Acquired Immunodeficiency Syndrome (AIDS) and HIV Infection
• Positive test for the human immunodeficiency virus (HIV)
• Primary risk factors: sexual contact with an HIV-infected person, intravenous drug user sharing needles, being born to a mother who has HIV
• Onset may vary:
May present with sudden onset (duration of up to 14 days) of fevers, sweats, malaise, fatigue, joint and muscle pain, headaches, sore throat, diarrhea, generalized swelling of lymph glands, rash on the trunk
May present insidiously, as unexplained progressive fatigue, weight loss, fever, diarrhea, and generalized swelling of the lymph glands
May present first as an opportunistic infection such as thrush (oral candidiasis) or Pneumocystis carinii pneumonia
• Advanced stages will show neurological changes including dementia and loss of nerve function (partial paralysis, vertigo, visual disturbances, etc.)
Acquired immunodeficiency syndrome (AIDS) is characterized by a profound defect in immune functions. The primary cause of AIDS is infection with the human immunodeficiency virus (HIV). The spectrum of HIV infection ranges from a person with a positive test for HIV without any signs of immune deficiency to the person with full-blown AIDS characterized by all of the now classic components of the disease. The HIV virus does not kill; what it does is cripple the immune system to such an extent that a person dies from severe infection or cancer. AIDS is now viewed as a late stage of HIV infection.
HIV is diagnosed when an individual has a positive blood test for HIV antigen and antibodies. AIDS is diagnosed when certain criteria are met, such as the presence of one of the 23 opportunistic infections (infections caused by normally non-infectious organisms) and cancers linked to AIDS, or a positive HIV test plus a CD4 count (a count of important white blood cells, also called T helper cells) of less than 200/μl or a ratio of T helper cells to total lymphocytes (CD4/CD8 count) of less than 14%. The current average time from becoming infected with HIV to the development of AIDS is 10 years.1
Estimates today are that more than 1 million Americans are infected with HIV and a little under 200,000 meet the requirements to be diagnosed as having AIDS. In the United States, African-Americans make up 10% of the population but about half of the HIV/AIDS cases nationwide. There are also geographic disparities in AIDS prevalence in the United States: it is most common in rural areas and in the southern states, particularly in the Appalachian and Mississippi Delta regions and along the border with Mexico. HIV infection is more prevalent in these populations due to a lack of information about AIDS and to people’s perception that they are not vulnerable, as well as to limited access to health care resources and a higher likelihood of sexual contact with at-risk male sexual partners.1
Globally, more than 30 million people are infected with HIV. Sub-Saharan Africa remains by far the worst affected region. In 2007 it accounted for an estimated 68% of all people living with AIDS and 76% of all AIDS deaths, with 1.7 million new infections bringing the number of people there living with HIV to 22.5 million; there are also 11.4 million AIDS orphans living in the region. Adult prevalence in 2007 was an estimated 5.0%, and AIDS continued to be the single largest cause of mortality in this region.1
AVOID CONTRACTING HIV
While this chapter focuses on treatment for HIV infection and AIDS, those who are not HIV-positive should take the following steps in order to avoid contracting the virus:
• Do not have sexual intercourse with people who are known to have or are suspected of having HIV or who use intravenous drugs.
• Practice safe sex.
• Do not share a toothbrush, a razor, or any other implement that could become contaminated with blood from someone with an HIV infection.
• Do not share needles with others.
HIV
The human immunodeficiency virus (HIV) is now regarded as the primary causative agent in AIDS by virtually every expert in the field. Our perspective is that nutritional status, lifestyle, and mental/emotional state play significant roles in the progression of HIV to AIDS, as does the susceptibility to infection in the first place.
