HIV and Nutritional Supplements

Quality nutrition is very important for each person regardless of health condition, and it plays an exceptional role in the well-being of people with HIV. The body responds to medications or diseases individually, and in some cases, nutrition adjustments are required.

Diarrhea may often occur due to some infections or medications, and if it is severe or lasts for a long time, it may lead to depletion of minerals and vitamins. Special nutrition may be recommended if the amount of body fat changes due to HIV infection or treatment. Malnutrition also affects people with HIV significantly. For instance, deficiency of Vitamin A and B12 may cause quicker progression of the disease. If serum level of micronutrients decreases, additional vitamins are required, and nutritional supplements can be helpful.

Nutritional supplements certainly play a significant role in the treatment of a diagnosed deficiency or malnutrition caused by HIV or poor nutrition. They are particularly important in the late-stage disease when consequences of HIV and weight loss are obvious.

So, do people with HIV have to use nutritional supplements? Can these products help reduce the risk of infection, delay progression of the disease or improve immune functions? Below, you will find the needed information on that.

Brief Information on Supplements Industry

According to the CDC, about half of all Americans use dietary supplements, such as minerals, vitamins and herbals. These products are regulated by the FDA that considers them to be products adding nutritional value to the diet. This means that multivitamins and other supplements are recognized as foods, but not as medications. That is why those products do not have to undergo strict tests to evaluate their effectiveness and safety.

The FDA regulates these products by monitoring customers’ complaints and requiring manufacturers to label a list of adverse events. You should note that adverse event reports are sent in case of serious or life-threatening side effects. Usually, mild to moderate effects, such as gastrointestinal distress or headache, are not reported unless the manufacturer decides to do it.

On average, research and development costs needed for one medication to be approved by the FDA reach $1.3 billion dollars. In 2011, sales of dietary supplements in the US equaled to $30 billion, which was twice as much as the global HIV medications market.

Effectiveness of Supplements in Improvement of Immunity

A balanced diet is one of the ways to improve your immune system. In order to become resistant to illnesses, it is also important to use antiretroviral medications. It is still uncertain if vitamins and other supplements are helpful.

Manufacturers always try to convince that certain research has been conducted, which adds lots of work to the FDA that has to deal with those claims and check whether they are real. In 2012, the HHS found that 20% of claims were prohibited, for instance, “immune support.” It does not mean that they were clearly wrong, but that evidence proving their effectiveness was not enough.

Many manufacturers like to use the research conducted in 2004 by Harvard School of Public Health on women from Tanzania, stating that the use of multivitamins, such as B, C and E is able to slow down HIV progression and has a range of other benefits.

The results of the research are often called “scientific proof” of immune-boosting properties of supplements. They obviously do not take into attention co-factors, such as hunger, poverty and malnutrition typical for the African population.

Anyway, in reality, nothing from this research proves the effectiveness of multivitamins. A range of other studies has also been conducted, but their results cannot be considered a proof of the effectiveness of supplements in people with HIV. As a matter of fact, the results of the research conducted in 2012 have shown that high-dose multivitamins might increase the risk of death in malnourished people. Some clinical studies have shown certain benefits in patients with an advanced disease, while no benefits for others.

One thing is certain — the use of multivitamins in recommended doses is safe, particularly for people with HIV who are in late stages of the disease or malnourished.

When Supplements Should Not Be Used

There is not enough information about the benefits of minerals, vitamins and other elements. Over the last several years, a range of studies has been conducted to check the effectiveness of selenium, a mineral with antioxidant properties. According to the research, not enough selenium in early HIV infection is related to the loss of CD4 cells when malnutrition and malabsorption are not considered the causing factors.

Anyway, no research has been able to prove any benefit of selenium supplementation, either in prevention of HIV illness or restoring CD4. Zinc and magnesium supplements have not been proven to have positive effects as well.

The use of supplements by HIV-positive people is often based on the belief that “natural” products are able to provide great support to the immunity and can be used additionally to HIV therapy. In reality, this may not be so. Moreover, lots of supplements are able to affect people with HIV by interacting with drugs or causing toxicities eliminating all possible benefits of supplementation.

Particularly, the following supplements taken in too high dosages can cause the following negative effects:

• Vitamin A taken in a dosage of above 25,000 IUs every day increases the risk of internal bleeding, liver toxicities, weight loss and spontaneous fractures. The WHO does not recommend using vitamin A supplements by pregnant HIV-positive women. The dosage of 5,000 IU a day increases the risk of transmission of the disease from mother to her child;

• Vitamin C is considered to be great for cellular immunity by some research, but the evidence is contradictory. High doses of vitamin C may cause diarrhea and gastrointestinal distress. Vitamin C taken in a daily dosage of 1,000 mg can reduce Crixivan levels;

• Vitamin B6 taken in dosages of 2,000 mg a day may lead to reversible nerve damage, which makes peripheral neuropathy (affected in HIV-positive patients) worse;

• Vitamin E is not recommended to be taken in dosages above 1,500 IUs, because it may affect blood clotting and cause muscular weakness, diarrhea and nausea;

• St. John’s Wort is a herbal preparation used for treatment of mild depression, which is able to reduce the levels of PI and NNRTI-class drugs, increasing the risk of drug resistance;

• Garlic supplements are able to reduce serum levels of a range of HIV medications, for instance, Invirase (saquinavir). Cooked and fresh garlic does not have the same effects;

• A glass of grapefruit juice can reduce serum levels of Crixivan by 26% and increase Invirase levels by 100%. This does not mean that you should not enjoy grapefruit juice at all, but it is important to take it two hours before/after you use your medication.

General Recommendations

Proper nutrition is extremely important particularly for people with HIV. Nutritional counseling allows obtaining more useful information on that. In particular, it helps achieve the following goals:

• Healthy body weight;
• Healthy lipid levels, such as triglycerides and cholesterols;
• Prevention of dietary complications due to the use of some antiretroviral medicines;
• Managing dietary complications due to HIV-related symptoms;
• Using food measures to prevent opportunistic infections.

It is also important to support physical health by regular exercises, which along with proper dieting reduce the risk of neurocognitive impairment associated with HIV.

As for supplements, daily use of multivitamins can help satisfy micronutrient needs. At the same time, the use of vitamins in too high dosages every day can do more harm than good. There is not enough information to confirm the effectiveness of herbal supplements in the treatment of HIV infection or increasing the effectiveness of antiretroviral drugs.

All in all, daily use of supplement by people with HIV is possible, but only if it is recommended by their healthcare providers. It is strongly recommended to avoid the use of vitamins or herbal supplement in high dosage, because this may lead to side effects, reduction of drug effectiveness and other negative consequences.