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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.

Upcoming NATAP Forums

The National AIDS Treatment Advocacy Project (NATAP) will hold the following FREE forums during May-June 2002. Telephone NATAP for additional information at 1/888- 26-62827(natap).

* Washington, DC - Saturday May 18 - "A Day For Women" - 9:30am - 4pm

* Ft Lauderdale, FL - Tuesday, May 28 - "The Challenge of Decade III" - 9am-3pm 

* Miami, FL
- Thursday, May 30 - For the Spanish Speaking Community - "Conferencia Actualizada Sobre el VIH/Hepatitis C y Problemas de la Mujer" - 9am-4pm
- Thursday, June 6 - A discussion of HIV/AIDS, Hepatitis and Mental Health "Your Health, Your Choice" - 10am-3pm
- Tuesday, June 18 - "Lipodystrophy and Metabolic Changes" - 6pm-9pm (305/891-2066)

* Lake Worth, FL - Monday, June 17 - "Positive Thinking for Palm Beach County" - 9am-3pm

Botanical Information

The September 2001 issue of Hepatology offers information on botanicals (to compliment that offered in Issue 21 and Issue 22 of the HIV ReSource Review) and liver disease (to compliment feature articles on HIV and hepatitis C in Issue 29 and Issue 30). "Complementary And Alternative Medicine In Chronic Liver Disease" contains a discussion of herbs, vitamins, and antioxidants used in the treatment of chronic liver diseases.

The Online College of Herbalism offers online courses on a number of subjects related to herbs. For instance, Medical Herbalism is a 6-month course held from June 3rd to Nov 30th while Plant Biology is a 3-month course held from June 4th to Aug 29th. Course registration runs from April 20th to May 20th. For additional information e-mail Mary L. Conley, MNH, ND.

Reliable Nutrition Information For HIV-positive People

The Spring 2002 ACRIA Update (Vol. 11, No. 2) offers "Nutrition & Immunity: You Are What You Eat" by Jennifer Muir Bowers, MS, RD, CNSD and "Diet Wise, Pound Foolish: Promoted Diets for HIV" by Anya Romanowski, MS, RD, CDN & Lisa Zullig, MS, RD.

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.

Plant Stanol Esters And Cholesterol

As noted in Issue 23 of the HIV ReSource Review, a margarine-like spread of free soyabean-oil sterols is effective in lowering both total and LDL cholesterol levels. (1) Margarine-like spreads containing stanol esters such as Benecol and Take Control are considered functional foods. They can lower total cholesterol and LDL cholesterol levels in mildly hypercholesterolemic people. (2) Two studies indicate that in addition to lowering cholesterol, margarines that contain the phytosterols responsible for this therapeutic effect might also cause malabsorption of fat-soluble carotenoids. Results of a yearlong study indicate that while the margarine reduced levels of total and LDL cholesterol, it also reduced beta-carotene levels by 25%. (3) In another six-week study, beta-carotene was lowered by 30% but Vitamin D, retinol and a-tocopherol levels were not affected. (4)

Although the US Food & Drug Administration (FDA) published an interim final rule authorizing the use of a health claim on the relationship between plant sterol/stanol esters and reduced risk of heart disease, Health Canada has issued an advisory on this type of margarine. Health Canada notes that the margarine has not been approved for sale and may pose health risks to those predisposed to hemorrhagic strokes, pregnant women, children and people on cholesterol- lowering medications. Some products contain 10 times more plant sterols than similar fat spreads and the effects of exposure to this product have not been properly assessed.

References
1. Sierksma A, Weststrate JA, Meijer GW. Spreads Enriched With Plant Sterols, Either Esterified 4,4-Dimethylsterols Or Free 4-Desmethylsterols, And Plasma Total- And LDL-Cholesterol Concentrations. Br J Nutr. 1999;82(4):273-82.
2. Nguyen TT, Dale LC, von Bergmann K, Croghan IT. Cholesterol-Lowering Effect Of Stanol Ester In A US Population Of Mildly Hypercholesterolemic Men And Women: A Randomized Controlled Trial. Mayo Clin Proc. 1999;74(12):1198-206.
3. Gylling H, Puska B, Vartianinen E. Retinol, Vitamin D, Carotenes And A-Tocopherol In Serum Of A Moderately Hypercholesterolemic Population Consuming Sitostanol Ester Margarine. Atherosclerosis. 1999;145:279-285.
4. Gylling H, Miettinen T. Cholesterol Reduction By Different Plant Stanol Mixtures And With Variable Fat Intake. Metabolism. 1999;48(5):575-580.

Upcoming Conferences

Nutrition and HIV/AIDS 2002, a series of workshops will be held in numerous locations in the month of June. Sponsored by the HIV/AIDS Dietetic Practice Group of the American Dietetic Association the HIV Nutrition Workshop is a one-day conference focusing on recent research findings, knowledge, and vital information essential in providing optimal nutritional management for people living with HIV/AIDS. The workshops will be held in Baltimore on June 10, Philadelphia on June 11, Hartford on June 12, Boston on June 13, and New York City on June 15. Workshops are for any professional involved with HIV-positive people. Alan Lee, RD, CDN, CFT, will lead the limited enrollment workshops. 
 