Classified as a retrovirus, HIV has the ability to insert its RNA into human DNA through the activity of an enzyme called reverse transcriptase. When the cell is activated, the inserted DNA produces new viruses. The cells most affected by this process are the T4 inducer/helper subset of lymphocytes. HIV is highly selective for and easily isolated from these white blood cells, but it is also found in other white blood cells. It actively replicates in these cells, especially when they are activated to mount a response to an infection. This infection-replication process renders the T cells nonfunctional, eventually destroying them and dramatically reducing their number, thus contributing to the profound disruption of the immune system.
Therapeutic Considerations
Conventional medical management of HIV/AIDS is continually changing but basically revolves around two treatment principles: (1) inactivate or slow the replication of HIV, and (2) provide antibiotics to patients with abnormally low CD4 counts. Progress was made in the treatment of AIDS in 1996 with the use of highly active anti-retroviral therapy (HAART). The five main classes of HAART that are currently being used in the care of HIV-positive patients in various combinations are:
1. Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs, or “nukes”)
2. Non–nucleoside reverse transcriptase inhibitors (NNRTIs, or “non-nukes”)
3. Protease inhibitors (PIs)
4. Entry inhibitors (including fusion inhibitors and CCR5 inhibitors)
5. Integrase inhibitors
The use of these drugs appears to be very much appropriate in HIV-positive patients with CD4 counts less than 500. More controversial is the use of these drugs in HIV-positive patients showing no signs of immune deficiency. Our current recommendation for HIV-positive individuals is to monitor immune function by having CD4 counts every six months as long as levels stay above 500 and every three months if levels drop below 500. There are also specialized tests to measure viral load and activity (such as p24 antigen levels, PCR-based HIV-RNA levels) that can be used as monitors.
In short, at this time we recommend conventional therapies for all individuals with CD4 counts below 500. That isn’t to say that natural measures should be abandoned at this point. Quite the contrary—with HIV infection, it is absolutely vital to employ aggressive natural measures that promote good health and immune function from the very start, and certainly when AIDS develops. It is important to remember that the HIV virus does not kill. It is the opportunistic infections allowed by a suppressed immune system that set into motion an accelerating downward spiral that ultimately results in death.
The basic therapeutic goals from a natural perspective are to optimize nutrition and enhance immune function. Studies indicate that more than 70% of HIV-positive persons are using some form of complementary or alternative medicine in their treatment, resulting in improvement in quality of life and better outcomes. Our goal is to provide some guidance in navigating the best course.
The immune system requires a constant supply of nutrients to function properly. Unfortunately, in this regard the AIDS patient has many obstacles to overcome, chief among them gastrointestinal tract infection and the wasting (muscle breakdown) promoted by the progressing infection. It is easier to institute nutritional therapies early on instead of after AIDS has developed.
There is a very strong association between nutritional status, immune function, and the progression from HIV to AIDS.2–4 It is vitally important to supply optimal levels of all nutrients. There is considerable debate over what is optimal for the general population, but there is a growing consensus that HIV/AIDS patients require higher levels of virtually all known nutrients. While recommendations here are in line with those in the chapter “Supplementary Measures,” aggressive supplementation is necessary. Supplementation with multiple vitamin and mineral formulas has shown significant value in improving immune status and delaying progression to AIDS in HIV-positive patients.5–8
The HIV-positive individual should consume a diet that promotes health, as defined in the chapter “A Health-Promoting Diet.” The diet should be rich in whole, natural foods, such as fruits, vegetables, grains, beans, seeds, and nuts, and should be low in fats and refined sugars; it is important to consume adequate but not excessive amounts of protein. On top of this, individuals are encouraged to drink five or six 8-fl-oz glasses of water per day. These dietary recommendations, along with a positive mental attitude, a good high-potency multivitamin-mineral supplement, a regular exercise program, daily deep breathing and relaxation exercises (meditation, prayer, etc.), and at least seven to eight hours of sleep per day will go a long way in helping the immune system function at an optimal level—a critical goal in HIV/AIDS.9–12
HIV-positive patients commonly require digestive support and may require the use of digestive enzymes to combat the adverse effects of HIV, HAART, and prophylactic antibiotics on the GI system.13,14 For information on the use of digestive enzymes, see the chapter “Digestion and Elimination.” HIV-positive patients should avoid high-sodium foods, high-fructose corn syrup in processed foods, alcohol, caffeine, and fried foods as well as raw eggs, unpasteurized milk, undercooked meat or fish, and any potentially contaminated food.
