Dietary Supplements and Their Role in HIV 37271

Dietary Supplements and Their Role in HIV

CHICAGOSeveral 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). Jerome Ernst, M.D., of the AIDS Community Research Initiative of America, New York, noted that, historically, HIV/AIDS patients have used alternative medicine for disease management, and usage is increasing in parallel with the increased popularity of alternative medicine in the mainstream (37, Suppl 2:S150-3, 2003). Colleen M. Hadigan, M.D., of Harvard Medical School in Boston, noted dietary modifications and exercise remain a first-line treatment for HIV-related 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 (37, Suppl 2:S101-4, 2003).

More specifically, Margo N. Woods, DSc, from the Tufts University School of Medicine, Boston, mentioned the fact that protease inhibitors used in HIV infection tend to affect vitamin B12 status, and HIV patients should have vitamin B12 status checked yearly (37, Suppl 2:S124-31, 2003). 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, and low levels of plasma zinc predict a three-fold increase in HIVrelated mortality, while normalization has been shown to slow disease progression and decrease additional infection (37, Suppl 2:S117-23, 2003). 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).

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 women, supplementation with these vitamins during prenatal and breastfeeding stages should be encouraged because it protects against adverse pregnancy and child outcomes. As for vitamin A, it seems to increase the risk of mother-to-child transmission, but reduce 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.