The Positive Side

Spring/Summer 2002 

The 7 Deadly Sins

For those wishing to live long and well with HIV

By Lark Lands

Sin #1  Thinking the disease is over.

It isn’t. When you reach the point where it’s appropriate, HAART (highly active antiretroviral therapy) can certainly suppress the virus, restore at least some lost immune function and slow disease progression, but it is by no means a final and complete answer. Issues of drug resistance and side effects make long-term use of HAART very problematic. For long-term good results, all aspects of the disease must be handled appropriately. This means doing everything possible to slow disease progression and prevent symptoms with good nutrition and other non-drug means. And, if you’re on HAART, it’s important to protect yourself from side effects of the drugs.

Sin #2  Ignoring the nutrient needs that both the disease and the medicines create.

Whether or not you’re taking antiretrovirals, your body is fighting an ongoing battle. It needs higher levels of nutrients to do that. You can’t power the body’s immune response or build replacement immune cells without the nutrient building blocks. You need to consume:

  • good levels of protein
  • good levels of unrefined complex carbohydrates (brown rice instead of white; whole-grain breads, crackers, cookies and pasta instead of those made with nutrient-poor white flour)
  • lots of fresh fruits and vegetables
  • moderate amounts of good fats every day (monounsaturated fats like olive oil are best; avoid the partially hydrogenated oils found in margarines, shortenings and many baked goods and snack foods. Read the labels!)
  • lots of healthful liquids (water, juices, teas — not chemical- and sugar-loaded junk drinks)

That’s how you power your body to keep up the immense battle against HIV. Numerous studies have shown that disease progression is faster in people with low levels of nutrients, so remember, nutrients are one of your best weapons against HIV. (Always make sure that the food you eat and the water you drink is safe.)

Nutrients can also help prevent or reduce the side effects and toxicity of medications while improving their absorption. You can help your body handle all the pills you’re taking by giving it good nutrition, lots of healthful fluids, appropriate supplementation and plenty of liver and kidney support.

  • With liver-toxic drugs: Consider L-carnitine (or L-acetyl-carnitine), and the nutrients that maintain glutathione levels in the liver — alpha-lipoic acid, vitamin C, vitamin E, N-acetyl-cysteine (NAC) and L-glutamine. Depending on drug interactions (check!), silymarin (milk thistle extract) may also be useful.
  • To help with kidney stress: Drink lots of water throughout the day. Aim for a large glass every hour or so, especially each time you pop your pills.

Don’t forget that nutrient supplementation can often help reduce or possibly eliminate HIV-related symptoms such as fatigue, skin problems, diarrhea and gas, memory loss, neuropathy and more. In order to manage a difficult disease long-term, you need to feel good!

Sin #3  Ignoring your intestines.

If your intestines aren’t working properly, you won’t absorb drugs or nutrients well. The results can be serious nutrient loss, wasting, and malabsorption of drugs — which can lead to lowered effectiveness and increased development of drug resistance. Use the nutrients that help heal and maintain the intestines, including zinc, vitamin A, B vitamins and especially L-glutamine. Natural anti-inflammatories may also help; possibilities are ginger, quercetin and other bioflavonoids, and essential fatty acids found in flaxseed oil or fish oil.

Sin #4  Ignoring instructions on taking drugs correctly.

You’ve heard this before but we’ll say it again: If you’re on HAART, medications must be taken very consistently, as per the precise dosage instructions. “Drug adherence” means: Never skip doses and always take your drugs exactly as prescribed and directed (with or without food, with lots of liquid, before or after a meal, etc.). This is terribly important to improve absorption and prevent toxicity and side effects. If you skip doses or take drugs improperly, effectiveness goes down and resistance goes up. Remember: Doing everything to eliminate side effects can help you adhere to your drug regimen because you won’t be getting the miserable symptoms that make you not want to take your pills!

Sin #5  Ignoring the maintenance of muscle mass that’s crucial for survival.

Wasting is still killing people. Monitor your body’s status with regular weight measurements and bioelectrical impedance analysis (BIA). If either weight or muscle mass begins to decline, address it aggressively. For both men and women, it is critical to test testosterone levels and use hormone replacement therapy, where necessary, to maintain lean tissue and, a nice side benefit, your sex drive and mood. Women may also need female hormone replacement. For people with any level of serious wasting, recombinant human growth hormone (Serostim) may be very important to prevent the loss of muscle mass that keeps you alive. And exercise, especially progressive resistance exercise like weight training, is crucial for building and maintaining muscles, which contain a large proportion of your body cell mass. Maintaining your body in these ways not only promotes survival but also helps you look, function and feel better.

Sin #6  Thinking that reducing viral load fully and quickly restores immune function.

If your immune cells were ever below the normal range before you started HAART, you may not have speedy or complete immune restoration even when CD4 counts go back up. Even though the evidence for immune cell restoration after a period of time on HAART is encouraging, the specific time frame for this is unknown and may vary widely between individuals. Studies have shown encouraging results when people discontinue either maintenance therapies (for an infection like CMV or cryptosporidiosis) or prophylactics (against common opportunistic infections), indicating that the body’s immune ability may have returned, if not fully, at least enough to control or prevent some infections. However, until there are better tests for assessing the return of immune function, it will be impossible to know precisely who is protected from which particular infections.

Optimal nutrient status is crucial for the best results. The thymus gland that programs T cells is very sensitive to nutrient deficiencies; cell expansion requires nutrients to build and maintain the cells; and just maintaining immune response, in general, requires good nutrient status.

Sin #7  Failing to manage this disease properly, day in and day out.

The good news is: You’ve got much better weapons now in the fight to live long and well with HIV. The bad news? It’s a lot of work that isn’t likely to decrease anytime soon. You have to:

  • beat the good diet,
  • handle the hormone problems,
  • do the exercise,
  • take the drugs precisely,
  • protect the body from infections, and
  • take the nutrients that are necessary to provide protection against disease effects and drug side effects; help prevent disease progression and infections; rebuild damaged tissue and replace cells; and prevent symptoms.

As you do that work, try to keep the optimistic hopeful outlook that programs you for survival. We’re not talking about doing all this for the next 10 minutes. We’re talking about every day for the rest of your, it is fondly to be hoped, long and happy life.

To discuss your personal needs, naturopathic doctors can be located through your provincial naturopathic association, or see your medical practitioner.
 
For much more in-depth info on eliminating drug side effects, see CATIE’s Practical Guide to HIV Drug Side Effects. For more info on nutrition, see CATIE’s Practical Guide to Nutrition.

Lark Lands, a medical journalist and longtime AIDS treatment educator and advocate, was a pioneer in bringing attention to the need for a total integrated approach to HIV disease. She has presented keynote addresses to many large AIDS conferences in North America and is the science editor of POZ magazine. For her fact sheets and treatment information summaries, go to www.larklands.net. The articles she has written for POZ are available at www.poz.com.