Diarrhea is a common complaint and an issue that can greatly affect quality of life. There are many reasons an HIV-positive person might develop diarrhea, and the specific cause guides the choice of treatment. Since there is an increased incidence of gluten intolerance in HIV-positive individuals, all sources of gluten should be eliminated in any HIV-positive patient with diarrhea (see the chapter “Celiac Disease” for more information).15 Lactose intolerance often develops in cases of chronic diarrhea, and so all milk and dairy products containing lactose should also be eliminated. The recommendations given in the chapter “Diarrhea” are appropriate in most cases, especially the use of probiotics.16,17
In addition to these basic recommendations, the person with HIV/AIDS has higher protein requirements. While the typical person does quite well with 0.8 g protein per kg of body weight, the individual with HIV/AIDS requires at least 1.5 g per kg.18 Supplementing the diet with whey protein, which is high in the amino acid glutamine, appears particularly useful in AIDS because of its possible ability to address the wasting syndrome of AIDS as well as its ability to heal the gastrointestinal tract and increase the level of the important antioxidant glutathione within body cells.19,20
Wasting syndrome (severe breakdown of body tissues) is a common complication of HIV infection and is marked by progressive weight loss and weakness, often associated with fever and diarrhea. The mechanisms responsible for this syndrome are not well defined, but it is clear that this is a multifactorial process. Contributors to wasting syndrome include inadequate dietary protein intake, malabsorption, increased metabolism, and increased levels of inflammatory compounds, known as cytokines, secreted by the immune system (e.g., tumor necrosis factor, interleukins, and alpha-interferon). These cytokines stimulate the breakdown of fat and muscle.
PROTEIN FOR AIDS PATIENTS
In order to assess the quality of a protein, scientists measure the proportion of the amino acids that are absorbed, retained, and used in the body. These determine the protein’s biological value. The protein with the highest biological value is found in whey, a natural by-product of the cheesemaking process. Cow’s milk has about 6.25% protein. Of that protein, 80% is casein (another type of protein), and the remaining 20% is whey protein. Cheese making uses the casein molecules, leaving whey. Whey protein is collected by filtering off the other components of whey, such as lactose, fats, and minerals.
Whey protein is a complete protein, in that it contains all essential and nonessential amino acids. One of the reasons the biological value of whey protein is so high is that it has the highest concentrations of glutamine and branched-chain amino acids found in nature; these substances are critical to cellular health, muscle growth, and protein synthesis.
Although the most popular use of whey protein is by bodybuilders and athletes looking to increase their protein intake, whey protein can also be used to support recovery from surgery, to offset some of the negative effects of radiation therapy and chemotherapy, and to help prevent wasting syndrome seen in both cancer and AIDS.
The protein found in eggs is a close second to whey protein.
Biological Value of Selected Protein Sources |
|||
PROTEIN SOURCE |
BIOLOGICAL VALUE |
||
Whey (ion exchange, microfiltered) |
100 |
||
Whole egg |
93.7 |
||
Milk |
84.5 |
||
Fish |
76.0 |
||
Beef |
74.3 |
||
Soybeans |
72.8 |
||
While general broad-spectrum nutritional support is required, including a high-potency multiple vitamin and mineral formula, there are several nutrients that deserve special attention.