MedWatch Report

Recent reports describe serious thrombotic events (vascular occlusion) possibly associated with the administration of Immune Globulin Intravenous (IGIV). Patients receiving IVIG include those with cardiovascular disease, diabetes mellitus or neuromuscular disorders. Caution should be exercised when prescribing IGIV for patients with a history of cardiovascular disease or thrombotic episodes. Adverse events include chest pain, myocardial infarction, congestive cardiac failure, severe headache requiring hospitalization, and pulmonary embolism. All patients with thrombotic risk factors such as coronary artery disease, hypertension, cerebrovascular disease and diabetes mellitus should be carefully evaluated. Please refer to the product direction insert or visit  MedWatch  for more information. 

AIDS Strains

There are numerous HIV strains but viral strain B causes most HIV infections in the United States and Western Europe. Scientists from the University of California in Los Angeles recently discovered that overseas viral strains are affecting American children. The scientists found an African strain of HIV in two infants who had developed resistance to anti-HIV drug regimens. While one infant carried the African strain D the other had African viral strains A and G (April issue of AIDS Research and Human Retroviruses - "Mother-to-Child Transmission in the United States of Subtypes D and A/G Human Immunodeficiency Virus Type 1" by Dr. Paul Krogstad and colleagues). For additional free information visit Sciencedaily.com.

Conference News

The Nurse Practitioner Associates for Continuing Education (NPACE) National Women's Health Care Conference will be held in Newport, Rhode Island from May 29, 2002 to June 1, 2002. Topics include women with HIV/AIDS, osteoarthritis in women, pharmacology of herbal and natural supplements, and sexually transmitted diseases. For additional information visit the NPACE web site. 

Internet Nutrition Resources

Nutrition News
NutritionFocus.com
Nutrition Facts and Fallacies
Association of Nutrition Services Agencies
 

Substance Abuse

Recent study results compliment information published on substance abuse in Issue 24 and Issue 25 of the HIV ReSource Review and previous HIV Nutrition News Updates. Reuters Health Information reports that HIV-positive intravenous drug users face a higher risk of brain problems. 

News from United Press International reports that chronic use of marijuana can cause a drop in intelligence quotient (IQ). Smoking marijuana regularly may result in short-term memory loss but it is unclear if any of the longer-term effects of marijuana may affect decision making. Information within the abstracts from the Workshop on Clinical Consequences of Marijuana adds to that presented in previous updates and in Issue 23 and Issue 24 of the HIV ReSource Review.

Resources

The New Mexico AIDS InfoNet offers a variety of Fact Sheets in both English and Spanish. Among them are treatment side effects information on anemia, lipodystrophy and bone disorders. A Fact Sheet on Vitamins & Minerals may be useful as well.

Trials

Information on trials for HIV-positive participants is available at HIV InSite. Among the trials offered is one on the treatment of cryptosporidiosis using Nitazoxanide (NTZ), which was covered in Issue 17 of the HIV ReSource Review. The Canadian HIV Trials Network also offers information on clinical trials such as Lactose Intolerance in HIV Patients with Diarrhea. 

Puffer Fish Warning

The Food and Drug Administration (FDA) has issued a warning on puffer fish (also known as blowfish or sea squab) from Florida. Consumers should not eat puffer fish harvested from the Titusville, Florida area because they may contain a naturally occurring marine toxin (a byproduct of algae found in seawater) that can cause serious illness or death. The symptoms of this toxin include: tingling and burning of the mouth and tongue, numbness, drowsiness, and incoherent speech that usually develop within 30 minutes to two hours after eating the fish. In severe cases, respiratory paralysis and death may occur. Cooking or freezing cannot destroy this toxin. The Centers for Disease Control and Prevention (CDC) note reports of illness related to the consumption of puffer fish from Florida, New Jersey and Virginia. Consumers with questions may call the FDA Center for Food Safety and Applied Nutrition Center's Outreach and Information Center at 1-888-SAFEFOOD.

Women & HIV/AIDS

Recent findings add to the information presented in Issue 12 of the HIV ReSource Review on women and HIV.

French and colleagues suggest that vitamin A deficiency is not associated with perinatal HIV-1 transmission. (1) There was no association between retinol status and genital viral load in their study of 301 HIV-positive women enrolled in the Women's Interagency HIV Study. Other researchers report that compared to HIV-negative women, women living with HIV infection experience more obstetric and gynecological surgery complications including severe fever.  (2)  Complications were more common among those HIV- positive women with weaker immune systems. 

Sources:1. French AL, Cohen MH, Gange SJ, Burger H, et al. Vitamin A deficiency and genital viral burden in women infected with HIV-1. Lancet 2002;359(9313):1210-12.
2. Grubert TA, Reindell D, Kästner R, Belohradsky BH, et al. Rates of Postoperative Complications among Human Immunodeficiency Virus Infected Women Who Have Undergone Obstetric and Gynecologic Surgical Procedures. Clinical Infectious Diseases 2002;34:822-830.

Medicaid, AIDS and HIV

Medicaid and AIDS and HIV Infection is a Fact Sheet published by the Centers for Medicare and Medicaid Services. The Fact Sheet adds to the information presented in our current issue of the HIV Nutrition Update on Nutritional Services For People Living With HIV. Medicaid serves about 55% of all persons living with AIDS (PLWA) and up to 90% of all children with AIDS. It is the largest single payer of direct medical services for PLWAs in the United States and Medicaid expenditures for this population are estimated at $7.7 billion for the year 2002. 

Foodborne Disease

Does Your Patient Have a Foodborne Disease? is a Medscape article  that adds to our new Food Safety And You patient education handout published in our May/June issue of the HIV Nutrition Update newszine. You need to register at Medscape to see the article but registration is free. 

