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The HIV Nutrition News Update is a free weekly review of  news related to nutrition and HIV/AIDS. View copyright and subscription information. 

Unintentional Weight Loss

As noted in the HIV ReSource Review Issue 19 and Issue 20, unintentional weight loss still occurs even with the use of highly-active antiretroviral therapy. Check out the Medibolics web site for information on three popular therapies to stimulate the appetite and decrease unintentional weight loss. Adrian Sandra Dobs, MD, MHS, asks "Is There a Role for Androgenic Anabolic Steroids in Medical Practice?". To learn more about the treatment of weight loss, view Issue 19 and "Answers to Recent Questions on Wasting, Diet, Nutrition, and Exercise" where you'll find a wide variety of questions and anecdotes from HIV-positive people. Also, Nutrition And Wasting In HIV Disease by Donald Kotler, MD, at Medscape.com provides a comprehensive overview of nutritional and metabolic issues in HIV care.

Unapproved Aloe Vera Treatments

A FDA recent Talk Paper reports that a Maryland businessman was sentenced for illegally marketing mixtures of aloe vera as treatments for AIDS and cancer. Besides selling bottled combinations of aloe vera and other unapproved drugs, Allen J. Hoffman (doing business as T-Up, Incorporated and Astec
Biologics, Incorporated) charged up to $18,000 for a two-week treatment with intravenous aloe vera. 

The abstract from Hello Aloe Vera published in Issue 4 of the HIV ReSource Review notes:
Many people living with HIV (PLWHIV) are willing to try 'promising' alternative therapies. One such treatment, said to have been used for centuries by a multitude of people, is aloe vera (AV). Several cultures regard the aloe as a religious symbol. It has been a popular alternative therapy among the HIV challenged since the mid 80's. Individuals may refer to aloe vera as Acemannan, Manapol, and Carrisyn. This review notes information on forms, uses, studies, and side effects of aloe vera therapy.

Aquascams & Water-related Illness

As with other 'complementary' treatments, water-related products are becoming increasingly popular with the HIV community. The Aquascams Web site offers information on fraudulent claims related to water such as clustered water and oxygenated water. And speaking of water, Staphylococcus aureus (S aureus), a common bacteria, has been detected in a hospital spa and hydrotherapy pool in the United Kingdom (UK). Although UK guidelines set limits for levels of bacteria such as E coli, health officials are concerned because testing for S aureus is only recommended when physicians suspect that a patient has become ill as a result of using a hospital spa or hydrotherapy pool. The organism appears to survive even in properly disinfected pools. 

Clinical Care of Women with HIV

See A Guide to the Clinical Care of Women with HIV.

Disclaimer- Information in this news update should not be construed as an endorsement of any kind. Comments are offered for general guidance only. This information is not intended to replace professional medical advice. Any use of the information is done strictly on your own risk and no responsibility is implied or intended on the part of HIV ReSources Inc., the editors, authors, or the publisher. Discuss any lifestyle changes you may be considering with your physician/health care specialist.

Kava Kava

According to the Food and Drug Administration's (FDA) MedWatch, dietary supplements containing kava are linked to serious hepatotoxicity. The FDA Safety Information and Adverse Event Reporting Program notes that in Europe products containing herbal extracts of kava have been implicated in at least 25 cases of serious liver toxicity including hepatitis, cirrhosis, and liver failure. It is unknown whether the use of dietary supplements containing kava in the United States poses similar public health concerns. The FDA is asking clinicians to review cases of liver toxicity and report any cases that they think may be related to the use of kava-containing dietary supplements. Clinicians should report the adverse effect as soon as possible to MedWatch by telephone 800/332-1088.

HIV, Diet & Exercise

Noting that a healthy diet and exercise program can make a difference to increase lifespan and quality of life, Meredith Liss, MA, RD, CDN, offers a few tips for people living with HIV. After reading her menu tips, review our HIV Nutrition News Update of November 16, 2001 to learn about the possible benefits of coconut and palm oils.