• Vitamin A (15,000–30,000 IU taken with food) slows progression to AIDS and decreases mortality, improves growth in infants and decreases stunting associated with chronic diarrhea, and prevents GI deterioration in mothers and infants.21,22
• Beta-carotene (60–120 mg [150,000 IU] taken with food) increased CD4+ count, CD4/CD8 ratios, and total lymphocyte count; it also decreased mortality.23 Deficiency found in all HIV+ patients is likely to be due to poor digestion, decreased free radical elimination, and high lipid peroxidation.24
• Folic acid (400 mcg) is important to offset the toxicity of the drug AZT on red blood cell formation.25,26
• Thiamine (vitamin B1, 50 mg) supplementation is associated with increased survival in HIV+ patients and decreased progression to AIDS.27–29
• Vitamin B6 (50 mg) is essential in nucleic acid and protein metabolism and cellular and humeral immune responses.30,31 B6 supplementation both alone and in conjunction with CoQ10 increased circulating IgG, CD4+ cells, and CD4/CD8 ratios.32
• Vitamin B12 (1,000 mcg per day) can improve lymphocyte counts, CD4/CD8 ratios, and NK cell activity.33 Supplementation has also been found to reverse AIDS dementia complex when that condition is associated with low levels of the vitamin.34 Deficiency has been associated with increased risk of progression to AIDS.35–37
• Vitamin C (500 to 1,000 mg three times per day) has been shown in test tube studies to exert some beneficial effects against HIV replication. Other studies have shown that HIV-positive people with the highest levels of vitamin C intake had the slowest progression to AIDS.4,38
• Vitamin E (400 to 800 IU per day as mixed tocopherols) also slows down the progression of HIV to AIDS.39–42 Men with the highest levels of vitamin E in their blood showed a 34% decrease in risk of progression to AIDS compared with those with the lowest levels. Deficiency is found in most HIV+ patients, with wasting, and in progression to AIDS.43
• Vitamin D deficiency is commonly found in urban HIV-infected men with suppressed viral load and a CD4 count over 200; tobacco use was correlated with severe deficiency.44 Undetectable levels of vitamin D in HIV-positive patients correlated with more advanced HIV infection, lower CD4 count, and higher levels of inflammation.45 Recommended dosage is 5,000 IU.
• Copper (2 mg) can inhibit HIV protease and viral replication.46 Deficiencies of copper are associated with AZT therapy and AIDS.47,48
• Magnesium deficiency is found in AIDS patients.49,50 Recommended dosage is 300 mg.
• Selenium (400 mcg) suppresses the progression of HIV, reduces viral burden, and provides indirect improvement of CD4 count.51 Selenium supplementation has been shown to decrease HIV-associated mortality, reduce the number of hospitalizations, and lower the costs of caring for HIV-positive patients.52–54 Deficiency in patients progressing to AIDS may be due to decreased caloric and protein intake, malabsorption, and various infections.55
• Zinc (15–30 mg) has been found to decrease frequency of infections.56,57 Zinc deficiency is very common in HIV+ patients progressing to AIDS.58
Antioxidants
Numerous studies have shown that individuals infected with HIV have a compromised antioxidant defense system.59 Furthermore, HAART is associated with oxidative damage to cellular components, including mitochondria.60 Blood levels of antioxidants are decreased in HIV-positive patients, and peroxidation products of lipids (fats) and proteins are increased. This blood profile may contribute to the progression of AIDS, because antioxidants such as glutathione prevent viral replication, while reactive oxidants tend to stimulate the virus. Consequently, it has been suggested that HIV-infected patients may benefit from antioxidant supplementation therapy. Antioxidant therapy, especially vitamin E and selenium, does in fact appear to slow down the progression from HIV to AIDS as well as offset the free radical damage caused by HAART.39–42,51,61
One of the more controversial antioxidants in HIV infection is N-acetylcysteine (NAC). It was proposed that NAC may act as an effective antioxidant and raise tissue glutathione levels in AIDS patients at dosages of 2 to 8 g per day.62–64 However, supplementation at a dosage of 1.8 g NAC failed to increase glutathione in white blood cells in patients with AIDS.65 Nonetheless, NAC inhibits HIV replication. Better options to raise glutathione levels may be vitamin E, beta-carotene, vitamin C, selenium, and alpha-lipoic acid.