HIV/AIDS Resources
* Office of AIDS Research at NIH 
* Links to AIDS/HIV Organizations
 

Medication Labeling Changes

A number of medications used by people living with HIV have undergone recent labeling changes. Among them are:

* AGENERASE (amprenavir) Capsules & Oral Solution Labeling now provides for the inclusion of pharmacokinetic, safety, and dosing information on the co-administration of AGENERASE Capsules/AGENERASE Oral Solution with NORVIR (ritonavir) in the AGENERASE Capsules and AGENERASE Oral Solution package inserts. Also, labeling for AGENERASE CAPSULES and AGENERASE Oral Solution provides for the inclusion of wording outlining the potential for redistribution/accumulation of body fat concurrent with the use of nucleoside analogues.

* REBETRON Combination Therapy REBETOL (ribavirin) Capsules & INTRON A (interferon alfa-2b) Injection 
Labeling includes precautions on drug interactions with nucleoside analogs. Notably, administration of nucleoside analogues has resulted in fatal and nonfatal lactic acidosis. Co-administration of ribavirin and nucleoside analogues should be undertaken with caution and only if the potential benefit outweighs the potential risks.

* RETROVIR (zidovudine) Capsules, Syrup, Tablets & IV Infusion 
Labeling includes information on adverse reactions observed during clinical practice including endocrine (Gynecomastia) and gastrointestinal (constipation, dysphagia, flatulence, oral mucosa pigmentation, mouth ulcer). Physicians are encouraged to register patients in an Antiretroviral Pregnancy Registry to monitor maternal-fetal outcomes of pregnant women exposed to RETROVIR by telephoning 800/258-4263. Nursing Mothers receiving RETROVIR should not breastfeed their infants.

* VIRACEPT (nelfinavir mesylate) Tablets & Oral Powder 
Labeling provides for updated information on proper storage conditions for VIRACEPT Oral Powder. 

* ZERIT (stavudine) Capsules 
Labeling changes include warnings on the possibility of lactic acidosis associated with antiretroviral combinations containing stavudine. Generalized fatigue, digestive symptoms (nausea, vomiting, abdominal pain, and sudden unexplained weight loss); respiratory symptoms (tachypnea and dyspnea); or neurologic symptoms (including motor weakness) might be indicative of lactic acidosis development. Patients with these symptoms should seek medical attention immediately. Redistribution or accumulation of body fat have also been observed in patients receiving antiretroviral therapy. 

Caffeine And Creatine

A recent study on creatine adds to the information presented in Issue 13 of the HIV ReSource Review. In a study of ten individuals, Belgian researchers found that caffeine intake destroys the potential benefits of creatine.

Upcoming Conferences

1) The Dietary Supplements Analytical Methods Workshop will be held on April 18, 2002. 
2) "2002 Minisymposium: Herbal Dietary Supplements: Health Effects and Mechanisms of Action" will be held on April 22, 2002, at the New Orleans Convention Center. Visit the Experimental Biology web site and the NIH web site at for further information. 
3) A conference cosponsored by the National Council Against Health Fraud on critical thinking about dietary supplements will be held on May 3, 2002, in Irvine, California. Download more information on the five-hour "Health, Hope or Hype? Dietary Supplement Conference: Critical Thinking for Consumers". 
4) AIDSWatch 2002 will be held on June 9-11, 2002 in Washington, DC. Given the toll of HIV/AIDS in communities of color, the participation of people of color in AIDSWatch 2002 is critical! Scholarship applications are available.

Treatment Guidelines

Visit the HIV/AIDS Treatment Information Service (ATIS) to view federally approved treatment guidelines for HIV and AIDS. Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents are dated February 4, 2002. ATIS also holds Perinatal and Pediatric Guidelines and Recommendations for the Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States. 

Supplement Warnings

Kava
The FDA Center for Food Safety and Applied Nutrition (CFSAN) notified healthcare professionals and consumers of the potential risk of severe liver injury associated with the use of kava-containing dietary supplements. Supplements containing the herbal ingredient kava are promoted for relaxation (e.g., to relieve stress, anxiety, and tension), sleeplessness, menopausal symptoms and other uses. Kava-containing products have been associated with liver-related injuries, including hepatitis, cirrhosis, and liver failure. Given these reports, persons who have liver disease or liver problems, or persons who are taking drug products that can affect the liver, should consult a physician before using kava-containing supplements. See MedWatch 2002 Safety Information. Additional information on kava is from the Traditional Medicines Evaluation Committee (TMEC), a subcommittee of the European Herbal Practitioners Associationon. Other sources of information on this issue include  source one and  source two. 

LipoKinetix
A weight loss supplement called LipoKinetix appears to have caused liver damage in seven healthy people. (1) U.S. Food and Drug Administration (FDA) officials warned the manufacturer to take it off the market and asked consumers to stop using the supplement. The patients who developed liver inflammation had symptoms such as fever, abdominal pain, jaundice and fatigue, which stopped after stopping LipoKinetix. The dietary supplement contains norephedrine (also known as phenylpropanolamine), caffeine, yohimbine, diiodothyronine, and sodium usniate. As noted in our two-part issues (Issue 21 and Issue 22 of the HIV ReSource Review) on botanical use among HIV-positive people, supplement manufacturers do not have to prove that their products are safe and effective before marketing them. Lewis and Strom remind us of the importance of discussing supplement use with doctors. (2)

Sources:1. Favreau JT, Ryu ML, Braunstein G, Orshansky G, et al. Severe Hepatotoxicity Associated with the Dietary Supplement LipoKinetix. Ann Intern Med. 2002;136:590-595.
2. Lewis JD, Strom BL. Balancing Safety of Dietary Supplements with the Free Market. Editorial. Ann Intern Med. 2002;136:616-618.