As noted in several of our HIV ReSource Review and HIV Nutrition Update newszine issues, it's important to remember that engaging in strenuous aerobic exercise, excessive resistance or excessive aerobic exercise may increase the risk of immunosuppression. As noted in our newszine Issue 26, studies show that weight resistance exercise can help to combat wasting in people living with HIV. Recent studies confirm this finding. Review Exercise and HIV by Glenn R. Preston, RD, which compliments our previously published issues on exercise as well. Also, always check with your physician before starting an exercise program or taking any dietary supplements.

Effects Of Party Drugs

The Community Research Initiative on AIDS web site has added a Community Forum Summary on party drugs and HIV medications. The summary compliments information published in our May/June 2000 and July/Aug 2000 HIV ReSource Review issues (24 and 25) on substance abuse. A recent study of chronic cocaine users notes an increased incidence of heart disease. Another resource notes that heavy (3 to 4 drinks per week or daily) alcohol use affects the effectiveness of anti-HIV medications. Along with diet, alcohol is also linked to HIV-related fat deposits. Investigators linked heavy drinking with higher levels of low-density lipoprotein cholesterol (LDL). Polyunsaturated fats, fiber and alcohol, were strongly associated with both insulin resistance and high cholesterol among study participants. Canadian AIDS Treatment Information Exchange (CATIE) News offers "Does ecstasy make the immune system happy?". The article by Sean Hoesin notes possible problems with long-term memory, effects on the immune system and adverse effects related to protease inhibitors and non-nucleoside reverse transcriptase inhibitors. 

Ginger For Nausea & Vomiting

A recent review of ginger for the control of nausea and vomiting compliments our newly published literature review of ginger in Issue 33 of the HIV Nutrition Update.

DEA Approves Medical Marijuana Study

The University of California at San Diego recently received approval from the Drug Enforcement Administration (DEA) for a medical marijuana study in AIDS patients with neuropathy and for patients with multiple sclerosis. As noted in HIV ReSource Review issues of March/April 2000 and May/June 2000, physicians may prescribe therapeutic marijuana for certain disorders even though it remains illegal. The Center for Medicinal Cannabis Research hopes to show whether marijuana can be useful for medical purposes.

Free CATIE Newsletter

The Community AIDS Treatment Information Exchange (CATIE) offers a free magazine for Canadians with HIV/AIDS. View the Positive Side.

Garlic Supplements

Garlic supplements can impede HIV medications, particularly saquinavir. Read more about the study. There's also a wealth of information on herb-drug interactions in Issue 28 (the Jan/Feb 2001) and Issue 29 (March/April 2001) of the HIV ReSource Review. A recent systematic review of the published clinical evidence on interactions between herbal supplements  and conventional drugs adds to the information presented in our previous newsletter issues. Additional information on garlic is in the Sept/Oct 1998 HIV ReSource Review.

Recreational Substances

Mixing energy drinks such as Red Bull with alcohol can be dangerous. Read more about this new craze. Another popular practice, mixing Viagra and Club Drugs such as ecstasy, amphetamines or "poppers" can cause detrimental effects such as heart attacks. 

Resources on Nutrition and HIV

View nutrition guidelines, slide shows and other resources at <http://www.infoweb.org>. Also, check out the variety of links from HIV ReSources that lead to nutrition information <http://www.hivresources.com/Nutrition.htm>.

Continuing Education Article

Although not specifically for nutrition professionals, Medscape offers a Continuing Education Article on the physician's first encounter of a person living with HIV. The article notes that "A chemistry panel is an important tool in the evaluation of the patient's nutritional status, to rule out HIV- or drug-related renal insufficiency and to diagnose liver damage due to alcohol or viral hepatitis". 

Lipodystrophy

Studies note that although some patients taking antiretrovirals develop lipodystrophy (covered in the Nov/Dec 1998 and Jan/Feb 1999 HIV ReSource Review) others may not. A small study, completed by researchers from Massachusetts General Hospital, found that visceral fat was a significant predictor of mean growth hormone concentrations. (1) Reduced growth hormone was evident in those patients with HIV lipodystrophy but further studies are needed to determine the clinical significance of this finding. 

We know that increased abdominal fat, found in those patients with lipodystrophy, is a risk factor for heart disease. According to Sattler and colleagues, along with increased abdominal fat, lipodystrophy patients are also more likely to be at increased risk of having higher blood pressure raising the risk of heart disease, kidney failure and disease in arteries outside of the heart. (2) Insulin resistance (covered in the Nov/Dec 2000 and Jan/Feb 2001 HIV ReSource Review) may play a role in elevated blood pressure but further studies are needed to investigate this phenomenon.

