AIDS and HIV Support. Lancet 1994;343: Humphrey JH, Quinn T, Fine D, et al. Short-term effects of large-dose vitamin A

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1 AIDS and HIV Support Acquired immunodeficiency syndrome (AIDS) is a condition in which the immune system becomes severely weakened and loses its ability to fight infections. Most scientists believe that the disease results from infection with the human immunodeficiency virus (HIV). AIDS is an extremely complex disorder, and no cure is currently available. Certain pharmaceuticals appear to be capable of slowing the progression of the disease. In addition, various nutritional factors may be helpful. However, because of the complicated nature of this disorder, medical supervision is strongly recommended with regard to dietary changes and nutritional supplements. Dietary changes that may be helpful: Individuals with AIDS often lose significant amounts of weight or suffer from recurrent diarrhea. A diet high in protein and total calories may help a person maintain his or her body weight. In addition, whole foods are preferable to refined and processed foods. Whole foods contain larger amounts of many vitamins and minerals, and individuals with HIV infection tend to suffer from multiple nutritional deficiencies. Nonetheless, no evidence currently suggests that dietary changes are curative for people with AIDS or even that they significantly impact the course of the disease. Nutritional supplements that may be helpful: Because individuals with HIV infection or AIDS often have multiple nutritional deficiencies, a broadspectrum nutritional supplement may be beneficial. In one study, HIV-infected men who took a multivitamin supplement had slower disease progression, compared with men who did not take a supplement. 1 Vitamin A deficiency appears to be very common in people with HIV infection. Low levels of vitamin A are associated with greater disease severity 2 and increased transmission of the virus from a pregnant mother to her infant. 3 However, little research has explored whether vitamin A supplements are helpful. In one trial, giving people an extremely high (300,000 IU) amount of vitamin A one time only did not improve short-term measures of immunity in women with HIV. 4 Beta-carotene levels have also been found to be low in HIV-infected individuals, particularly those with more advanced disease. 5 However, studies on the effect of beta-carotene supplements have produced conflicting results. In one double 1 Ince S. Vitamin supplements may help delay onset of AIDS. Med Tribune 1993;November 9:18. 2 Semba RD, et al. Increased mortality associated with vitamin A deficiency during human immunodeficiency virus type 1 infection. Arch Intern Med 1993;153: Semba RD, et al. Maternal vitamin A deficiency and mother-to-child transmission of HIV-1. Lancet 1994;343: Humphrey JH, Quinn T, Fine D, et al. Short-term effects of large-dose vitamin A supplementation on viral load and immune response in HIV-infected women. J Acquired Immune Deficiency Syndromes Human Retrovirol 1999;20: Sappey C, et al. Vitamin, trace element and peroxide status in HIV seropositive patients: asymptomatic patients present a severe beta-carotene deficiency. Clin Chim Acta 1994;230:35 42.

2 blind study, supplementing with 300,000 IU per day of beta-carotene significantly increased the number of CD4+ cells (an infection-fighting type of white blood cell that is low inpatients with AIDS). 6 In another study, the same amount of beta-carotene had no effect on CD4+ cell counts or various other measures of immune function. 7 Thiamine (vitamin B1) deficiency has been identified in nearly one-quarter of people with AIDS. 8 It has been suggested that a deficiency of this vitamin may contribute to some of the neurological abnormalities that are associated with AIDS. In another study, vitamin B6 deficiency was found in more than onethird of HIVpositive men, and a deficiency of this vitamin was associated with decreased immune function. 9 Low blood levels of folic acid and vitamin B12 are also common in HIV-infected individuals. 10 Vitamin C has been shown to inhibit HIV replication in test tubes. 11 Some doctors recommend large amounts of vitamin C for patients with AIDS. Reported benefits in vitamin C preliminary research include greater resistance against infection and an improvement in overall wellbeing. 12 In test tube studies, vitamin E improved the effectiveness of the anti-hiv drug zidovudine (AZT) while reducing its toxicity. 13 Blood levels of coenzyme Q10 were also found to be low in individuals with HIV infection or AIDS. Six people with HIV infection received 200 mg per day of coenzyme Q10. Five of these individuals experienced no further infections for up to seven months, and the white blood cell count improved in three cases. 14 In the category of minerals, both zinc 15 and selenium 16 levels are frequently low in people with HIV infection, and iron deficiency is often present in HIV- 6 Coodley GO, et al. Beta-carotene in HIV infection. J Acquired Immune Deficiency Syndromes 1993;6: Coodley GO, et al. Beta-carotene in HIV infection: an extended evaluation. AIDS 1996;10: Butterworth RF, et al. Thiamine deficiency in AIDS. Lancet 1991;338: Baum MK, et al. Association of vitamin B6 status with parameters of immune function in early HIV-1 infection. J Acquired Immunodeficiency Syndromes 1991;4: Boudes P, et al. Folate, vitamin B12, and HIV infection. Lancet 1990;335: Harakeh S, et al. Suppression of human immunodeficiency virus replication by ascorbate in chronically and acutely infected cells. Proc Natl Acad Sci 1990;87: Cathcart RF III. Vitamin C in the treatment of acquired immune deficiency syndrome (AIDS). Med Hypotheses 1984;14: Gogu SR, et al. Increased therapeutic efficacy of zidovudine in combination with vitamin E. Biochem Biophys Res Commun 1989;165: Folkers K, et al. Biochemical deficiencies of coenzyme Q10 in HIV-infection and exploratory treatment. Biochem Biophys Res Commun 1988;153: Fabris N, et al. AIDS, zinc deficiency, and thymic hormone failure. JAMA 1988;259: Dworkin BM. Selenium deficiency in HIV infection and the acquired immunodeficiency syndrome (AIDS). Chem Biol Interact 1994;91:

3 infected children. 17 Zinc supplements have been shown to reduce the number of infections in individuals with AIDS. 18 HIV-infected people who received selenium supplements experienced fewer infections, better intestinal function, improved appetite, and improved heart function (which had been impaired by the disease). 19 The amino acid N-acetyl cysteine (NAC) has been shown to inhibit the replication of HIV in the test tube. 20 In a double blind study, supplementing with 800 mg per day of NAC slowed the rate of decline in immune function. NAC may work better when glutamine (another amino acid) is also supplied. In combination, these two amino acids promote the synthesis of glutathione, a naturally occurring antioxidant that is believed to be protective in people with HIV infection. 21 The nonpathogenic yeast Saccharomyces boulardii in the amount of 1 gram three times per day has been shown to help stop diarrhea in HIV positive people in double blind research. 22 Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions. Herbs that may be helpful: Many different herbs have been shown in test tube studies to inhibit the function or replication of HIV. Few of these studies have been followed up with any kind of investigation in infected humans. Some notable exceptions to this rule are discussed below. One double blind study has found that 990 mg per day of an extract of boxwood (Buxus sempervirens) leaves and stems could delay progression of HIV infection as measured by decline in CD4 cell counts. 23 No adverse effects were reported due directly to the extract. Taking twice the dose of boxwood extract did not lead to further benefits and may have actually decreased its usefulness. Garlic may be helpful. In one study, administration of an aged garlic extract 17 Castaldo A, et al. Iron deficiency and intestinal malabsorption in HIV disease. J Pediatr Gastroenterol Nutr 1996;22: Mocchegiani E, et al. Benefit of oral zinc supplementation as an adjunct to zidovudine (AZT) therapy against opportunistic infections in AIDS. Int J Immunopharmacol 1995;17: Schrauzer GN, Sacher J. Selenium in the maintenance and therapy of HIVinfected patients. Chem Biol Interact 1994;91: Roederer M, et al. Cytokine-stimulated human immunodeficiency virus replication is inhibited by N-acetyl-L-cysteine. Proc Natl Acad Sci 1990;87: Robinson MK, et al. Glutathione deficiency and HIV infection. Lancet 1992;339: Blehaut H, Saint-Marc T, Touraine J. Double blind trial of Saccharomyces boulardii in AIDSrelated diarrhea International Conference on AIDS/Third STD World Congress, 1992, Abstract #2120, July 19 24b. 23 Durant J, Chantre Ph, Gonzalez G, et al. Efficacy and safety of Buxus sempervirens L. preparations (SPV30) in HIV-infected asymptomatic patients: a multicentre, randomized, double-blind, placebo-controlled trial. Phytomedicine 1998;5(1):1 10.

4 reduced the number of infections and relieved diarrhea in a group of patients with AIDS. 24 Licorice has shown the ability to inhibit reproduction of HIV in test tubes. 25 Studies on injections of glycyrrhizin isolated from licorice show it could have a beneficial effect on AIDS. 26 Preliminary evidence on orally administered licorice has also found it to be safe and effective for long-term treatment of HIV infection. 27 A physician should monitor the blood pressure of anyone taking licorice or glycyrrhizin long term. Deglycyrrhizinated licorice (DGL) will not inhibit HIV. Approximately 2 grams of licorice root should be taken per day in capsules or as tea. Immune-modulating plants often used by doctors of herbal medicine include Asian ginseng, eleuthero (Siberian ginseng), ashwagandha, and the medicinal mushrooms shiitake and reishi. Maitake mushrooms contain polysaccharides, including beta-d-glucan, which is currently under review as a supportive tool for HIV infection Bitter melon contains two proteins alpha- and betamomorcharin that inhibit the AIDS virus in test tubes. Very early reports indicate bitter melon juice or enemas may be beneficial for people infected with HIV, 30 but much more research is necessary before the effect of bitter melon is known for certain. An open trial of a combination naturopathic protocol (consisting of multiple nutrients, licorice, lomatium, a combination Chinese herbal product, lecithin, calf thymus extract, lauric acid monoglycerol ester, and St. John s wort) found that it could possibly slow progression of mild HIV infection and reduce some symptoms. 31 These results can be seen as preliminary at best and need to be repeated in controlled studies. It does begin to suggest that using several natural products in combination can be safe and potentially helpful. 24 Abdullah TH, et al. Enhancement of natural killer cell activity in AIDS with garlic. Dtsch Zschr Onkol 1989;21: Ito M, Sato A, Hirabayashi K, et al. Mechanism of inhibitory effect of glycyrrhizin on replication of human immunodeficiency virus (HIV). Antivir Res 1988;10: Hattori I, Ikematsu S, Koito A, et al. Preliminary evidence for inhibitory effect of glycyrrhizin on HIV replication in patients with AIDS. Antivir Res 1989;11: Ikegami N, et al. Prophylactic effect of long-term oral administration of glycyrrhizin on AIDS development of asymptomatic patients. Int Conf AIDS 1993;9:234 [abstract PO-A ]. 28 Yamada Y, Nanba H, Kuroda H. Antitumor effect of orally administered extracts from fruit body of Grifola frondosa (maitake). Chemotherapy 1990;38: Nanba H. Immunostimulant activity in-vivo and anti-hiv activity in vitro of 3 branched b-1-6-glucans extracted from maitake mushrooms (Grifola frondosa). VIII International Conference on AIDS, 1992 [abstract]. 30 Zhang QC. Preliminary report on the use of Momordica charantia extract by HIV patients. J Naturopath Med 1992;3: Standish L, Guiltinan J, McMahon E, Lindstrom C. One year open trial of naturopathic treatment of HIV infection class IV-A men. J Naturopathic Med 1992;3:42 64.

5 Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.