AIDS

Overview: AIDS

• Acquired immunodeficiency syndrome (AIDS) is a potentially life-threatening disease caused by the human immunodeficiency virus (HIV). HIV infection in humans, considered pandemic by the World Health Organization (WHO), affects approximately 0.6% of the world's population.

• The virus, which is transmitted by sexual contact and contact with blood and certain other body fluids, attacks a class of T lymphocytes called CD4+ cells, macrophages, and dendritic cells and results in severe declines in both number and effective function of this arm of the immune system.

• The result is a dramatically weakened immune system with a host at risk for life-threatening opportunistic infections, including Pneumocystis carinii pneumonia (PCP), Mycobacterium avium-intracellulare sepsis, and cerebral toxoplasmosis, and Kaposi's sarcoma.

• Before the advent of effective antiretroviral medications, AIDS was a fairly progressive and almost universally fatal condition.

Therapeutic Review

If viral load exceeds 30,000, if CD4+ counts fall to less than 500, or if patients are in any way symptomatic ofHIV disease, good practice requires that they be offered combination antiretroviral medication as the mainstayof treatment.

This approach does not preclude the use of integrative strategies as supportive adjuncts and to alleviate certain disease-related or medication-related symptoms.

Pharmaceuticals

Consultation with a physician familiar with the rapidly changing range of medication options is recommended for proper choice of pharmaceutical approaches.

Nutrition

Nutritional consultation early in the course of HIV infection should be recommended.Adequate calorie consumption and an emphasis on high intake of omega-3 essential fatty acids are important elements.Absorption issues should be considered as well.

Supplements and Botanicals

1. Multivitamin daily, emphasizing vitamins B, C,and E and avoiding additional vitamin A

2. L-Carnitine: 2000–3000 mg daily, especially in peripheral neuropathy or lipid disturbance

3. L-Glutamine: 2000 mg daily, especially in chronic diarrhea or malabsorption syndromes

4. Calcium carbonate supplementation: 500 mg twice daily for protease inhibitor–induced diarrhea

5. Milk thistle extract: 240 mg twice daily, in patients with elevated values on liver function tests or coinfection with hepatitis C

6. Red rice yeast: 1200 mg twice daily for hyperlipidemiaUse of Chinese herbal formulas in patientsnot meeting criteria for pharmaceutical treatment

7. High level of awareness among practitioners regarding possible interactions between herbal medicine, especially cytochrome P-450 inducers, and antiretroviral medications

8. Lauric oils (coconut oil) are used by the body to make monolaurin, which inactivates HIV.

9. Selenium deficiency increases the risk of death due to AIDS-related illness. One study found that 250 micro- grams of seleno-methionin daily for one year showed no improvement in CD4 cell counts or disease symptoms. Greater than 1,000 micrograms daily is toxic.

10. Vitamin C has antioxidant and antiretroviral activities. One study found that treatment caused a trend to de- crease viral load.

11. DHEA (dehydroepiandrosterone) is commonly used by AIDS patients to counteract wasting. One study found that DHEA had no effect on lymphocytes or p24 anti- gen levels. However, a 2002 study found that it was associated with a significant increase in measures that indicate mental health improvement.

12. Vitamin A deficiency is associated with increased mortality. One study of pregnant women with AIDS found that 5000 IU of vitamin A daily led to stabilized viral load as compared to a placebo group. Another study found that 60 mg of vitamin A had no effect on CD4 cells or viral load. Vitamin A has been associated with faster disease progression. Excessive vitamin A during pregnancy can cause birth defects.

Beta-carotene supplementation for AIDS is controversial as studies have shown both beneficial and detrimental effects. Beta-carotene supplementation has led to elevation in white blood cell counts and changes in the CD4 cell count. Some studies have found that beta- carotene supplementation led to an increase in deaths due to cancer and heart disease.

Supplements:

• Beta-carotene, 150,000 IU daily

• Vitamin C, 2,000 mg thrice daily

• Vitamin E, 400 IU twice daily

• Cod liver oil, 1 tablespoon daily

• Multivitamin, as directed

• Coenzyme Q10, 50-60 mg twice daily

Herbals and Chinese medicine

One small study of the effectiveness of Chinese herbal treatment in AIDS showed promise. AIDS patients took a tablet that contained 31 herbs that was based on the formulas Enhance and Clear Heat. Disease symptoms were reduced in the herbal treatment group as compared to the placebo group.

• Maitake mushroom extract. Recommended dose is 10 drops twice daily

• Licorice (Glycyrrhiza glabra) solid extract. Recommended dose is one quarter to one half teaspoon twice daily

• Boxwood extract (SPV-30) has antiviral activity. Recommended dose is one capsule thrice daily.

• Garlic concentrate (Allicin) helped reduce bowel movements, stabilized or increased body weight, or cured Cryptosporidium parvum infection in affected AIDS patients. However, a 2002 National Institutes of Health study cautioned that garlic supplements could reduce levels of a protease inhibitor that is used to treat AIDS patients, so patients should discuss using garlic supplements with their physicians.

• Tea tree oil (Malaleuca) improves or cures infection of the mouth by the yeast Candida. Tea tree oil is avail- able as soap, dental floss, toothpick, and mouthwash.

• Marijuana is used to treat wasting. Studies have found that patients who use marijuana had increased food in- take and weight gain. The active ingredient delta-9- tetrahydrocannabinol is licensed for treating AIDS wasting.

Psychotherapy and stress reduction

Many therapies that are directed at improving mental state can have a direct impact on disease severity and quality of life. The effectiveness of many have been proven in clinical studies. These include:

• Massage

• Laughter/humor

• Stress management training

• Visualization

• Cognitive therapy

• Aerobic exercise

• Prayer

Other treatments for AIDS include homeopathy, naturopathy, acupuncture, and chiropractic.

Mind-Body Approaches

• Biofeedback

• Deep relaxation therapy

• Visualization

• Cognitive-behavioral stress reduction training, or another mind-body strategy

Key Web Sources

• National HIV/AIDS Clinicians’ Consultation Center. http://www.nccc.ucsf.edu/

• The Body, a subsidiary of HealthCentral Network. http: //www.thebody.com/index.html

• Johns Hopkins Medicine. http://hopkins-aids. edu/. http://locator.aids.gov/

• National Institutes of Health HIV/AIDS Prevention & Service Provider Locator. www.aidsinfo.nih.gov