Updated HIV ReSources Web Site
New pages include: 
Issue 35 HIV Nutrition Update Preview
Nutritional Services For People Living With HIV

Updated pages include:
HIV Nutrition News Update Electronic Newsletter Archive - Issue Two
Conference Information
Recommended Easy Reading Books
Herbal, Supplement, And Prescription Information
Supplement Cautions And Warnings

On-line Survey

The National Association of People With AIDS (NAPWA)  conducted an on-line survey of people living with HIV/AIDS.  The Survey was brief with only 12 questions and helped NAPWA determine where to focus organizational education and advocacy efforts on behalf of people living with HIV/AIDS over the next 3-5 years. 

HIV/AIDS Resources

Health Resources & Services Administration
National Minority AIDS Council listserv

Exercise & HIV

As noted in previous updates and newszine issues it is important for people living with HIV to exercise. Resistance exercise training can help to reduce high triglycerides. A recent study of 6,213 consecutive men (presumed HIV- negative) referred for treadmill exercise testing found that exercise capacity is a more powerful predictor of mortality among men than other established risk factors for cardiovascular disease. (1) Review previous updates and newszine issues and search Google.com  to learn more about exercise and HIV.

Sources: 1. Myers J, Prakash M, Froelicher V, Do D, et al. Exercise Capacity and Mortality among Men Referred for Exercise Testing. N Eng J Med 2002;346(11):793-801.

Complementary Medicine

Bastyr University recently received a $1.145 million grant from the National Institutes of Health to train scientists on how to conduct research on complementary and alternative medicines.

Quackwatch is now summarizing Food and Drug Administration warning letters about foods, dietary supplements, herbs, homeopathic remedies, and devices marketed with misleading claims. 

Botanic Lab has recalled the herbal dietary supplement SPES capsules, Herbal Dietary Supplement, Immune System Formula because the product contains the prescription drug alprazolam (Xanax).

Women & HIV

The Body's detailed listing of service organizations, books and web sites for HIV-positive women adds to the information presented in Issues 12 and 13 of the HIV ReSource Review. Visit The Body for historical and other information on women and HIV. For additional information on women and HIV visit HIV ReSources.

Diabetic Diets

Recent publications add to the diabetes information presented in our previous weekly updates and newszine issues (see Issue 27 and Issue 28). The American Diabetes Association issued new nutrition guidelines for the treatment and prevention of diabetes and its complications. It is notable that routine supplementation with antioxidants is not advised however, as noted in the February 26, 2002 issue of Nutrition News Focus some "of the recommendations are not necessarily based on strong evidence."

Nutritional Assessment

Previous research has noted the need for HIV-positive people to learn about basic nutrition. (1) Teaching basic good nutrition can increase nutritional literacy and help to improve nutritional status as knowledge empowers individuals to make educated decisions. Margo Woods, DSc, and colleagues at the Department of Family Medicine and Community Health, Tufts University School of Medicine in Boston, MA recently sought to evaluate the baseline nutrient intake of an HIV positive population and determine the relationship between state of disease and nutritional intake. (2) The researchers found that macronutrient intakes of HIV-positive individuals in the Nutrition for Healthy Living study (featured in the May/June 2002 HIV Nutrition Update issue) were statistically and inversely associated with decreasing CD4 cell counts. A large percent of women and minorities had inadequate nutrient intakes as compared to NHANES III data. While 25% to 35% of the women studied had dietary intakes of less than 75% of the Dietary Reference Intakes for vitamins A, C, E and B-6, iron and zinc, white men had statistically higher values of all micronutrients compared with nonwhite men. Researchers concluded that these individuals would benefit from dietary assessment and counseling. Weight and body composition data showed differences in weight in relation to CD4 cell counts suggesting that weight loss consists primarily of fat loss in those individuals with adequate fat stores. (3)

It is important that all HIV-positive individuals obtain a dietary assessment. A dietary assessment can help to identify those with inadequate nutrient intakes that may benefit from dietary counseling. Effective nutritional services can assist the individual living with HIV to learn strategies that will help them to maintain an optimal weight, decrease the incidence of lipodystrophy or malnutrition, or prevent and correct nutritional deficiencies. Issue 10 of the HIV ReSource Review has comprehensive information on the nutritional assessment of HIV-positive individuals. 

Sources
1. Meyer SA. Nutrition knowledge of people with HIV infection in Broward County. AIDS Patient Care; 1994;8(5):279-281.
2. Woods MN, Spiegelman D, Knox TA, Forrester JE, et al. Nutrient intake and body weight in a large HIV cohort that includes women and minorities. J Am Diet Assoc 2002;102(2):203-11. 
3. Forrester JE, Spiegelman D, Woods M, Knox TA, et al. Weight and body composition in a cohort of HIV-positive men and women. Public Health Nutr 2001;4(3):743-7.

