AIDS Treatment News #158, September 4, 1992
Jason Heyman

The oral session, "HIV and Nutrition," moderated by Elinor Levy, M. D., of the Boston University School of Medicine, included presentations by three clinical researchers and by Rainy Cheeks, the director of a community organization, Us Helping Us, in Washington, D.C.

Mr. Cheeks has successfully used nutrition and alternative therapies in his own treatment, stressing a common-sense approach to diet as the foundation for all medicine. He discussed the treatment of certain symptoms and infections with nutritional supplementation and dietary change, and challenged researchers to bring their work to a level where it can be applied to the day to day lives of people with HIV and AIDS. Drawing from his own experience, he explained how educating yourself about nutrition is the most fundamental way of taking charge of your own health care.

Current research

During the oral session, Richard Beach, M. D., from the University of Miami School of Medicine, discussed the state of nutrition in asymptomatic HIV-positive individuals. He found an increased resting energy expenditure (the amount of energy your body uses while in a relaxed state) in asymptomatic people with HIV. This appears consistent with reactions seen in most types of infection, except that it may have a different mechanism of action in the case of HIV infection. These findings were similar to those of a study at St. Luc University Hospital, Brussels [abstract #PuB7569], and research done by another panelist, J. T. Hommes, M. D., of the Academic Medical Center in Amsterdam.

The panelists agreed that nutrient supplementation can be an effective prophylaxis against many kinds of infection, and discussed how common nutrient deficiencies are in people with HIV and AIDS. Dr. Beach stated that 20 to 40 percent of the asymptomatic patients he studied had abnormally low plasma levels of riboflavin, vitamins A, B6, C, E, zinc, and copper. Twenty five percent of the patients had a vitamin B12 deficiency [PuB7318] and were found to have low scores when tested for information processing speed, and visual/spatial ability. Upon normalization of B12 levels, performance in these areas normalized. A lack of vitamin B6 was directly correlated to decreased immune system activity. [Related work: PuB7126].

Research into nutritional status as a surrogate marker was carried out at the Graduate Hospital, University of Pennsylvania, Philadelphia [PoB3695, and PuB7113]. These papers show a correlation between nutrient deficiencies and disease progression. Nutrition can also alter the efficacy of other treatments; according to Dr. Beach, "patients who were put on AZT who had low plasma zinc levels did not do nearly as well on the drug as those who had normal plasma levels of zinc...In the original studies of AZT they found that B12 deficiency correlated with an increased incidence of side effects from the drug. So both the efficacy and the tolerance of antiretrovirals can be influenced by nutritional status."

He cautioned that there is some question as to the practical use of zinc since some studies have shown that large amounts can suppress the immune system. Low plasma zinc levels are a natural response by the body in the face of infection, and might have a beneficial effect such as slowing viral replication.

Dr. Beach's group at the University of Miami School of Medicine proposed that vitamin B6 deficiency is directly related to anxiety and depression in early HIV infection [PoB3711]. They also gave recommendations for nutrient supplementation in early HIV infection [PoB3675], suggesting that HIV-positive individuals consume more than the RDA (the U. S. Food and Drug Administration's Recommended Daily Allowance) of many nutrients, to maintain adequate blood levels. They made interim recommendations for vitamins A, B2, B6, B12, C, and E, and for zinc. (Selenium deficiencies have also been found in HIV infection [PuB7336].)

Three papers were submitted on vitamin A, including research from St. Vincent's Hospital in New York which showed that people with AIDS commonly have a vitamin A deficiency [PoB3698]. Researchers from the National University of Rwanda discovered a relationship between low maternal vitamin A levels and fetal death [PoC4221]. The immunostimulatory effects of beta-carotene (a vitamin A precursor, which is safer to use than vitamin A itself) were studied at Yale University School of Medicine in New Haven [PoB3458]. In this study, half the patients had an increase in T-helper cells while taking 120 mg. of beta-carotene per day. Upon discontinuation of therapy patients returned to previous T- helper levels.

Joan Priestley, M. D., a physician from Los Angeles, presented a poster abstract on an observational study of a nutrient replacement therapy she uses with her patients [PoB3710]. She reported that nutrient supplementation helped patients maintain stable body weight, enhanced quality of life, and even extended survival time.

[Other related abstracts: nutritional markers PoB3708; body composition PoB3840, PoB3693, PuB7175; community projects and risk factors: PoB3705, PuC8119, PoD5285, PoD5252].

Malnutrition and AIDS

"It is well known that the function of the immune system is influenced by the nutritional status," stated Dr. Hommes. Malnutrition has been shown to weaken the body's ability to fight infection, "resulting in increased susceptibility to infectious diseases with increased morbidity and mortality." Similar findings were presented in a poster abstract from the Clinique des Maladies Infectieuses, Grenoble, France [PoB3701].

Donald Kotler, M. D., from the Task Force on Nutrition Support in AIDS, St. Luke's-Roosevelt Hospital, New York, spoke during the oral session about the lack of research on the impact of malnutrition on AIDS pathogenesis. Malnutrition in people with HIV can be caused by a variety of things, including insufficient food intake and metabolic and absorption abnormalities. Studies have demonstrated that appetite stimulation and enteral feeding (through a tube) can lead to increased body weight. The correct application of these treatments is not clearly understood. Dr. Kotler has also researched physical conditioning (exercise), which he has found to improve quality of life, and which may be the least expensive way of making up for the adverse effects of weight loss [PuB7395 and PoB3401].

A number of papers addressed the use of nutritional interventions: counseling and prescribed diets [PoB3676], growth hormone therapy [PoB3835], parenteral nutrition [PoB3694, PuB7265], nutritional formulas [PoB3696], prevalence of nutritional interventions [PoB3699], and appetite stimulation using Dronabinol (marijuana extract) and Megace (megestrol acetate) [PoB3687, PuB7442, PuB7505, PuB7531].

Developing Countries

Dr. Beach estimated that one billion people, one quarter of the world's population, are malnourished. "Most of the new cases of HIV infection are occurring in the third world, and they are occurring in areas exactly where that malnutrition is particularly endemic...So, even if we have an HIV vaccine somewhere down the road we are going to have to pay attention to the nutritional status of the people who are getting that vaccine."

In Africa, AIDS was originally referred to as "slim disease" because wasting is one of the most common symptoms of HIV infection in developing countries. "The triad of diarrhea, fever and weight loss are the three principal symptoms you see everywhere in the third world," and they are directly related to the malnutrition of those who become HIV-infected. People who are malnourished are more susceptible to infection by HIV, so the cycle of poverty and disease continues unabated.

Note:

Other nutrition abstracts address: gastrointestinal function [PoB3839, PoB3690, PuB7106], and diarrhea [PoB3333, PoB3340, PoB3348, PoB3725, PuB7155].

920904
ATN15801

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1992. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .