HIV Disease and AIDS

Overview: HIV Disease and 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.

Important Points to Consider: HIV Disease and AIDS

Also see AIDS covered in another article

• St. John's wort increases cytochrome P-450 activity and can reduce serum levels of medications metabolized by this system. It can decrease indinavir levels up to 57%.

Immune Support Formula for HIV Infection Found in K-PAX Formulation

Prevention Prescription: HIV and AIDS

• Encourage a commitment to safe sex practices.

• Educate on the dangers of intravenous drugs.

• Provide for prompt prophylaxis of needle stick injuries in health care workers. For high-risk individuals, this involves lamivudine/zidovudine (Combivir) a 150/300-mg tablet orally twice daily for 4 weeks.

Therapeutic Review

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

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

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

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

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

Botanicals

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

• Red rice yeast: 1200 mg twice daily for hyperlipidemia.

• Use of Chinese herbal formulas in patients not meeting criteria for pharmaceutical treatment.

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

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