References
1. Rietschel P, Hadigan C, Corcoran C, Stanley T, Neubauer G, Gertner J, Grinspoon S. Assessment of Growth Hormone Dynamics in Human Immunodeficiency Virus-Related Lipodystrophy. J Clinical Endocrinology & Metabolism 2001;86(2):504-510.
2. Sattler FR, Qian D, Louie S, Johnson D, Briggs W, DeQuattro V, Dube MP. Elevated blood pressure in subjects with lipodystrophy. AIDS 2001;15(15):2001-2010.

Free Publications and Heart Attack Assessment Tool

The Institute for Clinical Systems Improvement (ICSI), which is a non-profit organization consisting of health care organizations, offers online guideline and technology assessment documents. The 53-page diabetes guideline is helpful to both clinicians and laypersons. There's also information on a health care guideline for treatment of lipid disorder in adults.

For people who know their cholesterol levels there's a Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack. It uses information from the Framingham Heart Study and is designed for adults over the age of 19 who do not have heart disease or diabetes.

Webcasts on Diabetes and Heart Disease

Although not specific to HIV-positive people, a diabetes and nutrition web site noted at abcnews.go.com holds lots of information including webcasts on timely topics such as diabetes and heart disease.

ATIS Site Update Service

The ATIS Site Update Service notifies you by electronic mail when new features and publications are available on their web site, including Treatment Guidelines. Subscribe to the free service.

The HIV ReSources Web Site is updated.

New pages include:
Free HIV Nutrition News Update Electronic Newsletter Links

Updated pages include:
Herbal Information

Conference Information

Herbs, Supplements & Prescription Drugs

Newszine Previews

HIV Nutrition News Update Electronic Newsletter Archive

Nutritionally Adequate Diets

Recent findings of a cross-sectional study of people living with HIV suggest that lifestyle and economics are the reason for nutritionally inadequate diets. Readers of the HIV Nutrition Update (formerly the HIV ReSource Review) may refer to the Sept/Oct 1997 issue (abstract below) for information on calorie requirements and the March/April 1998 issue (abstract below) for information on protein needs for HIV- positive people.

Calories and energy needs abstract:
This article is a research review of various factors affecting the energy needs of people living with the human immunodeficiency virus (HIV). 

Research documenting the relationship between nutrition and the immune system has increased steadily over the past several years. As a result, many people living with HIV now recognize the importance of reaching and maintaining optimal nutritional status. Most people know that they need to consume an adequate amount of certain nutrients to support their body processes. Yet, inadequate caloric intake is evident in a majority of those living with HIV. Subsequent weight loss plays a role in decreasing nutritional status and quality of life is adversely affected. Kotler relates that decreased functional performance often accompanies nutritional depletion. Poor nutritional status affects quality of life, morbidity and mortality. HIV-positive individuals often experience a significant loss of body cell mass. The depletion of lean body mass, reported even in the early stages of HIV, detrimentally affects quality of life and is often caused by poor oral intake. Progressive loss of fat and lean body mass is evident in women as well as in men. HIV-challenged patients with progressed disease have both inadequate energy and protein intake. Many scientists report that substandard caloric intake is the most influential factor of weight loss.

Protein needs and HIV abstract:
Adequate protein stores are vital for immune function and good health, especially for individuals who are challenged by the human immunodeficiency virus (HIV). Recently the focus has been on maintaining adequate lean body mass (LBM) and many people living with HIV infection (PLWHIV) have begun exercise regimes. Some have initiated lifestyle changes that include a change in dietary habits as well. Recommendations for PLWHIV to follow high-calorie and high protein diets are common. Currently there are no standard protein recommendations for HIV challenged individuals. 

Protein guidelines vary considerably among nutrition professionals and others who seek to improve the nutritional status of this population group. This review will serve to provide useful information on protein needs and recommendations for people living with HIV and AIDS. It focuses on various issues to consider when recommending increased protein intakes as well.

Check out the interactive healthy eating index for a dietary assessment of your daily food intake. To see recommended food choices, view the interactive food guide pyramid. Remember that nutritional quality may be increased when eating your meals with family or friends. 

