Appendix A: Oxidative Stress and Inflammation

Oxidative stress and inflammation begin during the early stages of HIV infection and continue over time. When left unchecked, they have the potential to cause serious damage—they harm immune cells, major organs and the nervous system and contribute to various diseases. We now know that taking antiretroviral therapy (ART) to control HIV can greatly reduce, but not eliminate, chronic inflammation. Fortunately, certain foods and supplements may also help counter oxidative stress and inflammation without adversely affecting the body’s immune responses.

Oxidative stress occurs when the body is low on antioxidants. Antioxidants are substances produced by the body and found in some foods (for example, many fruits and vegetables) and supplements. They protect the body from unstable molecules, called free radicals, which are generated by various bodily processes. When we don’t have enough antioxidants to counter oxidative stress, our immune cells and important organs—such as the liver, heart and kidneys—can be harmed.

Long-term infections, such as HIV, can cause the body to produce more free radicals than usual and can upset the body’s balance in the process. This is why it’s especially important for people living with HIV to get enough antioxidants.

Inflammation is part of the body’s immune response to injury, irritation or infection. For example, it kicks in when we cut ourselves, come into contact with something we are allergic to or become infected with a sexually transmitted infection (STI). Cells of the immune system are activated and travel to the site of infection or injury. Signs of inflammation can include redness, swelling, heat, pain and loss of function.

Inflammation is one of the body’s ways of fixing or suppressing the problem. Over the short term, it can help us fight a cold or flu or protect us from something we’re allergic to. But when inflammation continues over the long term—when it becomes chronic—it stops being beneficial and can contribute to the development of various diseases.

When a person is infected with HIV, inflammation (like oxidative stress) is part of the body’s effort to fight the virus. Different kinds of immune cells contribute to a coordinated effort: Some attack the virus and HIV-infected cells; some act as “generals,” coordinating the battle; and others try to amplify the immune response against the virus. However, ongoing inflammation can have the opposite effect: It can activate the virus, cause HIV to infect more cells and raise a person’s viral load.

HIV can directly affect tissues in the bones, brain, circulatory system and other parts of the body and can cause damage to the nervous system, important organs and other parts of the body. The end result is an increased risk of what we sometimes think of as the diseases of aging, such as cardiovascular disease, osteoporosis, liver disease and kidney disease.

Medications

Taking antiretroviral therapy (ART) greatly reduces HIV-related inflammation. That’s why it’s so important to initiate ART as early as possible after HIV infection and to take your medications every day, as directed, even if you don’t feel sick. Regular viral load testing will measure how much HIV is in your blood (your viral load) and help ensure that your treatment is working.

Unfortunately, meds do not completely eliminate the inflammation. The immune system continues to be activated and low-level inflammation persists even when a person’s viral load is undetectable.

Researchers are studying various other drug approaches to reducing the chronic inflammation caused by HIV.

Foods, seasonings and supplements

Although research findings on the benefits of antioxidant foods and supplements have been conflicting, certain foods and seasonings rich in antioxidants appear to have anti-inflammatory qualities. These include:

• ginger
• turmeric
• cherries, berries and red grapes
• onions and garlic
• the white inner rind of citrus fruits
• foods rich in omega-3 fatty acids, such as flaxseed, walnuts and fatty fish (in particular, wild salmon, mackerel, sardines, anchovies, cod and halibut). Fish oil or krill oil supplements provide anti-inflammatory omega-3 fatty acids in a form that can be processed by the body more easily than that in foods or other supplements containing omega-3 fatty acids.

The best way to add antioxidant nutrients to your diet is to consume a wide variety of colourful fruits and vegetables as well as nuts and seeds.

Antioxidant supplements can also help counter both oxidative stress and inflammation. Talk to your doctor and pharmacist (and dietitian/nutritionist or naturopathic doctor, if you see one) about taking supplements, such as:

• a good multivitamin
• vitamin E (choose a supplement that contains all members of the vitamin E family)
• vitamin C
• bioflavonoid complex
• selenium
• N-acetyl-cysteine (NAC)
• coenzyme Q₁₀
• supplements derived from anti-inflammatory foods, such as fish oil, ginger root, curcumin, quercetin and bromelain

Lifestyle changes and screening

Other important things that can help counter the level of inflammation in your body include:

• quitting smoking
• exercising (talk to your doctor about what type of exercise is right for you)
• treating co-infections, such as hepatitis B and C
• regular screening for sexually transmitted infections (STIs)
• maintaining a healthy weight
• maintaining healthy blood sugar levels (see “Diabetes and Blood Sugar Problems”)