treatment of AIDS-associated malabsorption.

Craig GB et al., Decreased fat and nitrogen losses in patients with AIDS receiving medium-chain-triglyceride-enriched formula vs those receiving long-chain-triglyceride-containing formula. J Am Diet Assoc, 1997 Jun, 97:6, 605-11.

1990 projection

There is no evidence that the AIDS epidemic is going away according to the National Academy of Sciences. It is hitting populations that have not received much attention such as women, younger gay men and partners of drug users. AIDS will be more prevalent in those who use crack and alcohol as well. At the Sixth International Conference in San Francisco it was noted that there is a rise of HIV infection among adolescents and an increase in infected women both from intravenous drug use and sexual intercourse.

"AIDS 1990: New Danger", Medical Tribune, July 12, 1990;6. (Address: Medical Tribune, 257 Park Avenue South, New York, New York 10010, U.S.A.)

Children

Growth

Malnutrition and growth failure are frequent clinical consequences of human immunodeficiency virus (HIV) infection in children. Tube feeding is a means by which to increase the enteral intake of nutrients.

Tube feeding resulted in significantly increased weight for age, weight for and arm fat area. However, it did not result in significant changes in height for age, or arm muscle area.

Tube feedings effectively increased the weight of HIV-infected children in this study, but they were not sufficient to correct linear growth deficits.

Effect of enteral tube feeding on growth of children with symptomatic human immunodeficiency virus infection. Henderson-RA; Saavedra-JM; Perman-JA; Hutton-N; Livingston-RA; Yolken-RH. J-Pediatr-Gastroenterol-Nutr. 1994 May; 18(4): 429-34.

Nutritional support in children with HIV: some answers, many questions [editorial]. Simpser-E. J-Pediatr-Gastroenterol-Nutr. 1994 May; 18(4): 426-8.

Dentistry

Transmission During Dental Procedure

Cover-up?

This article reconsiders the murder theory regarding the transmission of the human immunodeficiency virus (HIV) from Dr David J. Acer to at least six dental patients which was initially dismissed by American investigators from the Centers for Disease Control and Prevention (CDC) and Florida Health and Rehabilitative Service Department (HRS). In the light of withheld behavioural evidence from medical records, legal testimonies, and personal interviews obtained during the investigation, the information presented here strongly supports the conclusion that these transmissions were most likely intended by the dentist to execute a political and social vendetta.

Horowitz LG: Tetrahedron, Inc., Rockport, Massachusetts. Murder and cover-up could explain the Florida dental AIDS mystery. British Dental Journal 1994 Dec 10-24;177(11-12):423-7.

Transmission (Britain)

Over 19,000 patients treated by 57 HIV-infected health care workers (HCWs) have been tested for HIV. Apart from the notorious Florida dental case, no patient has been shown to be infected by treatment given by an HIV-infected HCW. Cases of 10 HIV-infected HCWs have been examined in some depth. The evidence indicates that HIV transmission from HCWs to patient is exceedingly improbable, and almost impossible where recommended infection control procedures are adhered to.

Scully C & Porter SR: Centre for the Study of Oral Disease, University of Bristol Dental School.

Can HIV be transmitted from dental personnel to patients by dentistry? British Dental Journal 1993 Nov 20;175(10):381-2.

There is compelling evidence that six patients of a Florida dentist. were infected with HIV at the dental practice. The strain of HIV in the dentist and patients was virtually identical. There is no evidence that either lapses in infection control or deliberate attempts to infect patients were responsible for this cluster of cases. Recent media analyses have emphasised that handpieces should be taken seriously as a potential source of cross infection but no evidence is available to confirm this as the route in the Florida practice. The unusual circumstances leading up to the detection of this cluster suggest that there could be other undetected cases and clusters.

Robinson P & Challacombe S: Department of Oral Medicine and Pathology, UMDS. Transmission of HIV in a dental practice--the facts. British Dental Journal 1993 Nov 20;175(10):383-4.

Vitamin A

Beta-Carotene and Helper Cells

HIV infected patients were given either 180 mgs per day of beta-carotene, or a placebo for 4 weeks. This was followed by 4 weeks of the opposite therapy. Blood samples were taken after 2, 4, 6 and 8 weeks. CD4 helper cells in some individuals improved after 4 weeks. The people on beta-carotene had average elevations in their CD4 cells of approximately 17%. Total white blood cell counts also increased on beta-carotene, but not placebo. There were no side effects of the vitamin therapy, and no one died. Beta-carotene supplemented, HIV infected patients may not be as susceptible to opportunistic infection. The progression of HIV to full blown AIDS may even be delayed.

McKeown, L. A.: "Beta-Carotene Lifts CD4 Counts: At Dose of 180 mg, Study Found 17% Increase in HIV-Infected People," Medical Tribune, February 25, 1993;4(34):1.

Vitamin A and HIV Infection

More than 15% of the HIV-1 positive subjects had plasma vitamin A levels less than 1.05 umol (consistent with a vitamin A deficiency). The HIV-1 seropositive individuals had lower mean plasma vitamin A levels than the HIV-1-seronegative individuals. Vitamin A deficiency was associated with lower CD4 (helper cells) levels among both seronegative and seropositive individuals. In the HIV-1-seropositive patients, vitamin A deficiency was associated with increased mortality. The authors conclude vitamin A deficiency appears to be an important risk factor for disease progression in HIV-1 infection.

Semba, R. D et al.: "Increased Mortality Associated with Vitamin A Deficiency During Human Immunodeficiency Virus Type I Infection." Archives of Internal Medicine, September 27, 1993;153:2149-2154.