Foodborne Illness

As reported in an earlier update, the incidence of foodborne illness is rising. Besides cryptosporidiosis, last mentioned in our update of November 2, 2001, there are a number of other foodborne illnesses that HIV-positive people are more prone to get than HIV-negative people. A recent report published in the New England Journal of Medicine notes the presence of salmonella in ground meats. Learn more about salmonellosis, which is an infection with the bacteria called salmonella. Resistant strains of salmonella are of great concern. Symptoms of salmonellosis usually include nausea, abdominal pain and diarrhea but in some cases salmonella may cause typhoid fever. Learn how to avoid foodborne illness from ground meat and ground poultry. Egg-associated salmonellosis is also an important public health problem.

Product Warnings

Recently posted MedWatch 2001 Safety Information for Lipokinetix warns consumers to immediately stop use of the product, which is sold as a weight loss dietary supplement. Some people using Lipokinetix have developed liver injury or liver failure. 

New HIV Subtype

The CDC recently reported on a new HIV subtype that may be tougher to treat than other subtypes. 

Bone Loss

Continuing our thread on bone loss, a recent study associates poor verbal memory in both men and women with thin bones. Yuqing Zhang of the Boston University Arthritis Center, Boston University School of Medicine, reports that bone mineral density and verbal memory impairment may be related. Whether this could relate to HIV-positive subjects is questionable as the study included 4,304 elderly subjects in the Third National Health and Nutrition Examination Survey (1988-1994). 

The National Institute of Mental Health (NIMH) is conducting a new study to determine if there's a relationship between major depression or stress hormones, such as cortisol, and low bone mass. NIMH-funded studies have reported a strong association between depression and osteoporosis.

Teriparatide (brand name - Forteo), which will be available through prescription by the end of the year, is another medication designed to help people with moderate to severe osteoporosis. It's the only treatment that prompts the body to make new bone however, it must be administered by daily injections. Read more about the drug. View a slide show at the Food and Drug Administration web site of the Endocrinologic and Metabolic Drugs Advisory Committee Meeting.

Complementary Treatments for Hepatitis

A recent report adds to the information we provided on complementary treatments for hepatitis in our May/June 2001 HIV ReSource Review issue. It notes that a review of nine randomized trials using medicinal herbs concluded that there is not enough evidence to recommend their use. Review the abstract. Source: Liu J, McIntosh H, Lin H. Chinese Medicinal Herbs For Chronic Hepatitis B: A Systematic Review. Liver 2001;21(4):280-286. 

Coconut and HIV/AIDS

A recent newsletter article by Stephen Byrnes, PhD, RNCP compliments the article written by Mary Enig, PhD, which was published in our July/Aug 2001 HIV Nutrition Update newszine. Like Enig's article, Byrnes piece notes that coconut holds promise for people living with HIV/AIDS. Enig offers the details of the first 15 people study in the HIV Nutrition Update article, which also notes information and references from test tube studies. Good sources of lauric acid found in coconut are macaroons, coconut milk, certain ice creams (Haagen Daas), and coconut oil. Based on her extensive research on fatty acids, Dr. Enig wrote a book "Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils and Cholesterol". Her book is easy-to-read and helps the reader to understand the relationship between dietary fat intake and health and dietary fat intake and disease. 

Skeptic Newsletter

Skeptic Newssearch provides a free skeptic newsletter and links to more than 100 mainstream media articles related to non- scientific claims each week. Recent links have offered information on vitamins, minerals and herbal supplements. 

World AIDS Day 

World AIDS Day is December 1st and many organizations are offering resources to help educate the general public about HIV/AIDS. The Henry J. Kaiser Family Foundation has created a World AIDS Day web page with numerous resources on the pandemic, which will be entering its third decade in 2002.

Sections of the World AIDS Day web page offer: 

* World AIDS Day Broadcasts and Webcasts including information on "Staying Alive 3", which is a half-hour special profiling young people infected with or affected by HIV and AIDS, "HIV/AIDS and the African American" and "Youth and HIV/AIDS Prevention Policy: New Directions". 

* Recent Kaiser Family Foundation HIV/AIDS Policy Publications and Projects including "The AIDS Epidemic at 20 Years: THE VIEW FROM AMERICA Survey", "Latinos' Views of the HIV/AIDS Epidemic at 20 Years: Findings from a National Survey", and numerous fact sheets, HIV/AIDS reports and surveys. Links also lead to the "Kaiser Daily HIV/AIDS Report", "Capitol Hill Briefing Series on HIV/AIDS", and "State-by-State HIV/AIDS Information".

The site also boasts: 
* LoveLife Resources on Preventing AIDS in South Africa 
* Sexual Health Information Campaigns and Media Partnerships 
* Other Kaiser Family Foundation HIV/AIDS Resources 
* World AIDS Day Scheduled Events 
* Other World AIDS Day Web Pages 

Osteopenia

Information in the August issue of the Journal of Endocrinology and Metabolism continues our thread on osteopenia by noting that it is seen in testosterone-deficient women who have AIDS wasting.

Source: Huang JS, Wilkie SJ, Sullivan MP, Grinspoon S. Reduced bone density in androgen-deficient women with acquired immune deficiency syndrome wasting. J Clin Endocrinol Metab 2001;86(8):3533-9.

HAART, fat, lean, and bone mass 

Research reported on also from Boston notes the effect of HAART on fat, lean, and bone mass in HIV-positive people. Using dual-energy X-ray absorptiometry (DEXA), researchers compared total and regional body composition in 265 HIV- positive individuals. Study participants on HAART displayed increased trunk fat with lower leg fat, which corresponded to a greater percentage of total fat mass located in the trunk than those individuals not on HAART. Men on HAART displayed lower total and regional bone mineral content and greater lean body mass with longer duration of HAART.

Source: McDermott AY, Shevitz A, Knox T, Roubenoff R, Kehayias J, Gorbach S. Effect of highly active antiretroviral therapy on fat, lean, and bone mass in HIV-seropositive men and women. Am J Clin Nutr 2001;74(5):679-86.

Foodborne Illness

A recent article draws attention to the increase in foodborne illness, which is more common in people living with HIV infection. According to this source, the incidence of United States foodborne illness is up two to ten times as compared to the incidence of food-related illness since 1994. The most common symptoms of foodborne illness are diarrhea and vomiting although chronic disorders of the heart and nervous system, arthritis, renal disease, and disease of the digestive system can also occur. Read more on the threat of foodborne illness and its possible association with genetically engineered food.

Source: US Foodborne Illnesses Up Two to Ten Fold. ISIS Report, November 3, 2001. The Institute of Science in Society: London. WWW: http://www.i-sis.org/.

HIV Nutrition Update

Visit <http://www.hivresources.com/Sample.html> to read Issue 31 of our HIV Nutrition Update Newsletter. The issue includes:

Lauric Acid-Rich Foods As Adjunct Therapy
Research News
Resource Corner
Update Central
Nutrition Forum
Med Watch
Program Spotlight

HAART and Bone Problems

As noted in our October 5, 2001 update, the use of highly active antiretroviral therapy (HAART) is associated with bone problems in HIV-positive people. A recent report in the journal AIDS notes the increased risk of osteopenia in children on HAART. The research team in Italy lead by Dr. Stefano
Moraa used DEXA (dual energy x-ray absorptiometry) to measure bone mineral density and found that HAART may be a risk factor for osteoporosis and fractures in HIV-positive children. The severity of osteopenia appeared to be related to lipodystrophy. 

Source: Moraa S, Salab N, Bricallib D, Zuinb, et al. Bone mineral loss through increased bone turnover in HIV-infected children treated with highly active antiretroviral therapy. AIDS 2001;15:1823-1829. 

Vitamin E and Hepatitis C

In our May/June 2001 HIV ReSource Review issue, we highlighted research using vitamin E to help people with hepatitis C to respond to interferon therapy. Recently the Canadian AIDS Treatment Information Exchange (CATIE) reported on a study of vitamin E and hepatitis B. View a number of abstracts noting studies of both hepatitis C and hepatitis B, although the majority are not especially related to HIV/AIDS. 

Cryptosporidiosis

We first mentioned cryptosporidiosis, a protozoan cause of diarrhea, in our September 28, 2001 HIV Nutrition News Update. Besides transmission through swimming pools or other contaminated water, cryptosporidium is transmitted by person- to-person or animal-to-person contact. It can cause persistent chronic diarrhea in immunocompromised patients and is recognized as a common enteric pathogen. To learn more about this pathogen visit the following web sites: 
Cryptosporidiosis: An Emerging, Highly Infectious Threat
Cryptosporidiosis
CBS HealthWatch by Medscape. 

Clinicians may view reproducible handouts including the one on cryptosporidiosis at the HIV ReSources Web Site. 

As noted in our October 5, 2001 update, lipodystrophy is common in people taking highly active antiretroviral therapy (HAART). Dr. Colleen Hadigan and Massachusetts colleagues have added to the research of this phenomenon by documenting their recent research results. Hadigan's group found that HIV- positive patients with lipodystrophy may have significantly increased waist-to-hip ratios, fasting insulin levels, and diastolic blood pressure. (1) As noted in the Nov/Dec 2000 and Jan/Feb 2001 HIV ReSource Review, patients with lipodystrophy are more likely to have glucose abnormalities and reduced levels of high-density lipoprotein cholesterol (HDL), the "good" cholesterol. Hadigan's research team learned that heart disease risk factors are markedly increased in those patients living with HIV who have fat redistribution.

The research group linked diet and alcohol to lipodystrophy in 62 men and 23 women with HIV and fat redistribution. (2) Polyunsaturated fats, fiber, and alcohol were strongly associated with insulin resistance and hyperlipidemia. Heavier alcohol consumption was linked to higher levels of low-density lipoprotein cholesterol (LDL) while diets low in fiber and high in polyunsaturated fat were associated with a greater incidence of insulin resistance. Recent reports of two randomized crossover trials document that switching dietary fats can lower cholesterol. (3) In a group of 42 HIV-negative patients researchers substituted saturated fat rich foods with either omega-6 polyunsaturated or monounsaturated fat rich foods and limited total fat intake to 30–33% of dietary energy. Patients on the polyunsaturated fat diet reduced their total cholesterol levels by 19%, LDL by 22%, and HDL by 14%. These studies reinforce our belief that dietary modification may help people living with HIV to lessen their risk of heart disease. Further research however, is needed to determine if metabolic factors associated with lipodystrophy might be affected by dietary interventions.

Sources
(1) Hadigan C, Meigs JB, Corcoran C, Rietschel P, et al. Metabolic Abnormalities and Cardiovascular Disease Risk Factors in Adults with Human Immunodeficiency Virus Infection and Lipodystrophy. Clinical Infectious Diseases 2001;32:130-139.
(2) Hadigan C, Jeste S, Anderson EJ, Tsay R, Cyr H, Grinspoon S. Modifiable Dietary Habits and Their Relation to Metabolic Abnormalities in Men and Women with Human Immunodeficiency Virus Infection and Fat Redistribution. Clinical Infectious Diseases 2001;33:710-717.
(3) Hodson L, Skeaff CM, Chisholm W-AH. The Effect Of Replacing Dietary Saturated Fat With Polyunsaturated Or Monounsaturated Fat On Plasma Lipids In Free-Living Young Adults. European Journal of Clinical Nutrition 2001; 55(10):908-915.

Osteonecrosis

HIV-associated Risk Factors in the Development of Osteonecrosis by Brian Boyle, MD adds to the information presented in our last update. 

Herb-drug Interactions

Many HIV-positive people use the dietary supplement silymarin, also known as milk thistle. As noted in the May/June 1999 (Issue 18) HIV ReSource Review, some preliminary human trials using silymarin have been promising for people with hepatitis and cirrhosis of various origins. Along with the concerns about product quality and occasional side effects such as nausea, abdominal distress and short-term loose stools, people are now beginning to worry about herb-drug interactions. Numerous studies involving the role of cytochrome P-450 liver enzymes and possible interactions have been completed since we first mentioned this enzyme system in the Nov/Dec 1998 HIV ReSource Review (Issue 15). Sharon Herr, RD covered numerous herb-drug interactions in her two-part article published in the Jan/Feb (Issue 28) and March/April (Issue 29) 2001 HIV ReSource Review issues. Additional information on the interaction of herbs such as milk thistle and St. John's Wort is available at Resource 1,  Resource 2, and Resource 3.

