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HIV/AIDS Incidence
Throughout the world, 25 million people have died of AIDS including three-million people who died last year. Estimated worldwide HIV infections are now 47,992,821. Women continue to make up a larger share of AIDS cases particularly in Massachusetts. (1) African American and Latina women constitute 75% of all female AIDS cases.

As noted in our two-part article on HIV and Women, in Issues 12 and 13 of the HIV ReSource Review, women typically have a more difficult time getting health care and caring for themselves in general. Many women do not even know that they carry the virus. Minority women continue to be stigmatized and have difficulty accessing services. (2) A recent report from the Hopkins HIV Report  highlights gynecological problems and differences in viral load, disease progression and metabolic problems.

By the year 2010, 11 African countries will have life expectancies of only 30 years. (3) As far as stemming the incidence of HIV, there is a small grain of hope on the horizon. AIDS researchers are currently working on a vaccine that may elicit antibodies that block the infection of multiple HIV virus strains. (4)

Sources
1. LeBlanc S. Women Making Up a Larger Share of AIDS Cases. AP; 21 Aug 2002.
2. Stapp K. Black, Latina Women With HIV Often Fall Through Cracks. Inter Press Service, 26 Aug 2002.
3. AIDS Epidemic Predicted To Continue Its Advance On Globe. The Nations Health. American Public Health Association,  Sept 2002; 32(7):1,8.
4. Promising Multi-Strain HIV Vaccine Candidate Emerges; 21 Aug 2002. University Of Maryland Biotechnology Institute. 

Nutrition And HIV/AIDS
A number of articles on nutrition and HIV/AIDS are online for HIV-positive people at the Positively Aware web site. These include: Update on Micronutrient Needs in HIV, Treating Unintentional Weight Loss: An Important Piece of the HIV Puzzle, Diarrhea...Again? Treatment Options for Medication- Induced Diarrhea, Nutrition and Lipodystrophy, Eating for Exercise, and Drug Nutrient Interactions and HIV.

HIV ReSources Web Site
The HIV ReSources Web Site is updated.

New pages include:
HIV, Nutrition & The Internet Slide Show
HIV Nutrition Discussion List

Updated pages include:
Wasting And Weight Loss Information
Why Be Tested For HIV?
National HIV Nutrition Guidelines - Testimony
Search Engines
Food Safety Resources
 

Recalls And Health Fraud
Products containing the undeclared prescription drug ingredients Alprazolam, Indomethacin, Ethinyl Estradiol, and/or DES have been recalled both nationwide and internationally. 

The Food and Drud Administration (FDA) has warned a Baton Rouge, Louisiana physician to stop marketing Dr. Wahid's Herbal Remedy (a syrup) for terminal illnesses. Patients using the syrup were required to sign a document which stated that, "This offer is for patients that are diagnosed with a terminal illness only. I have ____ illness and have tried everything else and now taking this remedy. . . . I also feel that there is no other treatment that will help me." The FDA also ordered T-Up Inc. of Baltimore and Astec Biologics of Hanover, PA to stop illegally marketing aloe vera treatments. Issue 4 of the HIV ReSource Review highlighted this complementary treatment, which is marketed for a wide variety of aliments and as an immune system booster. Company principals are now serving prison terms for fraudulently peddling an intravenous mixture containing aloe vera. Some patients were billed up to $18,000 for a two-week treatment of intravenous aloe vera that they received in either the Bahamas or Mexico. Bottled combinations of unapproved aloe vera, which may cause loose stools in users, are marketed by numerous companies.

Australia recently issued a recall of medicinal products that contain kava. Read about it at the Medline Plus Health Information web site.

For additional information on recalls and warnings visit the Consumerlab web site.

Working with the FDA, the Federal Trade Commission recently issued a new health fraud brochure called 'Miracle' Health Claims: Add a Dose of Skepticism. The brochure lists signs of fraudulent health claims such as:

* Statements that the product is a quick and effective cure-all or diagnostic tool for many ailments. 
* Statements that suggest the product can treat or cure diseases. 
* Promotions that use words like "scientific breakthrough," "miraculous cure," "exclusive product," "secret ingredient" or "ancient remedy." 
* Text that uses impressive-sounding terms.
* Undocumented case histories or personal testimonials by consumers or doctors claiming amazing results. 
* Limited availability and advance payment requirements. 
* Promises of no-risk "money-back guarantees." 

Substance Abuse & HIV
Previous issues of the HIV Nutrition News Update have focussed on substance abuse and people living with HIV. The July 2002 Hopkins HIV Report features an article on substance abuse and notes that substance abuse can play a major role in HIV transmission even among non-injection drug users. Although the article does not address nutritional issues, the information compliments Issue 24 and Issue 25 of HIV ReSource Review, which does address nutritional issues of substance abuse.
 

Product Labeling Change
Product labeling has been changed for AGENERASE (amprenavir) Capsules and AGENERASE (amprenavir) Oral Solution to reflect new precautions related to use of Agenerase with Methadone, and with oral (hormonal) contraceptives.

Methadone: Coadministration of amprenavir and methadone can decrease plasma levels of methadone.  AGENERASE may be less effective due to decreased amprenavir plasma concentrations in patients taking these agents together. Alternative antiretroviral therapy should be considered. Dosage of methadone may need to be increased when coadministered with AGENERASE.

Oral contraceptives: (Ethinyl estradiol/norethindrone)  Those taking AGENERASE should be instructed not to use hormonal contraceptives because some birth control pills (those containing ethinyl estradiol/ norethindrone) have been found to decrease the concentration of amprenavir.  This may lead to loss of virologic response and possible resistance to AGENERASE. Alternative methods of non-hormonal contraception are recommended.
Complete Agenerase label

More on the XIV International AIDS Conference 
Coverage of the XIV International AIDS Conference includes Medscape Conference Coverage, based on selected sessions including Dr. Kotler's update on lipodystrophy, the Report from AIDS2002 Nutrition and HIV satellite  and the full list of conference articles from Health and Development Networks. The Health and Development Networks also web site  includes links to eForums and various articles on HIV/AIDS.