Vitamin A deficiency (HIV)

Investigated whether hormonal contraceptive use, vitamin A deficiency, and other variables were risk factors for cervical and vaginal shedding of HIV-infected cells.

After adjustment for CD4 count, cervical proviral shedding was significantly associated with use of depot medroxyprogesterone acetate, and with use of low-dose and high-dose oral contraceptive pills.

Vitamin A deficiency was highly predictive of vaginal HIV-1 DNA shedding.

Mostad SB et al., Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina. Lancet, 1997 Sep, 350:9082, 922-7.

Phytochemicals

Plant-derived compounds

Many compounds of plant origin have been identified that inhibit different stages in the replication cycle of human immunodeficiency virus (HIV):

1) virus adsorption: chromone alkaloids (schumannificine), isoquinoline alkaloids (michellamines), sulphated polysaccharides and polyphenolics, flavonoids, coumarins (glycocoumarin, licopyranocoumarin) phenolics (caffeic acid derivatives, galloyl acid derivatives, catechinic acid derivatives), tannins and triterpenes (glycyrrhizin and analogues, soyasaponin and analogues);

2) virus-cell fusion: lectins (mannose- and N-acetylglucosamine-specific) and triterpenes (betulinic acid and analogues);

3) reverse transcription; alkaloids (benzophenanthridines, protoberberines, isoquinolines, quinolines), coumarins (calanolides and analogues), flavonoids, phloroglucinols, lactones (protolichesterinic acid), tannins, iridoids (fulvoplumierin) and triterpenes;

4) integration: coumarins (3-substituted-4-hydroxycoumarins), depsidones, O-caffeoyl derivatives, lignans (arctigenin and analogues) and phenolics (curcumin);

5) translation: single chain ribosome inactivating proteins (SCRIP's);

6) proteolytic cleavage (protease inhibition): saponins (ursolic and maslinic acids), xanthones (mangostin and analogues) and coumarins;

7) glycosylation: alkaloids including indolizidines (castanospermine and analogues), piperidines (1-deoxynojirimicin and analogues) and pyrrolizidines (australine and analogues);

8) assembly/release: naphthodianthrones (hypericin and pseudohypericin), photosensitisers (terthiophenes and furoisocoumarins) and phospholipids.

The target of action of several anti-HIV substances including alkaloids (O-demethyl-buchenavianine, papaverine), polysaccharides (acemannan), lignans (intheriotherins, schisantherin), phenolics (gossypol, lignins, catechol dimers such as peltatols, naphthoquinones such as conocurvone) and saponins (celasdin B, Gleditsia and Gymnocladus saponins), has not been elucidated or does not fit in the proposed scheme. Only a very few of these plant-derived anti-HIV products have been used in a limited number of patients suffering from AIDS viz. glycyrrhizin, papaverine, trichosanthin, castanospermine, N-butyl-1-deoxynojirimicin and acemannan.

Vlietinck AJ et al., Plant-derived leading compounds for chemotherapy of human immunodeficiency virus (HIV) infection. Planta Med, 1998 Mar, 64:2, 97-109.

European Mistletoe

European mistletoe (Viscum album L)

An extract from Viscum album can be given safely to HIV-positive and healthy individuals in subcutaneous doses of 0.01 mg to 10 mg twice weekly, according to this dose-escalating study conducted on 32 HIV-positive patients and 9 healthy subjects. While no severe side effects were found, the lower dose range resulted in some side effects, mainly in the HIV-positive group. Side effects included flu-like symptoms, and exacerbation of gingivitis, fever, and eosinophilia.

Gorter RW, van Wely M, Reif M, Stoss M: Tolerability of an extract of European mistletoe among immunocompromised and healthy individuals, Altern Ther Health Med 1999 Nov;5(6):37-44, 47-8

European mistletoe and Immune function

Specific European mistletoe extracts (non-viscotoxin, non-mistletoe lectin from the whole plant extract) activate granulocytes, a component of the immune system, according to this study conducted in vitro on neutrophils from healthy donors. When the cells were co-incubated with viscotoxin and mistletoe lectin, the granulocyte response was further intensified, indicating that the whole plant extract and viscotoxin may stimulate different activation pathways.

Stein GM, Pfuller U, Schietzel M: Viscotoxin-free aqueous extracts from European mistletoe (Viscum album L.) stimulate activity of human granulocytes, Anticancer Res 1999 Jul-Aug;19(4B):2925-8

Phytosterols

Phytosterols

Phytosterols found in plant-based food products, may increase the immune response by improving the activity of T-helper lympocytes, which play a role in all functions of the specific immune response. Phytosterols also seem to reduce the antibody response, which may be useful in hypersensitivity reactions. This aspect of phytosterol action deserves further research for use in immune disorders, like HIV and allergies.

Bouic PJ, Lamprecht JH: Plant sterols and sterolins: a review of their immune-modulating properties, Altern Med Rev 1999 Jun;4(3):170-7

Selenium & AIDS

Selenium & AIDS

Selenium, a powerful antioxidant, may actually help HIV particles to replicate and survive within the body, making HIV more harmful (pathogenic). Many HIV patients using injection drugs may be deficient in certain key antioxidant nutrients, including selenium, leading to further immune suppression. But biochemical analysis of HIV-1 indicates the presence of viral "selenoproteins" - proteins that require selenium - on the HIV cell envelope. These proteins may help to inhibit certain apoptosis (programmed cell death) mechanisms initiated by the host (infected person). In this manner, HIV may use host selenium for its own survival.

Taylor EW, et al: Nutrition, HIV, and drug abuse: the molecular basis of a unique role for selenium, J Acquir Immune Defic Syndr 2000 Oct 1;25 Suppl 1:S53-61