Upcoming Conferences

Los Angeles County will be the site of a two-day conference on hepatitis during the month of July (18-19) 2002. Hosted by the Hepatitis Foundation, this education and training conference is for health providers working with people affected or infected by hepatitis. Participants will include health care providers, outreach workers and patient advocates. For further information telephone the Hepatitis Foundation International at 800/891-0707. 

The United States Conference on AIDS is the most widely attended conference of HIV/AIDS prevention and service providers in America. The 2002 United States Conference on AIDS will be held at the Anaheim Hilton in Anaheim, California on September 19-22, 2002.

For information on a variety of conferences related to HIV and nutrition visit the HIV ReSources Conference Web Page.

Lipodystrophy And Heart Disease

We know that protease inhibitors can increase levels of cholesterol and the risk of heart disease. (1) A variety of prescribed medications help to deal with these changes. (2) As noted in our January 18, 2002 update and HIV ReSource Review issues of Jan/Feb and March/April 2000, dietary counseling and an exercise program along with other measures may be helpful in reducing the risk of heart disease. Although these measures have never been formally tested (3), research continues to slowly trickle in on the benefits of diet and exercise among those with lipodystrophy. (4)

Sources:1. Stein JH, Klein MA, Bellehumeur JL, McBride PE, et al. Use of human immunodeficiency virus-1 protease inhibitors is associated with atherogenic lipoprotein changes and endothelial dysfunction. Circulation 2001;104(3):257-262.
2. Grinspoon S. Fat loss, fat gain and related metabolic abnormalities in HIV-infected patients receiving highly active antiretroviral therapy (HAART). NeuroAids 2001;4(5). 
3. Grinspoon S. Insulin resistance in HIV disease. The PRN Notebook Online Edition, June 2001. 
4. Roubenoff R, Schmitz H, Bairos L, Layne J, et al. Reduction of abdominal obesity in lipodystrophy associated with human immunodeficiency virus infection by means of diet and exercise: case report and proof of principle. Clinical Infectious Diseases 2002;34:390-393.

NUMEDX

The current issue of NUMEDX is being mailed out this month. NUMEDX, the largest HIV/AIDS medical journal, brings patients and healthcare providers together in a way that has become increasingly necessary. NUMEDX is now a semi-annual, total patient management resource guide and web site with a current distribution of 130,000 issues and an estimated readership of over 650,000...and growing. The new journal format includes an expanded version of the "Quality of Life" section, which will include important information concerning co-morbidity issues as well as treatment issues. If you do not already get this free publication visit the web site to subscribe.

Zerit Product Labeling Changes

Lactic acidosis is a complication of therapy with nucleoside analogues, including Zerit (stavudine), d4T. Product labeling changes have been made to the Zerit (stavudine, d4T) label to describe the occurrence of lactic acidosis and neuromuscular toxicity in patients using stavudine. Symptoms that may be due to lactic acidosis include abdominal pain, nausea, sudden unexplained weight loss, respiratory symptoms, or neurologic symptoms (including motor weakness) and fatigue, which can lead to death. Although the incidence is rare, stavudine may increase the risk of lactic acidosis. Permanent discontinuation of stavudine should be considered in confirmed cases of lactic acidosis. Please refer to the Zerit label for full prescribing information. You can also telephone the Medical Information Department at Bristol-Myers Squibb Company at 800/426-7644 for further information.

Creatine Monohydrate Study

A recent one-month study of 39 patients with hereditary neuropathy ingesting creatine monohydrate adds to the information presented in the July/Aug 1998 (Issue 13) HIV ReSource Review issue. Creatine monohydrate supplementation did not alter strength, body weight or body composition. The randomized, double-blind, placebo-controlled, cross over trial also revealed that it did not improve activities of daily living or fatigue either. 

Source: Doherty TJ, Lougheed K, Markez J, Tarnopolsky MA. Creatine monohydrate does not increase strength in patients with hereditary neuropathy. Neurology 2001;57(3):559-560.

Two-Day Conference

The HIV/AIDS Dietetic Practice Group of the American Dietetic Association and the New York Nutritionists in AIDS Care (NIAC) group is sponsoring Progressive Management of Metabolic Complications in HIV: HAART, Bones, and Beyond a Spring workshop for allied health professionals. The workshop will be held on April 19-20, 2002 at Hunter College in New York City. Topics Will Include: 
* Pathophysiology of metabolic complications in HIV 
* Anabolic agents, hormones, and exercise 
* Individualized nutrition strategies on medication related side-effects, quality of life, physical and mental performance, immune function and disease progression for people living with HIV/AIDS. 

Bone Problems

People with untreated HIV infection are more prone to bone disorders based on recent reports. Learn more about bone disorders by viewing the article from the Bulletin of Experimental Treatments for AIDS (BETA).

Recreational And Prescribed Drugs

Recent articles on recreational drugs and HIV add to the information presented in Issues 24 and 25 of the HIV ReSource Review, which featured articles on substance abuse and HIV-positive people. Studies using mice show that cocaine enhances the development and progression of AIDS. (1) Read about possible side effects of AIDS medications taken with recreational drugs at The Body.