Kava Products Banned in Germany
As noted in Issue 21 and Issue 22 of the HIV ReSource Review, numerous people with HIV use complementary treatments including kava. In our December 21, 2001 HIV Nutrition News Update we noted that dietary supplements containing kava are linked to serious hepatotoxicity. Recently the German Federal Institute for Drugs and Medical Devices (BfArM) canceled the registrations of products with significant amounts of kava kava (Piper methysticum) because of the risk of liver damage. The decision was based on reports of more than 40 adverse reactions. Although it is unknown whether the use of U.S. dietary supplements with kava poses similar public health concerns, it appears prudent to avoid using kava-containing products.

The BfArM web site may be of interest to those wishing to see press releases such as the one on herbal medicinal products and St. John's wort and presentations on herbal and other complementary therapies from professional meetings.

Satellite Teleconference on Food Safety
The Food and Drug Administrations "Innovative Food Safety Grants to State and Local Agencies:  A Showcase of the Outcomes is a satellite teleconference designed to help people learn about innovations in food safety education. The broadcast took place on September 26, 2002 and was geared toward enhancing food safety in the retail setting to prevent foodborne illnesses and deaths. It featured results of the Innovative Food Safety Grants from FY 1999 and 2000.

Food establishments and others interested in promoting safe food practices can visit the FDA web site to get more information about the satellite coordinates, to register your location as an Open Site, or to see if there is an Open Site near you. 

XIV International AIDS Conference Information
Abstracts from the XIV International AIDS Conference are available through the official web site and may be viewed using Internet Explorer. Other reports are available on HIV InSite's Conference Coverage page  and Medscape's web site including "Liver Function Tests Independently Predict Survival".

Diabetes
Short-term treatment with vitamin C and vitamin E may help to lower the risk of progressing to end-stage renal disease in Type 2 diabetic patients with elevated urinary albumin excretion rates. (1) HIV ReSource Review subscribers may refer to Issue 27 and Issue 28 for additional information on HIV/AIDS and glucose abnormalities including diabetes.

Recent results from the 3-year Diabetes Prevention Program report a sharply lower risk for Type 2 diabetes with diet and exercise changes. (2) Thirty minutes of exercise each day along with changes in diet resulted in a five to seven percent loss of body weight. Treatment with Glucophage (covered in Issue 27 of the HIV ReSource Review) also resulted in a decreased risk of Type 2 diabetes. Although the study group was not reported to be HIV-positive these results may be useful to those HIV-positive people who have an increased risk of diabetes due to highly active antiretroviral therapy. 

Sources
1. Gaede P, Poulsen HE, Parving HH, Pedersen O. Double-blind, randomised study of the effect of combined treatment with vitamin C and E on albuminuria in Type 2 diabetic patients. Diabet Med 2001 Sep;18(9):756-60.
2. Diet, Exercise Delay Type 2 Diabetes. FDA Consumer Magazine 2002; 35(5):10-11.

Conference Information
AIDS Nutrition Services Alliance (ANSA), Project Angel Food, AIDS Project Los Angeles and Desert AIDS Project held Client Day 2002 at the Renaissance® Hollywood Hotel on Thursday, September 12, 2002. The fun-filled, free and educational program for people with HIV/AIDS was held in both Spanish and English, and focused on aspects important for the entire being. Speakers covered subjects such as medical benefit updates, buying food on a tight budget, cooking classes, the mind-body connection and safe ways to lose weight. Breakfast and lunch was provided. For more information on future conferences, visit ANSA’s web site.

Nutrition & Exercise Workshops were held at various locations between August 16, 2002 through March 1, 2003. During the two-day workshops, Dr. William Evans and Nancy Clark, MS, RD provided practical tools for all health professionals interested in exercise and nutrition. For further information on other sessions visit the Web Site above.

HIV ReSources Web Site
The HIV ReSources Web Site is updated.

Updated pages include:
Information on HIV-positive Women & Children
Conference Information
Books on HIV Prevention and Education
Books on Complementary Treatments
Agenerase Alert

XIV International AIDS Conference Nutrition Highlights
Abstracts from the XIV International AIDS Conference in Barcelona, Spain are available. Selected poster presentation abstracts are available. The site is viewed best using Internet Explorer version 5.0 or higher.

The conference offered limited exposure to nutritional issues. Some abstracts highlighted the need for nutritional services including nutrition education to help people living with HIV optimize medications and deal with their adverse effects, avoid malnutrition and increase quality of life. (1-11) Presenters noted the importance of the need for research to determine foods that are essential for the management of HIV/AIDS. (9) Prescribing specific meal plans to compliment medications used to treat opportunistic infection would be helpful as well. For people lacking access to HIV medications, African presenters noted the success of a program that incorporated a holistic approach to disease management based on nutrition and education. (12)

One abstract noted the need for Day Care Centers along with a focus on the use of body weight as an indicator for needed nutritional services. (6) Presenters stressed the need for optimal nutrient intake to help HIV-positive people meet their increased need for vitamins, minerals, calories and protein. One thing that is becoming increasingly clear is that nutrition must be incorporated into programs geared towards helping people with HIV. As noted by one presenter, health care providers must accept their responsibility for providing nutritional services including medical nutrition therapy to delay disease progression and increase the overall well being of HIV-positive people. Linking to health care programs for the general population may be more successful than developing specific initiatives for people with HIV. (7)