Vibrio Vulnificus

The CDC HIV/STD/TB Prevention News Update recently featured a short piece on the danger of eating raw oysters. Two deaths in Los Angeles County were linked to the consumption of raw oysters containing Vibrio vulnificus, a rare bacterium. Commonly found in raw oysters from the Gulf of Mexico, Vibrio vulnificus is more likely to cause death in people with diseases such as AIDS and hepatitis. People experience diarrhea, abdominal pain and vomiting typically within 24 hours of eating contaminated shellfish. Pasteurized or frozen products are free of the bacteria. For more information on food safety visit  Resource 1  and  Resource 2 .

FDA-HIV-AIDS Listserv

Join the FDA-HIV-AIDS Listserv. 

Hepatitis C

A Phase II Hepatitis C trial was recently initiated by Ribozyme Pharmaceuticals located in Boulder, Colorado. The multi-center trial uses Heptazyme(tm) for the treatment of patients with chronic hepatitis C. Trial sites are located in California, Colorado, New York and Miami. According to company representatives, the Phase II trial should show that Heptazyme(tm) is safe and effective in treating Hepatitis C causing less side effects than current treatments. 

As noted in the March/April (Issue 29) and May/June 2001 (Issue 30) issues of the HIV ReSource Review coinfection with HIV and Hepatitis C is a major concern and nutritional status can be adversely affected. Patients coinfected with hepatitis C and HIV have an increased risk of blood glucose abnormalities and type 2 diabetes mellitus. They are also at increased risk of having other metabolic abnormalities and changes in body composition. Infection with both Hepatitis C and HIV require that the infected individuals pay special attention to their eating habits. Coinfected individuals should see a doctor and nutrition professional for individualized nutrition assessment and dietary guidelines based on their disease stages. Alcohol should be avoided to give the liver and immune system a chance to heal and rebuild. Mega-vitamin supplements, particularly if they contain iron, vitamins A and D may be harmful. Coinfected individuals should avoid taking any dietary supplements, herbs, or medicines without a doctor's approval. 

Visit the Merck & Co., Inc. Pharmaceuticals Web Site for additional study information. 

Marijuana

As noted in the March/April (Issue 23) and May/June (Issue 24) 2000 HIV ReSource Review issues, numerous people living with HIV use marijuana to treat medication side effects and other HIV-related conditions. Research continues to document the effects of marijuana use and individual cannabinoids. In one study, investigators found that the use of marijuana was associated with an increased risk of heart attack. (1) Other research showed that although no trials evaluated marijuana, systematic reviews of clinical trials found individual cannabinoids more effective than other anti-emetic drugs in the control of vomiting. (2) Individual cannabinoids were as effective as codeine for pain relief as well. (3) To learn more about marijuana research visit the Medical Marijuana Research website. 

Sources
1. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation 2001;103(23):2805-2809.
2. Tramer MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 2001;323(7303): 16-20. Available at the British Medical Journal Web Site. 
3. Campbell FA, Tramer MR, Carroll D, Reynolds DJ, Moore RA, McQuay HJ. Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. BMJ 2001;323(7303):13-15. 

Nutritional Status

Poor nutritional status can influence both the incidence and severity of infectious disease including HIV infection. We know that infection may result in malnutrition and malnutrition can contribute to infection. A strong association exists between nutritional impairment and the development of chronic diseases such as diabetes and heart disease, which are increasing in HIV-positive people. 

Recently, the National Institutes of Health (NIH) announced a nutrition, infection mechanisms research program to increase basic research on mechanisms of the relationship between nutrition and infection. NIH is seeking grant applications to investigate "basic, epidemiological and clinical research on nutrition (including dietary supplements) and infection." Applicants are encouraged to research the areas of nutrition, microbiology and immunology to seek information on how nutrition-related immunosuppression leads to greater susceptibility to infection. Grant applications that address the role of nutrition in maintaining immunity and concepts such as the effects of nutrients on the genetic composition of microbes are strongly encouraged. The program will accept grant applications through Sept. 1, 2004 for proposed research projects limited to no more than $100,000 for a period of between two to five years. Visit the Office of Dietary Supplements at the NIH website for additional information on grants, awards and contracts. 

