FRANÇAIS HIV AND NUTRITION PREVIOUS PAGE NEXT PAGE SUBSCRIBE Chester Myers' Nutrition Series Vitamin/mineral supplementation & HIV/AIDS
From the mid 1980s until 1990, multiple deficiencies of vitamins and minerals (micronutrients) were documented in persons with HIV or AIDS. A November, 1990 publication, Nutrition and HIV Infection by DJ Raiten, Life Sciences Research Office of the Federation of the American Societies of Experimental Biology (FASEB), reviewed for the US Food and Drug Administration (FDA) the accumulated information as of 1990. At that time no recommendations were made for aggressive supplementation. However, in a section titled General Clinical Recommendations, it was suggested that "supplementation of vitamins and trace minerals one or two times the RDA may offset possible deficits and contribute to meeting increased requirements during hypermetabolic states". Also, a 1988 publication from Tufts University was cited in which had been included a suggestion that "multivitamin supplements ... may be helpful" for "debilitated ARC or AIDS patients who suffer from malabsorption" (Dwyer et al, "Unproven Nutrition Therapies for AIDS: What is the Evidence?", Nutrition Today March/April, 1988:25-33).
Since 1990, there have been increasing data documenting multiple micronutrient deficiencies in HIV/AIDS in the absence of aggressive supplementation. Not surprisingly, there have been increasing recommendations for supplementation. At the Third International Symposium on Nutrition and HIV/AIDS (Philadelphia, 1994) members of the Physicians Association for AIDS Care repeatedly noted the importance of supplementation. Carotenoids, magnesium, the B-complex vitamins and vitamin B12 were given special emphasis. Several stated that HIV-related dementia is largely unnecessary with good nutrition. While many of the accumulated data have been from homosexual men, there is no indication that women or children have been exempt from similar deficiencies. Dr. Gregg Coodley, Oregon Health Sciences University, noted at the 1994 Philadelphia meeting that levels of vitamin C, selenium and all carotenoids are also generally low in women, and implied vitamins A, B6, E, and the mineral zinc are also likely low in women as with men (again, in the absence of supplementation). Other speakers at this meeting presented their data as being applicable for both men and women. A 1995 meeting focused on "setting the research agenda" for pediatric HIV infection (reported in The Journal of Nutrition 126S(1996). The statement that "current studies suggest that many of the negative effects of PCM [protein calorie malnutrition] are related to attendant trace element deficiency", conflicts with those who naively view PCM only as inadequate intake of protein and calories .
In 1992, a research group (MK Baum et al) from the University of Miami made specific recommendations at the Amsterdam International AIDS Conference ("Interim Dietary Recommendations for Early Stage HIV-infected Persons", abstract PoB 3675). These recommendations were for supplementation with 5X to 25X the RDA levels of several B vitamins, vitamins A, C and E, and the mineral zinc. In 1994, in a letter to the editor of AIDS, this same group reiterated these recommendations on the basis of "preliminary data from an ongoing nutrition supplementation trial".
In a 1993 publication, also from Tufts university, a general recommendation was made, viz "supplements of vitamins and minerals, especially vitamins A (as -carotene), E, C, riboflavin, B6, and B12, and the minerals zinc and selenium, should be part of any oral regimen" (Gorbach et al, Nutrition Reviews 51:1993:226-234 - underlining added here for emphasis). It was also about this time that further research became available documenting benefits from such supplementation.
In 1993, the results from two large six year long epidemiological studies were published. One of these was a study of 296 men by researchers at the Berkeley campus of UCLA (B Abrams et al, "A Prospective Study of Dietary Intake and Acquired Immune Deficiency Syndrome in HIV-Seropositive Homosexual Men", J Acquir Immune Defic Syndr 6:1993:949-958). Findings included the observations that "higher intake of all 11 micronutrients was associated with higher CD4 counts at baseline",.. "daily multivitamin use was associated with a reduced hazard of AIDS and a significantly reduced risk for low CD4 counts .." Ominously, there was "no statistically significant association between AIDS and intake from food alone of micronutrients or the macronutrients fat and protein" (underlining added here for emphasis). More specifically, the authors stated that "daily use of a multivitamin supplement was associated with a 40% reduction in the risk of a low CD4 T-lymphocyte count", and that "those whose supplement consumption was within the highest tertile of intake were about half as likely to develop AIDS compared to those in the middle or lowest tertiles". In addition to the multivitamin, "intake of vitamin E and iron from supplements alone was also significantly associated with a reduced risk of AIDS".
The second six year study was from Johns Hopkins University. The initial analysis found that "the highest levels of intake (from food and supplements) of vitamins C and B1 and niacin were associated with a significantly decreased progression rate to AIDS", and "the progression rate to AIDS was also decreased in subjects in the highest quartile of intake for vitamins B1, B2, B6, and C" (Tang et al, "Dietary Micronutrient Intake and Risk of Progression to Acquired Immunodeficiency Syndrome (AIDS) in Human Immunodeficiency Virus Type 1 (HIV-1)-infected Homosexual Men", Amer J Epidemiol 138:1993:937-951). This initial analysis of the Johns Hopkins' study did not indicate whether benefits derived from food alone.