Health Canada reports that Hua Fo tablets, taken with the hope to enhance sexual function, contains sildenafil (Viagra). Besides awareness of the lack of quality control, it's important that people who take dietary supplements along with prescribed medications know the other risks involved. 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.CNN.com also offers information on mixing herbs with prescription drugs. A recent article on garlic and saquinavir further verifies the information presented in previous issues of the HIV ReSource Review. (2)

Sources:1. Roth MD, Tashkin DP, Choi R, Jamieson BD, et al. Cocaine Enhances Human Immunodeficiency Virus Replication in a Model of Severe Combined Immunodeficient Mice Implanted with Human Peripheral Blood Leukocytes. J Infectious Diseases 2002;185:701-705.
2. Piscitelli SC, Burstein AH, Welden N, Gallicano KD, Falloon J. The Effect of Garlic Supplements on the Pharmacokinetics of Saquinavir. Clin Infect Dis 2002;34:234-238.

Nutritional Management Of HIV-Positive People

As in previous issues of the HIV ReSource Review, Australian Marijka Batterham and colleagues note that nutritional management of HIV-positive people has become increasingly complex since the introduction of HAART. Lipodystrophy is likely to be a direct consequence of antiretroviral drugs interfering with normal metabolism or of the immune reconstitution on successful therapy. Researchers have found that diet, stress and exercise may contribute to metabolic disturbances. Changes in disease treatment due to the use of HAART have necessitated changes in nutritional management strategies, which may include dietary modification, exercise, and pharmacological treatments. As reported in the Jan/Feb and March/April 2000 HIV ReSource Review issues, dietary levels of fiber, alcohol and polyunsaturated fat may influence the risk of fat redistribution. Patients on HAART need an individually modified treatment strategy, which requires clinicians to keep up-to-date knowledge of conventional and current issues to assist people in maximizing their nutritional status.

Funding - Complementary And Alternative Medicine Research

The National Institutes of Health: National Center for Complementary and Alternative Medicine Clearinghouse Fund is offering up to three years of funding to support research into interactions between botanical substances and prescription drugs used in the treatment of HIV infection and its complications (Botanical/Drug Interactions in HIV - fund number: RFA-AT-02-003). Research findings published in the medical literature suggest harmful interactions between botanicals and antiretroviral medications; however some reports also suggest beneficial effects from botanical/drug combinations. A total of $600,000 is available to stimulate investigator-initiated biomedical research on botanical/drug interactions in-vitro, in animal models, and in phase I/II clinical studies relevant to the treatment of HIV-infection and its complications. Research supported by this initiative is expected to prevent adverse botanical/drug interactions during therapy for HIV-infection and its complications, establish possible synergistic combinations of botanicals with pharmaceutical drugs, and increase our knowledge of the mechanisms of action of botanicals. The information developed on interactions between botanical substances and pharmaceutical agents used in the treatment of HIV-infection and its complications is expected to provide the public and health professionals with the information necessary to make appropriate treatment choices. The Letter of Intent date is February 28, 2002 and applications (deadline- March 28, 2002) may be submitted by domestic and foreign, for-profit and nonprofit organizations, public and private, including universities, colleges, hospitals, laboratories, units of State and local government, and eligible agencies of the Federal government. The research grant application form PHS 398 (rev. 5/2001) and forms must be used in applying for these grants. These forms are available from the Division of Extramural Outreach and Information Resources, National Institutes of Health, 6701 Rockledge Dr, MSC 7910, Bethesda, MD 20892-7910, 301/435-0714, e-mail: GrantsInfo@nih.gov. Access the Web site  to get the RFA for this application. For further information, contact the Application Procedure Contact Person Victoria Carper at the National Center for Complementary and Alternative Medicine National Institutes of Health, 6707 Democracy Blvd, Ste 106, Bethesda, MD 20892 -5475, 301/594-9102.

Serum Vitamin E, C & A Status Of Drug Addicts Undergoing Detox

As reported in the May/June 2000 and July/Aug 2000 HIV ReSource Review issues, a recent Bangladesh study further notes the effect of illegal drug use on micronutrient status. The report notes that male drug addicts have reduced vitamin E (tocopherol), C (ascorbic acid) and A (retinol) status, which could be influenced by drug habit and occupation factors. The study of 253 drug addicts and 100 cohort control men used questionnaires and blood specimens. Tocopherol, ascorbic acid and retinol levels in the drug addicts were significantly low as compared to those in the controls with use of multiple illicit drugs for a longer period of time resulting in further reduced levels. Body mass index had a significant positive linear correlation with vitamin C. The investigators conclude that providing an antioxidant therapy to drug addicts undergoing detoxification may help them in rehabilitating to "normal life". 

Source: Nazrul Islam SK, Jahangir Hossain K, Ahsan M. Serum vitamin E, C and A status of the drug addicts undergoing detoxification: influence of drug habit, sexual practice and lifestyle factors. Journal: European Journal of Clinical Nutrition 2001; 55(11):1022-1027.

Type 2 Diabetes

The following adds to a previous update and to the information in Issue 28 of the HIV ReSource Review on dietary measures and supplement use for HIV-positive people who have type 2 diabetes. Recent research further verifies that lifestyle changes are best for decreasing the risk of diabetes. Knowler, at the Southwest American Indian Center for Diabetes Prevention in Phoenix, Arizona, and colleagues have reported a reduction in the incidence of type 2 diabetes with lifestyle changes or metformin. Research of dietary patterns and risk for type 2 diabetes in American men documents that a western diet (characterized by higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, sweets and desserts) may increase development of the disease. Findings from another study published in the Journal of the American College of Nutrition further confirms that zinc and chromium supplementation may be useful to decrease oxidative stress in people with type 2 diabetes.

Increased Antioxidant Levels In People on Protease Inhibitors?