Origin of AIDS Debate

Reports published earlier this year in Nature dispute the assertion in Edward Hooper's 1999 book - The River: A Journey to the Source of HIV and AIDS - that polio vaccine triggered the AIDS epidemic. Hooper asserts that researchers used chimpanzee kidney tissues infected with HIV when they developed an oral polio vaccine, which contaminated vaccine stocks with the virus. People interested in the origin of AIDS debate may find information from Edward Hooper interesting.

Bone Problems and HAART

Both in vitro and clinical data associate nucleoside analogues and protease inhibitors, especially when used in combination, with lipodystrophy. The use of highly active antiretroviral therapy (HAART) and corticosteroids have been associated with bone problems in HIV-positive people including children living with HIV. 

A well balanced diet that includes three servings of high calcium foods along with bone-building nutrients (such as magnesium, vitamin C and vitamin D) and weight-bearing exercise (such as brisk walking) can help to build healthy bones. Besides dairy products, a number of non-dairy foods such as tofu, and sardines with bones, or calcium-fortified foods such as certain cereals and beverages can help to boost calcium intake. Exercise is also an important component in building healthy bones. The HIV Fitness Newsletter reports on developments in the study of fitness for people living with HIV. The newsletter also announces new information and features added to HIV Fitness Guidelines.

For more information on osteoporosis readers may review Calcium & Vitamin D An Essential Element for Bone Health at the Osteoporosis Online Web Site. Also, the New Mexico AIDS InfoNet offers a free handout explaining bone disorders in HTML  or PDF format. People living with HIV can view Building Healthy Bones, a reproducible handout.

Recall Alert

Some HIV-positive people must take medications such as the ones mentioned in this recall alert. Recent warnings from the U.S. Food and Drug Administration report on a recall of Glyburide (Micronase and Greenstone Brand Glyburide) tablets and the withdrawal of the cholesterol-lowering drug Baycol/ Lipobay (active ingredient: cerivastatin), due to increasing reports of side effects involving muscular weakness (rhabdomyolysis).

Hepatitis C

Many HIV-positive people also have hepatitis C. This week researchers reported that treatment of acute hepatitis C with the medication interferon alfa-2b prevents chronic infection. Clinicians seeking information on the nutritional aspects of co-infection with HIV and hepatitis C may be interested in HIV ReSource Review newsletter issues from March/April (Issue 29) and May/June (Issue 30) 2001.

Clinical Studies

Volunteer for the MACS (Multicenter AIDS Cohort Study) or the Women's Interagency HIV Study (WIHS) by telephoning 800/874-2574. Additional information about each study is available at the National Institute of Allergy and Infectious Diseases (NIAID) web site.

September 11, 2001

HIV ReSources offers condolences to those directly touched by the tragic events of September 11, 2001. Our thoughts and prayers are with people from all nationalities who are affected by the national World Trade Center and Pentagon tragedy. Working together we can show the terrorists that we are strong and united against terrorism. For comprehensive links to information on this tragedy and to help those directly affected please visit Google and click on "News & Resources".

Cryptosporidium Infection

A news report in the Calgary Sun relates that cryptosporidium infection through swimming pools is still a concern. There were 16 confirmed cases of the infection in a southern Alberta city with at least two people being hospitalized. 

Source: Parasite Scare in the Hat. Calgary Sun 28 August 2001. CDC HIV/STD/TB Prevention News Update.

Hepatitis C and HIV/HCV Coinfection

Information at the National AIDS Treatment Advocacy Project (NATAP) notes developments in Hepatitis C and HIV/HCV coinfection. 

HAART

Although many people on HAART experience adverse effects such as lipodystrophy, which can include changes in body fat distribution, blood glucose abnormalities, and increased cholesterol levels, reports are still noting that HAART is cost-effective and improves life expectancy. As with many adults on HAART, hypercholesterolemia is also evident in children treated with protease inhibitors. Read about a cross-sectional cohort study conducted in Seattle at Medscape.

Viracept-related Diarrhea

Dietary supplements can help with Viracept-related diarrhea. 

Medical Marijuana 

The Canadian government recently expanded the use of medical marijuana to allow people with HIV/AIDS, cancer, severe arthritis and multiple sclerosis to possess and cultivate marijuana.