Sources
1- Fields-Gardner C, Hershey J, Roberts L, Weingartner K, Khanna P. The World Intitiative for Soy in Human Health (WISHH) addresses nutritional needs of HIV-infected and affected communities; abstract no. MoPeF4127.
2- Bassichetto KC, Piloto HF. A nutritional guideline to outpatient clinic care for adults living with HIV/AIDS; abstract no. ThPeF8212.
3- Hernandez V. Treatment and care support found in the model of attitude, medications, exercise, and nutrition (amen). abstract no. ThPeF8201.
4- Pieribone DL, Herman L, Singer S, Fenton M, L'Heureux J. Optimizing nutrition status through education in food pantry clients. ThPeF8208.
5- Lakshmikanthan RupaApsop S. Nutrition-an essential co-therapy; abstract no. WePeF6846.
6- Vadrevu1 R, Vadrevu L, Prasada Rao DVS, Saple DG. Out patient care program for PLWHA in resource poor setting - One year experience without external aid; abstract no. WePeF6772.
7- Pribram V, Gilbert C. A combined approach to nutrition, exercise, and smoking cessation to reduce lipodystrophy and ill-health in people with HIV taking HAART; abstract no. ThPeF8207.
8- Fields-Gardner C, Romeyn M, Bowers M. Development and field test of nutrition-related assessment and treatment guidelines in pediatric HIV infection; abstract no. WePeF6810.
9- Malakasuka1 EM, Masangi V. The impact of nutrition on HIV/AIDS clients; abstract no. ThPeF8213.
10-Csta JAC. Corporal image and life quality: the experience of the intervention nutritional in the care of the people living HIV/AIDS in a specialized service in Sao Paulo city- Brazil; abstract no. ThPeF8210.
11-Alves MEF, Alves MCF, Alves RCF. Profile of the dental needs of an urban HIV/AIDS population; abstract no. ThPeB7391.
12- Francis LK. What happens when there aren't any drugs? Living longer and healthier with HIV; abstract no. ThPeF8226.

July/August HIV Nutrition Update Newszine
The July/August issue of HIV Nutrition Update is now available. Subscribers with Internet access can view the issue using their assigned username and password. Issue 37 includes an original research article written by Brian Kineman, MA, Marcia L. Nahikian-Nelms, PhD, RD, LD and Christina L. Frazier, PhD titled " A Pilot Investigation of the microbial contamination of herbal supplements: Is there a risk for immunocompromised populations?" Issue 37 also includes an informative view of herbs used in Traditional Chinese Medicine by Richard A. Freiberg, D.O.M., D.Ac., A.P., Board Certified Diplomate.

In addition, it holds:
* Program Spotlight column on God's Love We Deliver located in NY, NY;
* Update Central column with information on lipodystrophy;
* Resource Corner with leads to Internet, client and clinician resources and free publications;
* Med Watch column on Tequin (Gatifloxacin);
* Nutrition Forum question and answer column on platelets.

Probiotics
Numerous benefits are attributed to probiotics. As noted in Issue 34 of the HIV Nutrition Update, evidence suggests that probiotics can enhance both specific and nonspecific immune responses. Dietary consumption of the probiotic strain Lactobacillus rhamnosus HN001 in low-fat milk appears to enhance systemic cellular immune responses. (1) Investigators note that it may be useful as a dietary supplement to boost natural immunity. A nine-week study of 30 people completed by Gill and colleagues notes enhancement of phagocytes and tumoricidal activity of natural killer cells with Bifidobacterium lactis (2) The researchers conclude that B. lactis HN019 may be effective for enhancing aspects of cellular immunity in the elderly. Earlier studies reported that dietary consumption of B. lactis HN019 can enhance natural immunity in healthy elderly subjects after a period of six-weeks. (3)

Anecdotal reports of the usefulness of probiotic strains in lessening diarrhea in HIV-positive people are increasing. Medscape recently reported that probiotics may prevent antibiotic-associated diarrhea. Although these studies do not specifically address the HIV population, probiotics may prove to be useful for people living with HIV/AIDS.

Sources
1. Sheih YH, Chiang BL, Wang LH, Liao CK, Gill HS. Systemic immunity- enhancing effects in healthy subjects following dietary consumption of the lactic acid bacterium Lactobacillus rhamnosus HN001. J Am Coll Nutr 2001;20(2 Suppl):149-56.
2. Gill HS, Rutherfurd KJ, Cross ML, Gopal PK. Enhancement of immunity in the elderly by dietary supplementation with the probiotic Bifidobacterium lactis HN019. Am J Clin Nutr 2001;74(6):833-39.
3. Arunachalam K, Gill HS, Chandra RK. Enhancement of natural immune function by dietary consumption of Bifidobacterium lactis (HN019). Eur J Clin Nutr 2000;54(3):263-7.

Culturally Sensitive Care Guide
The revised HHS Health Resources and Services Administration's "Provider's Guide to Quality and Culture"  includes information to help health care practitioners provide culturally sensitive care to minority groups. The guide features interactive video/audio streaming of best-practice vignettes on working with culturally and linguistically diverse patients. For more information about the Guide, contact Len Epstein, Quality Center, Bureau of Primary Health Care at 301/594-3803.

Conferences
WorldNutra 2002 - 3rd Annual International Conference & Exhibition on Nutraceuticals and Functional Foods was held in San Diego, California November 17-20, 2002. Further information on other conferences are at their web site.

The Sixth Annual United States Conference on AIDS was held on September 19-22, 2002 at the Anaheim Hilton in Anaheim, California. For comprehensive information on this and other conferences visit the web site. 

Atherosclerotic Disease and HIV Infection was held on Thursday, October 10, 2002 at the New York Marriott Marquis Hotel in NY, NY. For further information on other conferences visit  the web site  or contact the Office of Continuing Medical Education at St.Luke's-Roosevelt Hospital Center via telephone at 212/523-2138.

Lipodystrophy
Recent reports note that an increase in triglycerides can predict lipodystrophy in those patients who are taking highly active antiretroviral therapy (HAART). (1) Increased cholesterol levels may also have a role in predicting lipodystrophy. Interestingly, although the Food and Drug Administration has approved a new non-invasive palm test to measure skin cholesterol it is intended to be used along with standard blood tests. (2)

Numerous complementary therapies are taken by HIV-positive people to try and reduce triglyceride and cholesterol levels. These therapies include garlic, guggul, flaxseed and fish oil supplements. As noted in previous HIV Nutrition News Updates, garlic supplements can impede HIV medications, particularly saquinavir. A literature review of garlic is in Issue 14 of the HIV ReSource Review. Additional information on garlic is at Thebody.

In our June 7, 2002 HIV Nutrition News Update we noted that guglipid may reduce cholesterol in mice by blocking the body's Farnesoid X Receptor (FXR), which plays a key role in managing cholesterol levels. Readers of the HIV ReSource Review may refer to Issue 27, which holds a comprehensive literature review on guggul. Additional information on gugulipid is on the Internet. Information on flaxseed and fish oil is at Thebody.