Researchers from Tufts University in Boston, Massachusetts note that protease inhibitors may lower oxidative stress levels in HIV-positive people. The study, which included both HIV- positive and HIV-negative intravenous drug users reports that caution should be used when using or recommending high-dose antioxidant supplementation in HIV-positive people, especially those on protease inhibitors.

FDA Newsflash

The Food and Drug Administration (FDA) Safety Information and Adverse Event Reporting Program are warning consumers to stop using the dietary supplement / herbal products PC SPES and SPES capsules because they contain undeclared prescription drug ingredients that could cause serious health effects if not taken under medical supervision. Laboratory analysis of the products by the California Department of Health Services found PC SPES contains warfarin (Coumadin) and SPES contains alprazolam (Xanax), which are available only by prescription and sold either by their generic names or the trade names. PC SPES and SPES are respectively marketed "for prostate health" and strengthening the immune system. BotanicLab, the manufacturer of the products, has voluntarily recalled PC SPES and SPES nationwide. See the MedWatch 2002 Safety Information alert for PC SPES and SPES.

HIV Medical Specialists

California may become the first state to certify HIV medical specialists improving the health care of people in California living with HIV/AIDS. California specialists can become certified with the help of the American Academy of HIV Medicine. Read the proposed guidelines.

HIV-1 versus HIV-2

Although it is doubtful that HIV-2 facilitates HIV-1 infection, recent findings suggest that being HIV-2 positive may increase the risk for HIV-1 infection. 

HIV Medication Formulation and Labeling Changes

Sustiva: A recent update from the Food and Drug Administration (FDA) notes new formulation and labeling changes for Sustiva (efavirenz), which we covered earlier in Issue 25 of the HIV ReSource Review. A new formulation of Sustiva was FDA approved on February 1, 2002 and will now also be available as a 600 mg tablet to be taken once daily, in combination with a protease inhibitor and/or nucleoside analogue reverse transcriptase inhibitors (NRTIs). Revised statements in the Dosage and Administration section of the label include:
"It is recommended that Sustiva be taken on an empty stomach, preferably at bedtime.  The increased efavirenz concentrations observed following administration of Sustiva with food may lead to an increase in frequency of adverse events. Dosing at bedtime may improve the tolerability of nervous system symptoms." Additions to the Clinical Pharmaology and Precautions sections now include drug interaction information on Sustiva with the following medications; St. John's wort, lorazepam, methadone, cetirizine and rifabutin. In addition, the Adverse Reaction section was revised to update the incidences of adverse events and laboratory abnormalities seen in clinical trials. View the revised label in PDF format. In addition, one neural tube defect in a baby born to an efavirenz-user was recently reported by CATIE News.

Agenerase and Norvir: The FDA also approved a new dosing regimen for Agenerase (amprenavir) and Norvir (ritonavir) used in combination. Numerous revisions were made to the Agenerase package insert regarding the use of Agenerase plus ritonavir. Most notably, the Precautions section was revised to provide additional information about possible cholesterol, triglyceride and liver transaminase elevations when amprenavir is co-administered with ritonavir. The section now offers information about the potential for lipid elevations; guidance on monitoring and managing these clinical chemistry abnormalities.

Anabolic Steroids

This month a television show will add to the information we offered on anabolic steroids in Issue 20 and Issue 24 of the HIV ReSource Review. "Steroids: The Hard Truth" a program that highlights the dangers of anabolic steroids will air on "In the Mix", a popular television show, on PBS stations from February 16, 2002 to February 23, 2002 (check your local listings). Visit the National Institute on Drug Abuse web site or view "Research Report: Anabolic Steroid Abuse" and other information about the health effects of these drugs. 

Glucose Abnormalities & HIV

We know protease inhibitors (PIs) can cause diabetes by hindering the storage of glucose and that human fat cells absorb less glucose after they are exposed to PIs. The following adds to information, which we published on glucose abnormalities in HIV-positive people, in Issue 27 and Issue 28 of the HIV ReSource Review. Issue 27 includes a Diabetes Update clinician tool while Issue 28 holds information on dietary measures and supplement use for people living with HIV who have diabetes. 

Internet Based Resources On Diabetes

The Food and Drug Administration (FDA) offers information on diabetes in the Jan/Feb 2002 FDA Consumer magazine.

Hyperlipidemia and Insulin Resistance Due to HIV Infection and its Therapies

New Mexico AIDS InfoNet Fact Sheet Lab Results, Part 3: Blood Sugar and Fats helps people to understand their lab results.

Web Site Update

The HIV ReSources Web Site is updated. 

New pages include:
HIV Nutrition News Update Electronic Newsletter Archive- Issue Two

Updated pages include:
Nutrition & HIV Discussion Area Archive-1
Nutrition & HIV Discussion Area Archive-2
HIV Transmission
Free HIV Nutrition News Update Electronic Newsletter Links
Conference Information
Health Links

The following adds to information published in Issue 22 and Issue 23 of the HIV ReSource Review.

Metabolic Syndrome & Heart Disease

The importance of treating people with the metabolic syndrome to prevent heart disease can not be overstated. The Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP III) defines metabolic syndrome as three or more of the following conditions:

• waist circumference more than 88 cm in women and 102 cm in men;
• serum triglycerides level of at least 150 mg/dL (1.69 mmol/L);
• high-density lipoprotein cholesterol (HDL) level of less than 50 mg/dL (1.29 mmol/L) in women and 40 mg/dL (1.04 mmol/L) in men;
• blood pressure of at least 130/85 mm Hg;
• serum glucose level of at least 110 mg/dL (6.1 mmol/L).