Alpha-lipoic acid (also known as thioctic acid) is a sulfur-containing vitamin-like substance that plays an important role as the necessary cofactor in two vital energy-producing reactions involved in the production of cellular energy. Alpha-lipoic acid is not considered a vitamin because it is thought that either the body can usually manufacture sufficient levels or the nutrient can be acquired in sufficient quantities from food. However, as with many of the other compounds described in this section, a relative deficiency can occur in certain situations, and alpha-lipoic acid supplementation provides benefits beyond its role in normal metabolism. Alpha-lipoic acid is an effective antioxidant, unique in that it is effective against both water-soluble and fat-soluble free radicals.
Based on alpha-lipoic acid’s antioxidant effects as well as its ability to significantly inhibit the replication of HIV by reducing the activity of reverse transcriptase, it was suggested that it might be of value in HIV-positive patients.66,67 To test this hypothesis, a small pilot study was designed to determine the short-term effect of alpha-lipoic acid supplementation (150 mg three times per day) in HIV-positive patients.68 Alpha-lipoic acid supplementation increased plasma ascorbate in 9 of 10 patients, total glutathione in 7 of 7 patients, total plasma sulfur groups in 8 of 9 patients, and T helper lymphocytes and T helper/suppressor cell ratio in 6 of 10 patients, while the lipid peroxidation product malondialdehyde decreased in 8 of 9 patients. The results of this pilot study indicated that alpha-lipoic acid supplementation led to significant beneficial changes in the blood of HIV-infected patients. Perhaps the most significant of these effects was the increase in the glutathione content, since the level of glutathione is directly linked to preventing the progression to AIDS. Alpha-lipoic acid (600 mg) protected the liver, inhibited viral replication, increased intracellular glutathione, and increased CD4/CD8 ratios; it has the potential to decrease peripheral neuropathy pain because of its antioxidant effect on nervous tissue.
Coenzyme Q10 also seems to be an important consideration. CoQ10 levels are often deficient in HIV-positive patients, leading to impaired energy production. Supplementation with CoQ10 increases circulating antibodies, helper T cells, and CD4/CD8 ratios in normal subjects and may produce similar effects in HIV-positive patients.69,70
Carnitine
Several reports indicate that systemic carnitine deficiency may be a problem in patients with AIDS. Reduced levels of carnitine are often found in the blood and blood cells in AIDS patients. Increasing the carnitine content of the white blood cells has been shown to strongly improve their function, a finding that highlights the importance of carnitine to the immune system.71
Carnitine has also been shown to prevent the toxicity of the drug AZT on muscle cells. AZT poisons the mitochondria of the muscle, leading to abnormal energy production within the muscle, which manifests itself clinically as muscle fatigue and pain. Because L-carnitine is able to prevent this negative effect of AZT and similar drugs, it is critically important in these patients.72–74
Clinical studies indicate that carnitine supplementation can improve immune function. When AIDS patients being treated with AZT were given 6 g L-carnitine per day, it led to significant increased white blood cell proliferation and reduced circulating tumor necrosis factor—a known trigger of HIV replication.75 Supplementation has also been shown to be effective for the painful peripheral nerve pain common to HIV-positive patients.76
There are many different herbs and herbal components that are showing great promise as antiviral agents active against HIV. In our opinion, the three that are presented here offer the most promise.
Milk Thistle
Milk thistle (Silybum marianum) extract (silymarin) is strongly indicated for all patients on HAART to improve liver function, decrease liver damage, and increase antioxidant activity of blood cells. Even HIV-positive individuals not on HAART may benefit from the liver support provided by milk thistle. For more information see the chapter “Hepatitis.”