Preliminary data reports a reduction in cholesterol levels with the use of L-carnitine (3) Issue 36 of the HIV Nutrition Update newszine contains a literature review of carnitine including the use of carnitine in HIV-positive people.

Sources
1. Rodriguez-Guardado A, Maradona JA, Carton JA, Asensi V. Triglyceride Increase Can Predict Lipodystrophy in HIV Patients Under Highly Active Antiretroviral Therapy. AIDS 2002;16(10):1434-1436.
2. FDA Clears New Palm Test For Skin Cholesterol. FDA Talk Paper, T02-27; 25 Jun 2002.
3. Mauss S, Schmutz G. L-Carnitine in the treatment of HIV-associated lipodystrophy syndrome. HIV Med 2001 Jan;2(1):59-60.

Tuberculosis (TB)
In our June 14, 2002 HIV Nutrition News Update we noted a report that people with TB may benefit by adding both vitamin A and zinc to their anti-TB medication. People living with HIV however, would be wise to consult with their physician or an HIV-savvy nutrition professional before adding any dietary supplements to their daily regimen. As noted in a literature review of zinc published in Issue 16 of the HIV ReSource Review, too much zinc can depress the immune system. Although this research must be confirmed in larger studies, it is a welcome promising development that may allow physicians to reduce the amount of anti-TB drugs that must be taken by TB patients. Online resources for TB include the HIV InSite Knowledge Base, MMWR and the MEDLINEplus web site.

HIV/AIDS Continues To Increase Especially In Young People. About 14,000 new HIV infections occur every day. Approximately 5-10 % of the people with AIDS are infected via blood transfusions. More than a third of the 40 million people living with HIV today are under the age of 25. Young people ages 15 to 24 account for half of all new infections among adults. Sadly, most of the world's young people have no idea how HIV/AIDS is transmitted or how to protect themselves from the disease. New projections indicate that the number of young people living with HIV/AIDS will increase to 21.5 million by the end of the decade. 

View all the Kaiser Daily HIV/AIDS Reports, search the archives, or sign up for email delivery. 

Source: The Tip of the Iceberg: The Global Impact of HIV/AIDS on Youth. XIV International AIDS Conference in Barcelona, Spain: Henry J. Kaiser Family Foundation.

Highlights From The 14th International AIDS Conference
News from the 14th International AIDS Conference in Barcelona Spain highlights the importance of nutrition in the care of HIV-positive people. As food insecurity increases, the need to examine its link with HIV/AIDS becomes more apparent. The focus on food security and nutrition is increasing as reports of diminishing food supplies, due to decreased production and loss of family labor, become known. Malnutrition continues in sub-Saharan Africa where food insecurity further increases the risk of disease progression. A declaration of commitment made last year by the United Nations General Assembly Special Session on HIV/AIDS documents as essential the inclusion of nutrition as a core part of any HIV-care package. As nutritional deficits make HIV-positive people more susceptible to disease and infections, increasing access to food is an overwhelming priority in many parts of the world.

HIV/AIDS: A Guide for Nutrition, Care and Support was field-tested in Malawi and Uganda and developed for community organizations. The guide helps program managers to make recommendations on food management and nutritional issues for households affected by HIV/AIDS.

Source: Machipisa L. AIDS Posing Serious Threat to Food Security. Inter Press Service, IPS-ONLINE, 5 July 2002. WWW: Distributed by AEGiS. 7 Jul 2002.

HIV Nutrition Education Materials
Eat up! Nutrition Advice And Food Ideas For People Living With HIV And AIDS is a helpful guide for anyone living with HIV by nutritionist Charlie Smigelski, RD. Visit the web site for further information.

Dr. Mary Romeyn's Nutrition And HIV A New Model For Treatment is a "must-have" book! It contains lots of nutrition information, vitamin and mineral recommendations. Find it at the library, your local book store or visit HIV ReSources book links for a reduced price.

The Complete Nutrition Education Binder is a peer-reviewed 600+ page assortment of research articles and information on nutrition, HIV and complementary therapies. It holds issues 1-30 of the HIV ReSource Review with more than 5,000 references and 15 handouts and clinician tools. Visit the AIDS Book Review Journal at 2 and 1 for their review of this publication. Selected issues of the newsletter are free at the HIV ReSources web site.

Recalls And Safety Alerts
FDA has determined that "Nicotine Water" should be regarded as an unapproved new drug and cannot be legally marketed as a dietary supplement. 

Nature's Way Has Recalled Nettle because the product contains excessive amounts of lead. Nettle is a common herbal supplement used for arthritis and kidney problems and as an expectorant and pain reliever. 

Diet, HIV & Heart Disease
The risk of heart disease for people living with HIV has increased since the advent of highly active antiretroviral therapy (HAART). Studies show that HAART, which includes a protease-inhibitor, increases the risk of heart disease. (1) Increased dietary intakes of fruit and vegetables are associated with reduced risks of heart disease. Ensuring a nutritious diet can help HIV-positive people to meet their daily nutrient requirements and decrease the risk of heart disease as well. Investigators for the Oxford Fruit and Vegetable Study Group recently found that an increased intake of fruit and vegetables can lead to increased plasma concentrations of carotene, ß-carotene, lutein, ß-cryptoxanthin, and ascorbic acid. (2) In their six-month, randomized, controlled trial of 690 healthy participants between the ages of 25 to 64 years old, increased consumption of fruit and vegetables also decreased blood pressure. Since a diet with increased fruit and vegetable consumption can lower the risk of heart disease in the general population, people living with HIV may experience these beneficial effects as well.

A two-part article notes heart healthy food choices for HIV-positive people in Issue 22  and Issue 23 of the HIV ReSource Review. AIDS Community Research Initiative offers some tips to ensure a nutritious diet. AIDS Project Los Angeles offers It Pays To Be Picky a guide on vitamins found in fruit and vegetables at 1 and 2. And the June 2002 issue of HIV Treatment Bulletin offers Nutrition And Immunity: You Are What You Eat, The Role Of Dietary Supplements In HIV and Using Evidence To Make Nutrition Decisions: A Look At Zinc.

