Supplements Improve Outcomes for HIV-Positive Patients

Norra MacReady

July 20, 2010

July 20, 2010 (Vienna, Austria) — Nutritional supplementation improves immune function and survival in HIV-infected people, according to findings presented here at AIDS 2010: XVIII International AIDS Conference.

In 3 studies conducted in the United States and Botswana, supplementation with vitamin and mineral antioxidants was associated with longer survival, less immune failure, and better mitochondrial function in CD4+ cells, Marianna K. Baum, PhD, said in a poster session. Dr. Baum, who is professor of dietetics and nutrition at Florida International University in Miami, participated in all 3 investigations.

The first 2 studies were small preliminary trials involving HIV-infected patients in Miami, about half of whom were homeless, Dr. Baum told Medscape Medical News.

They all had normal plasma albumin levels, but 50% to 65% had low levels of zinc or B vitamins, and about one third were deficient in vitamin A. About 20% of these patients also had wasting. "They may not have had frank malnutrition, but their nutritional status wasn't great," Dr. Baum said. Many of these patients obtained their meals from soup kitchens, and if they did not feel up to standing in long lines or sitting in the hot Florida sun, they might go several days without food, she noted.

In the first study, the investigators examined the effect of zinc supplementation on the prevention of immune failure in 40 HIV-positive adults on antiretroviral therapy (ART). The participants, all of whom had an undetectable viral load, were randomly assigned to receive zinc or placebo and were followed for 18 months. Immune failure was defined as a CD4 cell count below 200 cells/mm3.

Over the 18 months, 4 patients in the placebo group (21%) experienced immune failure, compared with none in the zinc group (0%; P = .043). Dr. Baum and her coauthors conclude that zinc supplementation is safe and might prevent immunologic failure in HIV-positive patients on stable ART.

HIV infection and long-term ART use increase cellular oxidative stress and might damage mitochondria, which can have implications for immune function, Dr. Baum said.

In the second study, conducted on a different but similar population, she and her colleagues randomized 13 patients to supplementation with multiple antioxidants, including vitamins C, E, and B complex, selenium, N-acetyl cysteine, and alpha-lipoic acid, as well as zinc, and compared outcomes with those in 12 patients given a placebo for 8 weeks.

Over that time period, patients receiving the antioxidants had increased CD4% (β = 8.61; P = .06), CD4/CD8 ratio (β = .277; P = .09), and activity of complex IV, an enzyme involved in oxidative phosphorylation within the mitochondria (P = .016), suggesting decreased mitochondrial damage.

These findings were encouraging even if the CD4 results did not quite attain statistical significance, Dr. Baum told Medscape Medical News. "It was pretty amazing that within 2 months we could have this effect on such a small number of patients. We showed that micronutrients can be immunostimulatory even in people with good viral control."

The outcomes were even more promising in Botswana, where 875 HIV-positive adults participated in a prospective randomized clinical trial comparing supplementation with vitamins C, E, and B complex plus selenium with multivitamins alone, selenium alone, and placebo.

These patients had CD4 cell counts above 350 cells/mm3 and were not receiving ART at the time of enrollment. Over the subsequent 24 months, the patients were followed for events of combined outcomes of disease progression, which the investigators defined as a CD4 count below 250 cells/mm3, the development of an AIDS-defining condition, or death.

Time to any event indicating disease progression was longer among people receiving any type of nutritional supplementation than among those not receiving nutritional supplements (hazard ratio, 0.65; P = .0157).

People in Botswana are relatively well nourished, yet "this simple micronutrient supplementation was safe, improved CD4 count, and prolonged the time to AIDS-defining conditions," Dr. Baum said. "We recommend that, at least in Africa, people in the early stages of HIV infection have their nutritional status monitored and receive supplements when appropriate. This should probably occur in the United States too."

The authors have disclosed no relevant financial relationships.

AIDS 2010: XVIII International AIDS Conference: Abstracts MOPE0100, MOPE0101, and MOPE0102. Presented July 19, 2010.


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