Curcumin from Turmeric
HIV infection and progression to AIDS are associated with activation of a latent virus. This activation is governed by the long terminal repeat (LTR) sequence in the viral DNA. The virus remains in an inactive form until the LTR tells it to replicate. Whether or not LTR signals the latent provirus to become active is determined by a complex interaction of positive and negative regulators that bind to specific sites within the LTR. It is thought that if the stimuli that activate LTR can be reduced while, simultaneously, compounds that block activation of LTR are used, the progression of HIV infection or AIDS could be halted or at least delayed.
In March 1993, researchers at Harvard Medical School published results of a study showing that curcumin inhibits the replication of HIV by blocking LTR expression.77 Curcumin is the yellow pigment and active ingredient of the spice turmeric (Curcuma longa), an important ingredient in curry. The research may have been performed as a follow-up to a population study in Trinidad. About 40% of Trinidad’s population is of Indian descent and these Trinidadians use curry extensively in their diet. Another 40% of the population is of African descent; these people rarely use curry. Population studies in Trinidad indicated that people of African descent were more than 10 times as likely to have HIV as people of Indian descent. Whether this was due to dietary factors or culturally determined sexual behaviors remains to be shown; however, given the recent antiviral studies with curcumin, a strong case could be made for the former.
In another study, curcumin was shown to inhibit HIV integrase, the enzyme that integrates a double-stranded DNA copy of the RNA genome, synthesized by reverse transcriptase, into a host chromosome.78,79 Curcumin has also been shown to inhibit other factors that stimulate HIV to replicate, such as tumor necrosis factor (TNF) and NF-kappa B.80–82 TNF, a chemical mediator of inflammation, is part of the immune system’s inflammatory response, which, when working properly, is used to kill disease-causing organisms. TNF production, however, triggers the production of NF-kappa B, a chemical messenger that plays a critical role in initiating HIV replication.
In addition, curcumin is a powerful antioxidant showing activity as much as 300 times greater than that of vitamin E. Preliminary studies of its effect on HIV/AIDS are encouraging. For example, in a controlled clinical study, a group of 18 HIV-positive patients with CD4 counts ranging from 5 to 615 took an average of 2,000 mg curcumin per day.83 This regimen resulted in an increase in CD4 counts compared with control treatment. Unfortunately, with the development of HAART, the interest in curcumin as an anti-HIV agent has waned. The only other clinical study of curcumin evaluated its effect in eight patients with HIV-associated diarrhea, who were given an average daily dose of 2,000 mg curcumin and followed for an average of 41 weeks.84 All had resolution of diarrhea and normalization of stool quality, usually within two weeks. The average number of bowel movements per day dropped from 7 to 1.7. Seven of eight patients also had considerable weight gain on curcumin (10.8 lb). Five of six patients had resolution of bloating and abdominal pain. Patients on anti-retroviral therapy experienced no discernible drug interactions, changes in CD4 count, or changes in HIV viral load while taking curcumin.
The curcumin content of turmeric is about 1%. To reach an effective dosage (1.2 to 2 g per day) of curcumin, a person would need to consume 100 to 200 g (roughly 3 to 6 oz) of turmeric. For this reason, pure curcumin preparations are preferred to turmeric when medicinal effects are desired. Although the benefit of curcumin in HIV and AIDS remains to be proved, given the safety of curcumin along with its possible benefit, supplemental curcumin makes sense.
One concern regarding curcumin has been absorption, but there now exist a number of methods and products that enhance the absorption of curcumin. One of those methods is complexing the curcumin with soy phospholipids, as in the product Meriva. Absorption studies in animals indicate that peak plasma levels of curcumin after administration of Meriva were five times higher than those after administration of regular curcumin.85 Studies with another advanced form of curcumin, Theracurmin, show even greater absorption.86
Turmeric can be consumed liberally in the diet, but since curcumin is so poorly absorbed, Meriva at a dosage of 1,000–1,200 mg per day or Theracurmin at a dosage of 300 mg per day may produce significantly better clinical results.