As high blood cholesterol increases the risk of heart disease, readers may find the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) helpful. The report summarizes the detection, evaluation, and treatment of high blood cholesterol in adults.

Sources
1. Koppel K, Bratt G, Schulman S, Bylund H, Sandström E. Hypofibrinolytic State in HIV-1- Infected Patients Treated With Protease Inhibitor- Containing Highly Active Antiretroviral Therapy. JAIDS 2002;29(5):441-449.
2. John JH, Ziebland S, Yudkin P, Roe LS, Neil HAW. Effects Of Fruit And Vegetable Consumption On Plasma Antioxidant Concentrations And Blood Pressure: A Randomised Controlled Trial. Lancet 2002; 359(9322): 1969-74.

Conferences & Meetings 
National Association of People With AIDS (NAPWA) sponsored the 5th National Association of People With AIDS (NAPWA) Annual Conference: Staying Alive; Rising Above on August 16-18, 2002. The conference was held in Philadelphia, PA. Visit for additional information on other conferences. 

What Now - What Next? 4th Annual Women and HIV/AIDS Conference was held on August 24, 2002 in Miami, FL. The conference was sponsored by the Center For Positive Connections. For further information on this and other conferences visit amfar. 

The Los Angeles AIDS Nutrition Services Alliance (LA ANSA) meets once every six weeks to discuss pertinent topics related to foodservice, nutrition and HIV/AIDS in Los Angeles County. Visit the Web Site for further information.

The ANSA Conference, 2002: Honoring Our Past - Shaping Our Future was held in Hollywood, CA on September 12-15, 2002. This informative conference was a treasure chest full of resources for anyone who offers nutritional counseling, works or volunteers for a food bank or is associated with other sources of nutritional services. This year conference planners addressed the impact on an agency when expanding to serve populations other than those living with HIV/AIDS. For more information on future conferences visit the ANSA web site.

Additional conference information
 

HIV ReSources Web Site
The HIV ReSources Web Site is updated. Updated pages include:

* Conference Information
* Books For People Living With HIV
* Nutrition Resources
* Books on Medications, Nutrients And Herbs
* National HIV Nutrition Guidelines
* Nutrition Related Conditions
* Nutrition & HIV Discussion Archive Page 1
* Nutrition & HIV Discussion Archive Page 2

Herbal Products Warning
As noted in Issue 21  and Issue 22 of the HIV ReSource Review there are a variety of herbal products that are commonly used by people living with HIV. When taking herbal products it's important to learn about their safety, effectiveness and herb-drug interactions. Health Canada recently warned the general public of some Chinese herbs containing undeclared prescription drugs. The herbal products, which contain the prescription drugs Diethylstilbestrol, Indomethacin, and Alprazolam are made in the U.S. by BotanicLab. They are marketed for a number of bone, muscle, and other disorders including decreased immune system. Subscribers to this update will recall that Botanic Lab has already recalled several products (see the HIV Nutrition News Update of March 22, 2002) because they contained the prescription drug alprazolam (Xanax). MedWatch offers a variety of safety information. Find additional warning and safety information on herbs, supplements, and prescriptions at 1 and 2. 

Sharon Herr, RD covered numerous herb-drug interactions in her two-part article published in Issue 28 and Issue 29 of the HIV ReSource Review.

Foodborne Illness
As the temperature rises, so does the incidence of illness from Vibrio vulnificus which is often found in raw oysters. State officials in warm climates usually issue raw oyster warnings for especially susceptible people such as those with AIDS, cirrhosis, hepatitis or cancer. More than 300 infections have been reported from Gulf Coast states. The incidence of raw oysters infected with Vibrio vulnificus is increased in the Los Angeles area as well based on reports during the past few years (1993-1995;1993-1996; and MMWR; 2001; and 2002). 

Additional sources of information on Vibrio vulnificus and other foodborne illness include the Food Protection Program and the HIV ReSources web site.

May/June HIV Nutrition Update Newszine
The May/June HIV Nutrition Update has been published. The newzine issue includes:
Handout titled "Food Safety And You"
Feature on Carnitine And Acetyl Carnitine
Program Spotlight - Nutrition For Healthy Living in Boston, MA
Update Central - Diet & HIV Infection and Bone Disorders
Resource Corner - client, clinician, and free resources
Med Watch - Indinavir sulfate (Crixivan)
Nutrition Forum - question and answer column on T-cells
 

Vitamins, Minerals & HIV
Recent information suggests that the general population should take one vitamin supplement per day to avoid an increased risk of chronic disease. (1, 2) Sub-optimal intake of some vitamins is common in the general population and in some people living with HIV as they do not eat a diet that provides an optimal amount of all vitamins. Inadequate intake of vitamins is linked to chronic diseases (such as heart disease and colon and breast cancer- folate, vitamin B6, vitamin B12; prostate cancer- vitamin E, lycopene; and osteoporosis- calcium, vitamin D). (2) HIV infection can negatively affect many nutrients leading to other complications. Although we do not have standard guidelines for the supplementation of vitamins and minerals for those living with HIV, a number of sources offer information on the use of dietary supplements. Review "The Role of Dietary Supplements in HIV" by George Carter of AIDS Community Research Initiative (CRIA) and "Vitamins and Minerals, From A to Z". Jennifer Muir Bowers, PhD, RD, CNSD discusses natural vitamins and minerals. Diana Peabody, RD reminds us that recommendations should depend on the quality of evidence that is available. Evidence noting the use of vitamin and mineral supplements in people living with HIV is very limited and most of it took place before the widespread use of HAART (highly active antiretroviral therapy).

Some vitamins and minerals taken in excess can be harmful. Over- supplementation of some micronutrients decreases immune function and may increase the progression of HIV. For instance, an excess of zinc or iron can result in decreased immune function. Some vitamins in excess can cause problems like nausea, stomach cramps and diarrhea. Also, as there may be interactions between antivirals, medications and herbs, it is vital that people living with HIV learn more about vitamins and minerals before they take them on a routine basis. Seeking reliable information on vitamins and minerals from health care professionals such as physicians and registered dietitians (RDs) who are familiar with these interactions will help individuals to avoid unnecessary complications.