A later presentation, however, from the same group at Johns Hopkins has noted that "the apparent protective effects observed from the B-group vitamins were primarily due to the intake of vitamins from supplements rather than food" (underlining added here for emphasis), and "quartiles of food intake showed no association with survival" (Tang et al, "The Effect of Micronutrient Intake on Survival in HIV-1 Infection", Toronto presentation by Dr. Neil Graham, 1995). This analysis was later published in Amer J Epidemiol (143:1996:1244-1256,Tang et al,"The Effects of Micronutrient Intake on Survival in Human Immunodeficiency Virus Type 1 Infection").Then, in 1996, this group noted "subjects with low serum B12 levels had an approximate two-fold increase in risk of progression to AIDS" ("The Role of Serum Micronutrient Levels in HIV-1 Disease Progression", abstr. MoC 320, Vancouver XI AIDS Conference).
While there are many publications noting the importance of specific micronutrients in HIV/AIDS, those relating to zinc, selenium, vitamins A, C and E, and the carotenoids are in greatest abundance. The first textbook making general recommendations was published in 1995. The author is Dr. Mary Romeyn, an internist at the Saint Francis Memorial Hospital in San Francisco, and member of the Scientific Advisory Committee of the San Francisco AIDS Foundation and HIVCare. She "has a private practice specializing in HIV and nutrition, and writes and lectures on nutritional aspects of HIV disease management". A chapter of the book is devoted to recommended supplementation, with particular emphasis given to a multivitamin and antioxidants, also individually the vitamins C, E, -carotene, B complex, magnesium and selenium ("Vitamins, Minerals and Trace Elements", Chapter 4 in Nutrition and HIV - A New Model for Treatment, Jossey-Bass Publishers, 1995).
In addition to the above studies, there is increasing evidence that micronutrient supplementation is associated with absence of, or lessened, deficiencies, and clinical stability (abst. WeB3258 by McDermid et al and WeB3264 by Knox et al, Vancouver XI AIDS Conference).
Finally, the supplement N-acetyl cysteine (NAC) has been noted to be of importance in HIV/AIDS. It is a safe means to supplement the amino acid cysteine which becomes deficient in HIV/AIDS (Mihm et al, "Modulation of transcription factor Nf kappa B activity by intracellular glutathione levels and by variations of the extracellular cysteine supply", FASEB J 9:1995:246-252). One group has stated simply that "AIDS may be the consequence of a virus-induced cysteine deficiency" (W Droge et al,"Effects of N-acetylcysteine (NAC) on the T Cell System - In Vivo Results of a Placebo Controlled Double-Blind Trial", Conference on Oxidative Stress in HIV/AIDS, NIH, 8-10 Nov., 1993). Cysteine deficiency is also a known source of wasting (Dr. Thompson, University of Toronto). It is associated with the many documented deficiencies of the important protective compound glutathione (de Quay et al, "Glutathione depletion in HIV-infected patients: role of cysteine deficiency and effect of oral N-acetylcysteine", AIDS 6:1992:815-819). Recommendations for NAC supplementation were made as early as 1988 (W Droge et al, Biol. Chem. Hoppe-Seyler 369:1988:143-148) and 1990 (San Francisco AIDS Conference, abstract ThB 515). In addition to its importance in combating deficiency of the amino acid cysteine, Dr. Luc Montagnier, the discoverer of HIV, has commented that "when the NAC treatment is longer than six months, NAC will restore apoptosis back to normal levels" (in interview with Dr. RA Passwater, "Antioxidant Nutrients and AIDS: Exploring the Possibilities", Whole Foods, Sept/1995). Apoptosis is a type of spontaneous cell death that is accelerated in HIV/AIDS, and may contribute to decline in CD4 cells. A study (M Feregrino-Goyos et al, "AZT Monotherapy Compared to AZT+DDC Combined Antiviric Therapy and AZT+DDC+NAC", abstract PB0260) presented at the Yokohama 1994 International AIDS Conference noted enhancement, based on CD4 counts and the number of "new AIDS events", of the effectiveness of AZT/ddC combined antiretroviral therapy with NAC administration over a 12 month period in 100 people vs two control groups each with 100 persons. At the 1994 Philadelphia meeting, recommendations were made for up to 3200 mg daily of NAC supplementation (D. Dieterich, New York University School of Medicine). In 1997, the Herzenberg group from Stanford University School of Medicine has noted that in those with CD4 counts under 200/µL low glutathione is "remarkably predictive of poor survival" (reportd by John S. James in AIDS Treatment News, issue 266, also in Proc Nat Acad Sci USA, 1997).
Author, Chester Myers, holds both honours B.Sc. and M.Sc. (1969) degrees in physical chemistry from Dalhousie University, and a Ph.D. (1975) from the University of Toronto (biophysical chemistry) where he investigated the mechanism of action of one of the digestive enzymes. In addition to publishing in the scientific literature and having authored several patents, he has written extensively on topics regarding health and HIV. The latter include articles in The Positive Side, Canadian AIDS News, and monographs available from the AIDS Committee of Toronto (ACT), the Community AIDS Treatment Information Exchange (CATIE), and various other organizations.
Disclaimer:
The material in this publication is for information purposes only. It does not endorse any particular treatment program nor strategy; neither is it intended as medical advice nor as a replacement for medical advice.
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