Micronutrients: Current Issues for HIV Care Providers - Article in Medscap

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Wed, 15 Jun 2005 19:52:10 +0200

" Sepp Hasslberger " <sepp

Micronutrients: Current Issues for HIV Care Providers -

Article in Medscap

 

 

Perhaps, ever so slowly, the question of nutrition being an integral

part of any anti Aids strategy, is sinking into the medical

mainstream...

 

Kind regards

Sepp

 

 

 

Micronutrients: Current Issues for HIV Care Providers

 

<http://mp.medscape.com/cgi-bin1/DM/y/epsn0Fkieu0Dys0GgJv0Ec>http://mp.medscape.\

com/cgi-bin1/DM/y/epsn0Fkieu0Dys0GgJv0Ec

 

Conclusions

 

Micronutrients play a critical role in the maintenance of immune

function (including mucosal immunity) and overall metabolism. With

the complexity of HIV infection and treatment, and the pace of

clinical research, it is not surprising that sophisticated studies of

the role of micronutrients in HIV have lagged somewhat behind other

areas of inquiry. Much credit is due to researchers who have been

asking, and continue to ask, questions about micronutrient status and

the progression of HIV infection. As HIV becomes a more chronic,

manageable disease, and treatment becomes available to more of those

infected throughout the world, it may be possible to begin to more

precisely define the areas in which micronutrients may help to

maximize the clinical status of HIV-infected patients. Studies to

date reveal that this is a complex topic, fraught with pitfalls. For

example, it is difficult to ascertain true micronutrient status,

measures of intake are imprecise, recommendations for desired intakes

vary, and surrogate markers of oxidative stress may not be

reproducible.

<http://www.medscape.com/viewarticle/505659_Tables#T4>Table 4

summarizes some of the outstanding questions that remain in this area

of research.

 

As more HIV infected individuals around the world are initiated on

effective anti-HIV therapy, the need to maximize durability of viral

suppression will become increasingly important. Data are needed on

the role that micronutrient status may play on low-level viral

replication among subjects on therapy. For HIV-infected individuals

with adequate viral suppression, but inadequate CD4+ cell counts,

micronutrients could play a role in boosting the immune response.

 

As HIV-infected individuals co-exist with chronic viral infection and

chronic antiretroviral therapy, the need to examine creative

interventions to minimize long-term complications such as fat

atrophy, insulin resistance, lipid abnormalities are becoming

increasingly important. The role that micronutrients, particularly

the antioxidants, may play in modulating these toxicities is not yet

clear and should be studied. In addition, for the patient with

multiple chronic viral infections, such as HIV and hepatitis B and/or

C, micronutrient supplementation may also be beneficial in minimizing

the co-morbidities associated with these co-infections. As the

HIV-infected population ages, and the risk of cardiovascular disease

increases, antioxidants may again play a role in diminishing

progression of such disease. There is also some evidence for the role

of antioxidants in modulating subtle cognitive defects in HIV and

this area needs further study as well.[109]

 

Research is also needed to address the appropriate dosages of

micronutrient supplementation among HIV-infected individuals at

various stages of disease and treatment. Little consistency has been

found in the studies done to date on dose or duration of

administrations, making comparisons between studies and

interpretations of results difficult.

 

The intention of clinicians and clinical researchers in HIV in 2005

should be to maximize the quality and duration of survival for

HIV-infected individuals throughout the world. This objective could

entail the study and use of interventions, such as micronutrients,

that may not be part of the traditional care or thought process of

the HIV care provider. Attempts to improve dietary quality and

micronutrient status may play an overall role in maximizing health

for the HIV-infected individual, particularly in undernourished

populations, and may also play a role in the more subtle management

of HIV infection in the future.

 

Funding Information

 

Sponsorship: This study was supported by: 1P01D45734, 1K24AI055293,

1P30DA13868, and 1P30A142853, 1R01DA14501 and 1R01DA11598

 

 

 

 

 

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