Sources
1. Fletcher RH, Fairfield KM. Vitamins for Chronic Disease Prevention in Adults Clinical Applications. JAMA. 2002;287(23):3127-3129. 
2. Fletcher RH, Fairfield KM. Vitamins for Chronic Disease Prevention in Adults Scientific Review. JAMA. 2002;287(23):3116-3126.

HIV/AIDS Informational Newsletters
An e-newsletter on Infectious Diseases (OPINIONS 2) is now available in both html and pdf formats. The newszine considers the efficacy of infectious disease policies and discusses alternatives. 

Kaiser Daily HIV/AIDS Report is a free service of The Henry J. Kaiser Family Foundation.

The Hopkins HIV Report is available online. 

HIV i-Base publications are on line. Subscribe or receive the publications by email.

Conference Information
Seafood Sense was held on September 11-13 in Lewes, DE. For additional conference information visit the web site.

The National Institutes of Health, American Society for Nutritional Sciences, and National Cancer Institute sponsors Cancer Prevention conferences. Visit the web site for additional information.

Thinking Globally -- Working Locally: A Conference on Food Safety Education, 2nd National Conference for Food Safety Educators was held on September 18-20 in Orlando, FL. Details of this USDA and HHS and other sponsored conferences are at the web site.

Additional conference information is at the HIV ReSources web site.
 

Minerals And HIV
Recently a study by Gail Shor-Posner and colleagues at the University of Miami found that selenium supplementation at 200 µg per day may lower the risk of mycobacterial disease, such as Mycobacterium tuberculosis, in HIV-positive people. (1) For additional information read the February 2002 article in the Journal of Acquired Immune Deficiency Syndromes. 

Researchers at Johns Hopkins University revealed that high manganese levels might decrease HIV's reverse transcriptase activity. (2) This could delay the HIV virus from progressing to AIDS. United Press International reports that this finding could lead to a new class of medications for the HIV. Dietary supplements of zinc (15 mg) and vitamin A (5,000 IU) may help anti-TB medications to work more effectively based on research completed by Elvina Karyadi and colleagues in the Netherlands. (3) The supplementation helps to boost the immune response in these patients. Although the research still needs to be confirmed in larger studies, adding supplements of vitamin A and zinc may allow for a reduction in the length of the regimen and dosage of TB medicine. Readers of the HIV ReSource Review may refer to our literature review of zinc in Issue 16.

Sources
1. Shor-Posner G; Miguez MJ, Pineda LM, Rodriguez A, et al. Impact of Selenium Status on the Pathogenesis of Mycobacterial Disease in HIV-1– Infected Drug Users During the Era of Highly Active Antiretroviral Therapy. JAIDS 2002;29:169-173.
2. Bolton EC, Mildvan AS, Boeke JD. Inhibition of Reverse Transcription In Vivo by Elevated Manganese Ion Concentration. Molecular Cell, Vol 9, 879-889, April 2002.
3. Karyadi E, West CE, Schultink W, Nelwan RHH, et al. A Double-Blind, Placebo-Controlled Study Of Vitamin A And Zinc Supplementation In Persons With Tuberculosis In Indonesia: Effects On Clinical Response And Nutritional Status. Am J Clin Nutri 75(4):720-727.

St. John's Wort and Depression
As noted in our two-part issues on botanical use among HIV-positive people (Issue 21 and Issue 22 of the HIV ReSource Review), supplement manufacturers do not have to prove that their products are effective or even safe before marketing them. Studies of St. John's Wort have generally suggested that it may be useful in treating mild to moderate depression, however experts have noted some study limitations within these trials. A recent study on St. John's Wort showed that it was ineffective for major depression. (1) The double-blind, randomized, placebo-controlled trial of 340 people found that an extract of Hypericum perforatum was ineffective against moderately severe depression. Clinical trial results were published in the Journal of the American Medical Association. (2) Questions and Answers: A Trial of St. John's Wort (Hypericum perforatum) for the Treatment of Major Depression is on the Internet. Additional trials are needed to determine if St. John's Wort is useful for the treatment of mild to moderately severe depression.

Sources
1. Study Shows St. John's Wort Ineffective for Major Depression. FDA Consumer. May/June 2002:8.
2. Hypericum Depression Trial Group. Effect Of Hypericum Perforatum (St. John's Wort) In Major Depressive Disorder. JAMA 287:2801-1814, 2002. 

APLA Nutrition in HIV Care Education/Training Program
Nutrition in HIV Care Education & Training Programs are held in Los Angeles regularly. Additional information and materials are at the APLA online web site under the nutrition topics. Participants are required to attend all sessions on all four days and need to successfully complete an Educational Objective Evaluation (post test) to receive Continuing Professional Education hours and certificate of completion.

PROCRIT Product Safety Warning
PROCRIT (epoetin alfa) is used primarily for the treatment of anemia associated with various conditions including zidovudine treatment in HIV patients. Ortho Biotech Products, L.P. notified pharmacists, health care providers, and wholesalers/distributors of counterfeit PROCRIT. Vials of PROCRIT labeled as 40,000 U/mL in four-pack boxes, lot number P002641, expiration date: 9/03, have been found to contain active ingredient that is approximately 20 times lower than would be expected. It is thought that all existing inventory of AUTHENTIC lot number P002641 may have been used so any product bearing this lot number should be considered suspect and be closely examined. A brief description of the differences between the actual product and the counterfeit, with comparative photographs, is provided in the Ortho Biotech letter.

In addition lot number P002384, expiration: 03/2003 has also been determined to be counterfeit. Any product bearing this lot number in particular should be considered suspect. 

Shrimp Warning
Ready-to-eat shrimp is a threat to HIV-positive people as it can contain antibiotic-resistant bacteria. Duran and colleagues believe that contamination could come from both the packaging process and the water that the shrimp was grown in. 

