Article

Studies of vitamins and minerals and HIV transmission and disease progression

Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
Journal of Nutrition (Impact Factor: 4.23). 05/2005; 135(4):938-44.
Source: PubMed

ABSTRACT HIV-1 infection is having a devastating impact on people in developing countries. Poor nutrition and HIV-related adverse health outcomes contribute to a vicious cycle that may be slowed down by using nutritional interventions, including vitamins and minerals. Among children, periodic supplementation with vitamin A starting at 6 mo of age has been shown to be beneficial in reducing mortality and morbidity among both HIV-infected and uninfected children. Limited data exist on the role of other nutrient supplements among children. Among HIV-infected adults, the safety and the efficacy of vitamin A supplements need further study, although adequate dietary intake of this essential nutrient is recommended. Multivitamin supplements were efficacious in reducing adverse pregnancy outcomes and early childhood infections, and is currently provided to pregnant HIV-infected pregnant women in many programs. The efficacy of such supplements among HIV-negative pregnant women needs further study. Daily multivitamin supplements were found to reduce HIV disease progression among men and women in several observational studies and randomized trials, and to provide an important low-cost intervention that could be provided to adults in early stages of HIV disease to prolong the time before antiretroviral therapy is recommended. Next, research priorities include examining the roles of minerals, including selenium, in HIV infection, as well as determining the safety and the efficacy of micronutrient supplements among individuals who are advanced in their disease and who are receiving antiretroviral therapy.

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    • "However, more research is needed before specific recommendations can be made. Fawzi et al (2005) underscored that poor nutrition and HIV-1 related adverse health outcomes contribute to a vicious cycle that may be slowed down by using nutritional interventions, including vitamins and minerals. Among children, periodic supplementation with vitamin A starting at six months of age has been shown to be beneficial in reducing mortality and morbidity among both HIV-1-infected and uninfected children. "
    HIV and AIDS - Updates on Biology, Immunology, Epidemiology and Treatment Strategies, 10/2011; , ISBN: 978-953-307-665-2
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    • "In another randomized, doubleblinded , placebo-controlled trial, the co-administration of a trace mineral and antioxidant-rich supplement to patients on highly active antiretroviral therapy (HAART) led to significantly increased immune reconstitution at 12 weeks, as indicated by a 24% increase in absolute CD4 count in the micronutrient group, versus a 0% change in the (HAART-only) placebo group (P = 0.01); (Kaiser et al., 2006). A comprehensive retrospective of the evidence for the role of nutritional factors in HIV disease pathogenesis and treatment is not my goal here, as there are already a number of recent reviews, some focused on specific nutrients or types of nutrients, and others looking at the broader spectrum of nutrition in HIV/AIDS (Allard et al., 1998; Baum, 2000; Baum and Shor-Posner, 1998; Coodley et al., 1993; Drain et al., 2007; Fawzi et al., 2005; Lanzillotti and Tang, 2005; Patrick, 1999; Singhal and Austin, 2002; Tang et al., 1996; Taylor et al., 2000). The conventional viewpoint is that dietary supplementation is beneficial in HIV infection simply because certain micronutrients are particularly important for proper functioning of the immune system. "
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    ABSTRACT: Although several specific micronutrient deficiencies are associated with disease progression and increased mortality risk in HIV/AIDS, and even a simple multivitamin/mineral supplement can prolong survival, this is typically viewed merely as nutritional support of the immune system, and only necessary if there are deficiencies to be rectified. However, the reality is more complex. Several striking nutrient-related metabolic abnormalities have been consistently documented in HIV infection. One is chronic oxidative stress, including a drastic depletion of cysteine from the glutathione pool, and a progressive decline of serum selenium that is correlated with disease progression and mortality. Another is decreased blood levels of tryptophan, with an associated intracellular niacin deficiency. Tryptophan depletion or “deletion” by induction of indoleamine-2,3-dioxygenase (IDO), the first step in oxidative tryptophan metabolism, is a known mechanism for immune suppression that is of critical importance in cancer and pregnancy, and, potentially, in HIV/AIDS. Existing evidence supports the hypothesis that these nutrient-related metabolic abnormalities in HIV infection regarding antioxidants, selenium, sulfur, tryptophan and niacin are interrelated, because HIV-associated oxidative stress can induce niacin/NAD+ depletion via activation of poly(ADP-ribose) polymerase (PARP), which could lead to tryptophan oxidation for compensatory de novo niacin synthesis, thereby contributing to immune tolerance and T-cell loss via tryptophan deletion and PARP-induced cell death. This “oxidative stress-induced niacin sink” (OSINS) model provides a mechanism whereby the oxidative stress associated with HIV infection can contribute to immunosuppression via tryptophan deletion. This model is directly supported by evidence that antioxidants can counteract indoleamine-2,3-dioxygenase (IDO), providing the critical link between oxidative stress and tryptophan metabolism proposed here. The OSINS model can be used to guide the design of nutraceutical regimens that can effectively complement antiretroviral therapy for HIV/AIDS.
    Toxicology 11/2010; DOI:10.1016/j.tox.2009.10.018 · 3.75 Impact Factor
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    • "Observational studies examining the relationship between individual micronutrients and pregnancy outcome in HIV-infected women have described an association between low plasma concentrations of vitamin A and a higher risk of mother to child transmission of HIV (Fawzi & Msamanga 2004). Although most prospective randomized trials have failed to demonstrate a beneficial effect of vitamin A supplementation in the prevention of transmission of HIV (Fawzi et al. 2005), mothers receiving vitamin A did not have more adverse effects. One notable exception was a study in Tanzania, where supplemented mothers were more likely to transmit HIV to their babies (Fawzi et al. 1999; Wiysonge et al. 2005). "
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    ABSTRACT: To assess the efficacy of weekly zinc or zinc plus retinol as adjuncts for the treatment of pulmonary tuberculosis.   Double-blind, randomized, placebo-controlled trial in 350 patients >15 years old with smear-positive tuberculosis in Nigeria (ISRCTN36636609). In addition to antituberculous treatment, patients were randomly allocated to weekly supplements of zinc (90 mg), zinc plus retinol (5000 IU) or placebos for 6 months. Primary outcomes were time to sputum smear conversion and resolution of radiographic abnormalities. After 8 weeks of treatment, 68% had achieved sputum smear conversion, and the median conversion time was 6.5 weeks. Hazard ratios (HR, 95%CI) for sputum conversion relative to the placebo group were not significant for zinc (1.07, 0.92-1.29) or zinc plus retinol (0.89, 0.76-1.07). Significant predictors of time to sputum conversion were lung abnormality score, sputum smear grade, age and serum C-reactive protein. HIV co-infection and gender were not independent predictors of time to sputum conversion. There were no significant differences between supplement groups in clinical, radiological or laboratory outcomes at 2 months or 6 months. There were 9, 9 and 2 deaths in patients receiving zinc, zinc plus retinol or placebos, respectively. Mortality in those who received zinc (HR 1.71, 0.88-3.58) or zinc plus retinol (HR 1.54, 0.78-3.26) did not differ significantly from those who received placebos. Most deaths occurred in patients co-infected with HIV.   Supplementation with zinc or zinc plus retinol did not lead to better outcomes than placebos, and caution is warranted regarding routine micronutrient supplementation, particularly in patients co-infected with HIV.
    Tropical Medicine & International Health 10/2010; 15(12):1481-90. DOI:10.1111/j.1365-3156.2010.02638.x · 2.30 Impact Factor
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