Licorice
The primary active components of licorice (Glycyrrhiza glabra) root are glycyrrhizin and its backbone structure glycyrrhetinic acid (glycyrrhizin minus a small sugar molecule). These are showing promise in the treatment of AIDS as well as chronic hepatitis (see the chapter “Hepatitis”). Although much of the research has featured intravenous administration, this route of administration may not be necessary, as glycyrrhizin and glycyrrhetinic acid are easily absorbed orally and well tolerated.
The benefit of oral administration is most evident in a recent double-blind study on the clinical effectiveness of glycyrrhizin by long-term oral administration to 16 hemophiliac patients who were HIV-positive.87 The patients received daily doses of 150 to 225 mg glycyrrhizin for three to seven years. Helper T cell and total T cell numbers, other immune system indicators, and glycyrrhizin and glycyrrhetinic acid levels in the blood were monitored. The results indicated that orally administered glycyrrhizin was converted into glycyrrhetinic acid without producing any side effects. None of the patients given the glycyrrhizin suffered progression to AIDS or deterioration of immune function. In contrast, in the group not receiving glycyrrhetinic acid showed decreases in helper and total T cell counts and antibody levels. Two of the 16 patients in the control group developed AIDS.
Glycyrrhizin in HIV-positive and AIDS patients produces almost immediate improvement in immune function. In one study, nine symptom-free HIV-positive patients received 200 to 800 mg glycyrrhizin intravenously per day. After eight weeks, the groups had increased CD4 count, improved CD4/CD8 ratio, and improved liver function. In another study, six AIDS patients received 400 to 1,600 mg glycyrrhizin intravenously per day. After 30 days, five of the six showed a reduction or disappearance of the P24 antigen (an indicator of viral load and severity of active disease).88
In a more recent study, high-dose glycyrrhizin (Stronger Neo-Minophagen C, SNMC) was shown to prevent the liver damage produced by HAART in four hemophiliacs infected with both HIV and hepatitis C. Two of the patients had previously had to discontinue HAART because of the liver damage. After SNMC administration, these patients were able to resume HAART.89
The results of these studies and others with HIV-positive and AIDS patients are encouraging. The big concern is that licorice root at a dosage of more than 3 g per day or glycyrrhizin at more than 100 mg per day for more than six weeks may cause sodium and water retention, leading to high blood pressure. Monitoring of blood pressure and increasing dietary potassium intake are suggested.
Regular exercise has been demonstrated to provide benefit to individuals with immunodeficiency diseases, particularly through stress alleviation and mood enhancement. HIV-positive individuals had increases in CD4, CD8, and natural killer (NK) cells immediately following aerobic exercise, and long-term exercise has demonstrated increases in other immune indicators.90,91 HIV-positive individuals practicing tai chi demonstrated greater overall perception of health and significant improvements in several measures of physical function when compared with controls.92 Other patients practicing yoga reported increased self-confidence and quicker return to athletic activities after medical interventions.93
QUICK REVIEW
• Acquired immunodeficiency syndrome (AIDS) is characterized by a profound defect in cell-mediated immunity.
• The HIV virus does not kill; what it does is cripple the immune system to such an extent that a person dies from severe infection or cancer.
• Nutritional status, lifestyle, and mental/emotional state play significant roles in the progression of HIV to AIDS.
• At this time we recommend that conventional therapies be used for all individuals with CD4 counts below 500.
• There is a very strong association between nutritional status, immune function, and the progression from HIV to AIDS.
• Optimal levels of all nutrients are vitally important in patients with HIV/AIDS.
• Supplementation with multiple vitamin and mineral formulas has shown significant value in improving immune status and delaying progression to AIDS in HIV-positive patients.
• Supplementing the diet with whey protein appears particularly useful in AIDS because of its possible ability to address the wasting syndrome of AIDS as well as its ability to heal the gastrointestinal tract and increase the level of the important antioxidant glutathione within body cells.