Guggul and Cholesterol
Investigators recently found that guglipid may reduce cholesterol by blocking the body's Farnesoid X Receptor (FXR), which plays a key role in managing cholesterol levels. (1) The researchers findings are published in a May issue of Science magazine. (2) Readers of the HIV ReSource Review may refer to Issue 27, which holds a comprehensive literature review on guggul. As reported in the HIV ReSource Review, preliminary studies show that adding guggulipid with a cholesterol-lowering diet can further reduce cholesterol. Additional studies will attempt to determine the biochemical reasons for the cholesterol-lowering effect. Lead investigator Nancy Urizar notes that "there is a lot out there on the Web that we can't support". Consumers should always thoroughly research products to find reliable information and consult with their health care providers before using dietary supplements.

Sources
1) Natural Cholesterol Fighter Shows The Way. Baylor College of Medicine: Houston, TX.
2) Urizar NL, Liverman AB, Dodds DT, Silva FV, et al. A Natural Product That Lowers Cholesterol As An Antagonist Ligand for FXR. Science 296: 1703-1706; Published online 2 May 2002. 

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Conference Announcement
The Orange County Health Care Agency sponsored a Hepatitis Summit, "Viral Hepatitis: An Emerged Epidemic" on July 18-19, 2002 at the Holiday Inn Conference Center in La Mirada, CA. For additional information on other conferences visit  the web site.

Diabetes
As noted in previous updates and Issue 27 and Issue 28 of the HIV ReSource Review, patients with lipodystrophy are more likely to have glucose abnormalities that can lead to diabetes. A nationwide campaign, "Take Time to Care", sponsored by the Health and Human Services Food and Drug Administration (FDA), the American Diabetes Association, and the National Association of Chain Drug Stores (NACDS) has been launched to raise women's awareness about diabetes. (1) Local pharmacies offered free risk assessment and clinical testing, free educational materials and a Diabetic Management Kit in 10 key cities where residents have a high incidence of diabetes. Diabetes risk assessment events were conducted at chain pharmacies from May 28th to June 22, 2002. Participants received diabetes-related brochures, wallet-sized calendars, and cards with recipes for nutritious meals in Atlanta, Baltimore, Chicago, Dallas, Detroit, Los Angeles, Miami, New Orleans, Indianapolis and Philadelphia. The brochure highlights the warning signs of diabetes, which include fatigue, frequent urination, unusual thirst, extreme hunger, unusual weight loss and irritability. Recurring skin, gum, and bladder infections, blurred vision, cuts and bruises that are slow to heal are also potential signs and symptoms. Additional information about the "Take Time to Care" campaign is at the FDA web site. Consumer information about diabetes is available through the National Diabetes Education Program or from the American Diabetes Association, telephone 800/342-2383. People with diabetes are at risk for foot injuries that could lead to serious complications. Learn five tips every diabetic should know about foot care. As noted in an earlier update it's important to treat people with the metabolic syndrome to prevent heart disease. The prevalence of metabolic syndrome increases with age (2) and clinicians screening people living with HIV should be aware of this increased incidence in older adults.

Sources
1. Take Time To Care About Diabetes. HHS Press Release. FDA Press Office; 2 May 2002.
2. Ford ES, Giles WH, Dietz WH. Prevalence Of The Metabolic Syndrome Among US Adults: Findings From The Third National Health And Nutrition Examination Survey. JAMA 2002 Jan 16;287(3):356-9. 

HIV ReSources Web Site 

5/23/02-The HIV ReSources Web Site is updated.

New pages include:
* Issue 36 HIV Nutrition Update

Updated pages include:
* Newsletters & Magazines
* HIV Nutrition News Update Electronic Newsletter Archive
* Issue Two, Number One
* Issue One

* Conference Information
* Questions and Referrals
* Newsletter Previews Menu
* Miscellaneous HIV/AIDS Topics
* Search Engines

FDA Notification 
Labeling information for several pharmaceutical products have changed including numerous products noted in issues of the HIV Nutrition Update and HIV ReSource Review. Serono, Inc. became aware of a counterfeit lot of Serostim [somatropin (rDNA origin) for injection] (covered in Issue 11 of the HIV ReSource Review) packaged to appear as drug product lot number S810-1A1. This is not a legitimate Serostim lot number. Preliminary information appears to indicate that the counterfeit material may have been distributed via the Internet. However, pharmacists should examine Serostim prior to dispensing to ensure that the package does not note lot number S810-1A1. Patients should also check products in their possession and return those with the above lot number. Access the MedWatch through the FDA web site.

AMGEN, in cooperation with the FDA, notified pharmacists and health care providers of counterfeit EPOGEN (epoetin alfa), covered in Issue 12 of the HIV ReSource Review. Epogen is used to treat the anemia that some patients with HIV/AIDS experience while taking AZT (zidovudine). EPOGEN 40,000 U/mL vials in ten-pack boxes, lot number P002970 with expiration date 7/03 has been found to contain active ingredient that is about 20 times lower than would be expected for this product. Pharmacists and health care providers should carefully examine all vials of EPOGEN before use. 

CARNITOR (levocarnitine) Tablets, Oral Solution & Injection, made by Sigma-Tau, now lists precautions for individuals with renal disease. As noted in our May/June 2002 HIV Nutrition Update, many specialized medical beverages for renal patients contain added carnitine. The safety and efficacy of oral levocarnitine has not been evaluated in people with renal insufficiency and high doses of the product in these patients may result in accumulation of potentially toxic metabolites. It is unknown whether specialized medical beverages containing carnitine may pose the same risk but caution in the use of these products seems prudent.

LIPITOR (atorvastatin calcium) Tablets, noted in the Med Watch column in HIV Nutrition Update Issue 32, is manufactured by Pfizer. Labeling changes, Indications, and Usage reflect the updated NCEP treatment Guidelines table.