Homocysteine & Heart Disease

We know that an elevated homocysteine level is an independent risk factor for heart disease. Homocysteine is a product of the metabolism of methionine (an amino acid). The metabolism of homocysteine involves micronutrients such as folate, vitamins B6 and B12. Researchers recently reported that dietary changes and supplementation with folic acid, vitamin B6, and vitamin B12 may help to lower homocysteine levels. Although we still need to see documentation of randomized controlled trials, dietary changes and supplementation may prove useful for some people living with HIV infection.

Since HIV-positive people with gastrointestinal diseases are more likely to have nutritional deficiencies including deficiencies of the B vitamins, which could elevate homocysteine, supplements may help to lessen the occurrence of heart disease. Caution in choosing dietary supplements is in order though as ConsumerLab.com, a commercial testing company in White Plains, New York, has reported that vitamin B supplements may exceed safe levels.

Web Sites Of Interest

HAART to Heart Lipodystrophy and Heart Disease
Nutrition-related Conditions

Heart Disease And Micronutrients

The following information compliments our two-part article on heart healthy food choices noted in Issue 22 and 23 of the HIV ReSource Review. In a large-scale study of 19,496 people, scientists from Cambridge University found that increased intake of fruits and vegetables resulting in increased vitamin C intake cuts the risk of death from heart disease. Another study of diabetics completed by investigators at the University of Texas's Southwestern Medical Center in Dallas found that supplements of vitamin E may help to prevent diabetic heart disease. The researchers note that vitamin E supplementation could be an adjunctive therapy in the prevention of atherosclerosis. 

More On Health Health

Find more information on patients with lipodystrophy having an increased risk of coronary artery disease at The Body and The prn Notebook. Read a personal account of heart disease and HIV. To learn how to reduce your risk of heart disease.

Non-Invasive Skin Cholesterol Test

Predictive medicine company IMI International Medical Innovations Inc. has announced it's new non-invasive skin cholesterol test that identifies people at risk of heart disease.

Bone Disorders Among HIV-positive People

Resources on bone disorders that are complications among HIV- positive people have been increasing as reports of osteoporosis (depletion of bone mineral) and osteopenia (mild to moderate bone mineral depletion) become common. Numerous sources add to the interview with Dr. Mary Romeyn, which was published in Issue 26 of the HIV ReSource Review and included a handout on building healthy bones.

Selected resources include information from:
HIVandhepatitis.com including Emerging Bone Problems in HIV-Infected Patients and lipodystrophy; The Body including  osteoporosis and a fact sheet on bone problems; Osteoporosis, Prevention, Diagnosis, Therapy from the National Institutes of Health including a  Consensus Statements; Bone Disorders In HIV-Infected Patients by William G. Powderly, MD and Individuals Vary Greatly In Their Ability To Absorb Calcium

Resources on Nutrition and HIV

The following web site resources may be helpful to learn more about nutrition and HIV:

APLA Nutrition Links
Coming Through Breaking the Barriers to Good Eating
HIV ReSources Nutrition Links

HIV and Hepatitis C Co-infection

Project Inform offers a fact sheet on the symptoms, transmission, prevention and treatment of hepatitis C in HIV-positive persons that compliments information on HIV and Hepatitis C co-infection published in our March/April 2001 and May/June 2001 HIV ReSource Review Issues. For a wealth of information on hepatitis visit HIVandHepatitis.com.

Food and Drug Administration (FDA) Alerts

The FDA recently notified health professionals and patients that goat antiserum to treat HIV/AIDS is not currently approved for the treatment of HIV/AIDS or for any human clinical study. Concerns regarding kidney toxicity associated with herbal products containing aristolochic acid are important to note as well. Also, the FDA is taking steps to remove phenylpropanolamine hydrochloride from all drug products due to the risk of hemorrhagic stroke.

Substance Abuse

Recent research on heroin abusers adds to the information presented in Issue 24 and Issue 25 of the HIV ReSource Review, which featured articles on substance abuse and HIV-positive people. Spanish investigators recently found that morality was a function of the length of drug use and HIV status. People who started abusing intravenous heroin at an earlier age were at a greater risk of dying prematurely. Researchers also associated premature death among older HIV-positive people starting drug injection.

Reference: Muga R, Roca J, Egea JM, et al. Mortality of HIV- Positive and HIV-Negative Heroin Abusers as a Function of Duration of Injecting Drug Use. Journal of Acquired Immune Deficiency Syndromes 2000;23(4):332-338.

Helpful Internet sources of further information include:
NIDA Notes
Information on Club Drugs
Canadian Centre on Substance Abuse
Join Together Online/Substance Abuse

Vitamin Supplementation & Vertical Transmission Of HIV-1

Dr. Wafaie W. Fawzi and colleagues note that neither vitamin A or other vitamin supplementation reduces the risk of vertical transmission of HIV in utero or during the intrapartum and early breastfeeding periods. Recently Duggan and Fawzi reported that among communities at risk of vitamin A deficiency supplementation can reduce mortality and morbidity in children younger than age 5. Supplementation with zinc could reduce the incidence and severity of diarrheal diseases and pneumonia in children with poor dietary zinc intake or bioavailability. 

Copyright HIV ReSources, Inc.