Dietary Supplements and Their Role in HIV

CHICAGO--Several editorials covering the role of micronutrients in human immunodeficiency virus (HIV) infection were published in a supplement to the September issue of Clinical Infectious Diseases (www.journals.uchicago.edu/CID/home.html). Researchers discussed the role of alternative medicine, dietary habits, and micronutrients such as iron, zinc and vitamin B12 in the health of HIV-infected patients.

Jerome Ernst, M.D., of the AIDS Community Research Initiative of America, New York, wrote a paper on alternative treatment modalities in HIV and acquired immune deficiency syndrome (AIDS) (37, Suppl 2:S150-3, 2003). He noted that historically, those with HIV/AIDS used alternative treatments for disease management--and often those therapies were the only ones available. However, even with the advent of highly active antiretroviral therapy, Ernst noted alternative medicines continue to be popular among HIV/AIDS patients, and their increased popularity parallels the increased usage among the general population.

Colleen M. Hadigan, M.D., of Harvard Medical School in Boston, reviewed the association between dietary habits and metabolic abnormalities in HIV-related lipodystrophy (37, Suppl 2:S101-4, 2003). Lipodystrophy, a disorder of adipose (fatty) tissue characterized by a selective loss of body fat that can lead to insulin resistance, diabetes, high triglyceride levels and fatty liver, can be developed through the use of protease inhibitors used to treat HIV. Hadigan noted that dietary modifications and exercise remain a first-line therapy for HIV patients with dyslipidemia and glucose intolerance, although she suggests there is a need for sound dietary guidelines based on investigational research to combat the metabolic abnormalities--hyperlipidemia, insulin resistance and increased cardiovascular disease risk--among patients with HIV and lipodystrophy.

Protease inhibitors also affect vitamin B12 status, according to Margo N. Woods, DSc, from the Tufts University School of Medicine, Boston, and HIV patients should have vitamin B12 status checked yearly (37, Suppl 2:S124-31, 2003). Woods' research indicated during intervals with no protease inhibitor use, each 1 mcg/d increase in B12 intake was associated with a 1.06 pg/mL increase in serum B12 levels; however, while patients were taking protease inhibitor therapy, each 1 mcg/d increase in intake was associated with only a .12 increase in serum B12 levels. Woods concluded adequate vitamin B12 levels cannot be assumed, and dietary supplementation may not be adequate to ensure normal levels.

Randomized trials among HIV-positive men and women have shown immune status benefits from supplementation with the B vitamins and vitamins C and E, according to a review by Wafaie Fawzi, Dr.P.H. (37, Suppl 2:S112-6, 2003). In pregnant women, though, Fawzi noted supplementation with these vitamins during prenatal and breastfeeding stages should be encouraged because it protects against adverse pregnancy and child outcomes. However, he stated, vitamin A seems to increase the risk of mother-to-child transmission, although it reduces morbidity and mortality among HIV-infected children aged six months and older. Fawzi added additional research is needed to determine the roles selenium, zinc and other trace minerals play on various measures of health in HIV infection.

Zinc deficiency is the most commonly seen micronutrient abnormality in HIV infection, according to Marianna Baum, Ph.D., and colleagues from Florida International University in Miami (37, Suppl 2:S117-23, 2003). Low levels of plasma zinc predict a three-fold increase in HIV-related mortality, and normalization has been shown to slow disease progression and decrease additional infection. Baum et al concluded the amount of zinc supplementation in HIV infection is critical because deficiency has negative effects on immune cell counts and compromises an already weakened immune system.

Iron-deficiency anemia is also prevalent among HIV-infected patients, particularly females who are injection drug users, according to Richard D. Semba, M.D., of the Johns Hopkins University School of Medicine, Baltimore (37, Suppl 2:S105-11, 2003). He noted that because iron-deficiency anemia can cause fatigue, lower aerobic capacity and decrease endurance, it may contribute to the cycle of poverty among inner-city women by decreasing their ability to work, earn money and buy iron-rich sources of food. Semba concluded that while iron supplementation may prevent or treat iron-deficiency anemia, the use of iron supplements should be approached cautiously in women with HIV and/or hepatitis C infection.