MEGACE (megestrol acetate) Oral Suspension, covered in Issue 8 of the HIV ReSource Review and discussed in several subsequent issues, is produced by Bristol Myers Squibb. Labeling changes for this product now note a revision of the third paragraph in the Warnings section. Specifically, "The glucocorticoid activity of MEGACE Oral Suspension has not been fully evaluated. Clinical cases of new onset diabetes mellitus, exacerbation of pre-existing diabetes mellitus, and overt Cushing's syndrome have been reported in association with the chronic use of MEGACE. In addition, clinical cases of adrenal insufficiency have been observed in patients receiving or being withdrawn from chronic MEGACE therapy in the stressed and non-stressed state. Furthermore, adrenocorticotropin (ACTH) stimulation testing has revealed the frequent occurrence of asymptomatic pituitary-adrenal suppression in patients treated with chronic MEGACE therapy. Therefore, the possibility of adrenal insufficiency should be considered in any patient receiving or being withdrawn from chronic MEGACE therapy who presents with symptoms and/or signs suggestive of hypoadrenalism (e.g., hypotension, nausea, vomiting, dizziness, or weakness) in either the stressed or non-stressed state. Laboratory evaluation for adrenal insufficiency and consideration of replacement or stress doses of a rapidly acting glucocorticoid are strongly recommended in such patients. Failure to recognize inhibition of the hypothalamic-pituitary-adrenal axis may result in death. Finally, in patients who are receiving or being withdrawn from chronic MEGACE therapy, consideration should be given to the use of empiric therapy with stress doses of a rapidly acting glucocorticoid in conditions of stress or serious intercurrent illness (e.g., surgery, infection).

Global Strategy On Traditional And Alternative Medicine
The World Health Organization (WHO) has launched the first Global Strategy On Traditional And Alternative Medicine. The information on this important effort compliments articles on the use of complementary therapies noted in Issue 21 and Issue 22 of the HIV ReSource Review. Review the WHO Strategy for Traditional Medicine for 2002-2005.

Canadian HIV/AIDS Policy and Law Review
The latest issue of the Canadian HIV/AIDS Policy and Law Review is online. Recent events in Canada and internationally show once again how developments in one country resonate with those in another, both for good and for ill. Features in this issue include information on preventing mother-to-child transmission of HIV; compulsory HIV testing after occupational exposure; safe injection facilities in Canada; complementary health care; and HIV/AIDS in prisons. Single-issue print copies of the Review can be obtained from the Canadian HIV/AIDS Clearinghouse (1565 Carling Avenue, Suite 400, Ottawa ON, K1Z 8R1); tel: 877/999-7740 or 613/725-3434; fax: 613/725-1205.

Clinical Trials
Studies show that non-Hispanic blacks and Hispanics are less likely to participate in medication trials. It's interesting that HIV-positive patients enrolled in private health maintenance organizations (HMOs) may be less likely to participate in medication trials than those patients with fee-for-service insurance.

Having access to information on clinical trials is vital to increase trial participation of these ethnic groups. Canadian HIV/AIDS Clinical Trials have included:

... CTN 141 - PEG-IFN/Ribavirin/ddI/3TC for HIV/HCV- This study examined the safety and antiviral effect of a combination of drugs chosen to eliminate the hepatitis C virus while controlling the HIV resulting in an increased chance of tolerating future highly active antiretroviral therapy (HAART). Dr. Marina Klein in Montreal; Dr. Emil Toma in Montreal; Dr. Anita Rachlis in Toronto; and Dr. Jonathan Angel in Ottawa took part in the study. 

... CTN 157 - Fenofibate (Lipid Supra) & L-Carnitine (Carnitor) for Elevated Triglycerides- This study was designed to assess two approaches in managing hypertriglyceridemia or elevated triglyceride levels in the blood. Fenofibrate and its combination with L-carnitine was compared for their safety and efficacy in lowering the amount of triglycerides in the blood.

Participants received nutritional advice from a dietitian to reduce the risk of diet being a contributing factor in increasing triglycerides. At certain sites, a substudy also assessed the effect of the two approaches on fasting blood cholesterol, C-peptide (residue in the formation of insulin) and insulin levels. Investigators were those named above in addition to Dr. Walter Schlech in Halifax; Dr. Fiona Smaill in Hamilton; Dr. Sharon Walmsley in Toronto; Dr. François Laplante in Montreal; Alain Piché in Sherbrooke; Dr. Julian Falutz in Montreal; Dr. Richard Lalonde in Victoria; and Dr. Réjean Thomas in Montreal.

Heart Disease and Antiretrovirals
We know that antiretrovirals result in changes in lipid and sugar metabolism. As noted in our previous updates, these symptoms overlap risk factors for heart disease and are a growing concern. Diet and exercise can help to deal with lipodystrophy. Issue 22 and Issue 23  note how people can deal with these issues through dietary measures. A recent anecdotal report published in the February issue of Clinical Infectious Diseases also notes that diet and exercise may help to lessen the effects of lipodystrophy. 

Bone Diseases
Resources on bone disorders are increasing as reports of osteoporosis (depletion of bone mineral), osteopenia (mild to moderate bone mineral depletion), and bone death (avascular necrosis) become more common. Recent publications add to the information presented in our HIV ReSource Review interview with Dr. Mary Romeyn and previous updates. San Francisco AIDS Foundation tells us more about avascular necrosis (AVN). The New England Journal of Medicine offers Perspective: Bisphosphonates and Osteoporosis by C.G. Solomon and The Body offers a variety of information on bone problems.

Substance Abuse, Iron and Hepatitis
Research on injection drug users adds to the information presented in Issue 24 and Issue 25 of the HIV ReSource Review featuring articles on substance abuse and HIV-positive people. Investigators at Johns Hopkins University in Baltimore, Maryland recently found that iron deficiency is common among female injection drug users. As noted in Issue 29 and Issue 30 of the HIV ReSource Review, iron supplementation may not be advisable for individuals with both HIV and hepatitis C infection. Semba notes studies suggest HIV progression with iron supplementation and iron overload. It is questionable as to whether the benefits of iron supplementation outweigh the potential risks.

Reference
1) Semba Rd, Shah N, Strathdee SA, Vlahov D. Brief Report: High Prevalence of Iron Deficiency and Anemia Among Female Injection Drug Users With and Without HIV Infection. J Acquir Immune Defic Syndr 2002;29:142-144.