• Numerous studies have shown that individuals infected with HIV have a compromised antioxidant defense system.
• Antioxidant therapy, especially vitamin E and selenium, does in fact appear to slow down the progression from HIV to AIDS as well as offset the free radical damage caused by HAART.
• Alpha-lipoic acid is demonstrating extremely encouraging results in HIV patients.
• Clinical studies indicate that carnitine supplementation can improve immune function and reduce the level of HIV-induced immune suppression.
• Milk thistle extract (silymarin) is strongly indicated for all patients on HAART to improve liver function, decrease liver damage, and increase antioxidant activity of blood cells.
• Curcumin exhibits potent anti-HIV activity and is showing promise in clinical trials.
• Licorice components have shown tremendous benefits in clinical studies.
• HIV-positive individuals had increases in CD4, CD8, and natural killer cells immediately following aerobic exercise, and long-term exercise has demonstrated increases in other immune indicators.
TREATMENT SUMMARY
The goal of treatment for HIV-positive individuals is to slow down the progression of HIV to AIDS. That goal is accomplished by optimizing nutritional status, following a health-promoting lifestyle, and employing measures to enhance immune function. In the treatment of AIDS the goal shifts to supporting the conventional therapies available at this time. It is particularly important to maintain high nutritional and antioxidant status.
• Perform a relaxation exercise (deep breathing, meditation, prayer, visualization, etc.) for 10 to 15 minutes each day.
• Get regular exercise (non-strenuous walking, tai chi, stretching, etc.).
• Follow the dietary recommendations in the chapter “A Health-Promoting Diet.”
• Consume adequate amounts of protein; consider supplementation with a high-quality whey protein at a dosage of 1 g/kg.
• Eliminate alcohol, caffeine, and sugar.
• Drink at least 48 fl oz water per day.
• A high-potency multiple vitamin and mineral formula as described in the chapter “Supplementary Measures”
• Key individual nutrients:
Vitamin C: 500 to 1,00 mg three times per day
Vitamin E: 400 to 800 IU per day
Vitamin D: 5,000 IU per day (ideally, measure blood levels and adjust dosage accordingly)
Carotene complex: 50,000 to 100,000 IU per day
Methylcobalamin (active form of vitamin B12): 1,000 mcg per day
• Flaxseed oil: 1 tbsp per day
• Fish oils: 3,000 mg EPA + DHA per day
• One of the following:
Grape seed extract (>95% procyanidolic oligomers): 100 to 300 mg per day
Pine bark extract (>95% procyanidolic oligomers): 100 to 300 mg per day
Some other flavonoid-rich extract with a similar flavonoid content, super greens formula, or another plant-based antioxidant that can provide an oxygen radical absorption capacity (ORAC) of 3,000 to 6,000 units or higher per day
• Probiotic (active lactobacillus and bifidobacteria cultures): a minimum of 5 billion to 10 billion colony-forming units per day
• Specialty nutrients:
Alpha-lipoic acid: 150 mg three times per day.
Carnitine: 2,000 mg one to three times per day
• Milk thistle (Silybum marianum):
The standard dose of milk thistle is based on its silymarin content. For this reason, standardized extracts are preferred. The best results are achieved at higher dosages, i.e., 140 mg to 210 mg silymarin three times per day. The dosage for silymarin phytosome is 120 mg two to three times per day between meals.
• Curcumin, one of the following:
Curcumin: 600–800 mg three times per day with meals
Meriva: 1,000 to 1,200 mg per day
Theracurmin: 300 mg per day
• Licorice root (Glycyrrhiza glabra), one of the following:
Powdered root: 1 to 2 g three times per day
Fluid extract (1:1): 2 to 4 ml three times per day
Solid (dry powdered) extract (10% glycyrrhetinic acid content): 250 to 500 mg three times per day
Note: If licorice is to be used over a long period of time, increase the intake of potassium-rich foods.