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Nonvitamin, Nonmineral Dietary Supplementation in HIV-Positive People

Nonvitamin, Nonmineral Dietary Supplementation in HIV-Positive People. Nutrition in Clinical Practice 22:679-687, December 2007 American Society for Parenteral and Enteral Nutrition. Nonvitamin / Nonmineral (NVNM). Dietary supplement Herbs Botanicals Concentrates Metabolites

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Nonvitamin, Nonmineral Dietary Supplementation in HIV-Positive People

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  1. Nonvitamin, Nonmineral Dietary Supplementation in HIV-Positive People Nutrition in Clinical Practice 22:679-687, December 2007 American Society for Parenteral and Enteral Nutrition

  2. Nonvitamin/Nonmineral (NVNM) • Dietary supplement • Herbs • Botanicals • Concentrates • Metabolites • Constituents • Extracts • Most common • echinacea, gingko biloba

  3. HIV-infected population • ~15% used herbal medicine • Questions to ask… • How the components of these pills will interact with conventional medicine and alter patient care? • How the financial burden of these supplements will affect the patient.

  4. Therapy for HIV/AIDS • Health maintenance • Control of viral replication • Highly active antiretroviral therapy (HAART) • Questions to ask… • Do supplements interfere with HAART metabolism? • What supplements the HIV-infected population is taking? • What is the interaction with HIV medications and disease process?

  5. Objective • Describe current NVNM supplement use of HIV-infection people • Financial burden of buying these supplements • Review current literature on potential interaction between NVNM supplements

  6. Methods • Nutrition for Healthy Living study • Subjects: • Boston area/ Rhode Island • 1995 to 2002 • Documentation of HIV infection • Age >18 years

  7. Data Collection • Data • Medical • Nutrition • Dietary intake • Body composition • Quality of life • Met with a registered dietitian • Educated on keeping a 3-day food record

  8. Study Design • Cross-sectional • Population: • HIV-infected patients in the NFHL study • Duration: • 9/1/2001 to 9/1/2002

  9. Results • 72 subjects out of 368 reported consumption of NVNM supplements • 24% men, 8% women • Caucasian • Education: at least a high school diploma • A mean of 6 NVNM supplements per subject

  10. NVNM supplements • Most common • Glutamine (51%) • N-acetyl-cysteine (36%) • Fish oil (33%) • Alpha-lipoic acid (32%) • Acetyl-L-carnitine (28%) • Coensyme Q10 (28%)

  11. Vitamin/Mineral • Most common • Multivitamin / Multimineral (83%) • Vitamin E (51%) • Vitamin C (47%) • Vitamin B complex (43%) • Calcium (29%) • Selenium (28%)

  12. Discussion • Supplement users • Take an average of 4 VM + 6 NVNM • White • Well-educated • High incomes • Secure housing • Not IV drug users • Receive appropriate HIV/AIDS therapy • Diet • High fiber and protein • More calories from polyunsaturated and monounsaturated fatty acids

  13. Glutamine • Functions • Increased body weight • Increased body cell mass • Increased interacellular water • Provide a highly cost-effective therapy for HIV patients

  14. N-acetyl-cysteine (NAC) • Glutathione precursor • Sulfur containing amino acid • Functions • Restore cysteine and glutathione levels • Inhibit the replication of HIV virus

  15. Fish Oil • Polyunsaturated fatty acid • Eicosapentaenoic acid (EPA) • Docosahexaenoic acid (DHA) • Functions • Lower triglyceride levels • Decrease mortality • Lower blood pressure

  16. Alpha-lipoic acid (ALA) • Vitamin-like antioxidant • Nonessential nutrient • Functions • Treatment of diabetic polyneuropathy • Inhibit the replication of HIV

  17. Acetyl-L-carnitine • Transports long-chain fatty acids across the inner mitochondrial membrane in the form of acetyl carnitine • Functions • Promote energy metablosim • Promote regeneration of nerves • May prevent cell death of CD4 cells

  18. Coenzyme Q10 • Vitamin-like fat-soluble substance • Functions • Produce energy needed for cell growth and maintenance • Antioxidant

  19. Conclusions • NVNM supplement use is common in HIV patients • Estimated cost : $25-40 / week • May involve some risk • Further research is necessary

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