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Recall Alert

Due to the accidental presence of dextromethorphan, South Beach Beverage recalled SoBe Green Tea and SoBe Energy. Dextromethorphan is a substance commonly found in over-the- counter cold and cough medications. The products were distributed in California, Illinois, Indiana, Iowa, Kentucky, Minnesota, Nevada, Oklahoma, Tennessee, Texas and Wisconsin. 

Diabetes And Glycosylated Hemoglobin

Glucose abnormalities in HIV-positive people are a common complication of medical treatment. Metabolic changes associated with the advent of highly active antiretroviral therapy (HAART) include abnormal body fat and fat redistribution, heart disease, bone disorders and blood glucose alterations such as diabetes.

As noted in "Blood Glucose Abnormalities In HIV-Positive People: Part One" published in the Nov/Dec 2000 issue of the HIV Nutrition Update, glycosylated hemoglobin (HbA1c) is created as a result of the interaction between hemoglobin and glucose. Measuring the amount of HbA1c helps to monitor the body's average blood sugar level over the past 90 to 120 days. HbA1c is not recommended for use as a tool to diagnose diabetes but is useful in monitoring how well insulin or other diabetes medications are working. Practice recommendations for not using HbA1c for the diagnosis of diabetes included the lack of nationwide standardization of the HbA1c test and the fact that test results can be affected by factors such as blood disorders, dialysis and pregnancy. 

Recently the Food and Drug Administration approved Metrika A1c Now an over-the-counter glycated hemoglobin test. The test allows diabetics to monitor how well insulin or other diabetes medications are working by pricking their finger and placing a drop of blood into a monitor that reads the levels within a few minutes.

For information on dietary measures and supplement use for people living with HIV disease who have diabetes, readers of the HIV Resource Review may refer to Issue 27 and Issue 28. 

Sources

1. Wittenbrook W, Tinnerello D, Meyer SA. Blood Glucose Abnormalities In HIV-Positive People: Part One. HIV ReSource Review 2000;5(3):1, 8-15.

2. Wittenbrook W, Tinnerello D, Meyer SA. Blood Glucose Abnormalities In HIV-Positive People: Part Two. HIV ReSource Review 2000;5(4):1, 10-17, 23.

3. The Expert Committee On The Diagnosis And Classification Of Diabetes Mellitus. Report Of The Expert Committee On The Diagnosis And Classification Of Diabetes Mellitus. Diabetes Care. 2000;23(Suppl.1):S4-S19.

HIV/AIDS Internet Resources

Adult and Adolescent and Perinatal treatment guidelines for Palm PDA's are available through the AIDSinfo web site at.

The Glossary of HIV/AIDS-Related Terms, 2nd Edition dated September 2002, contains definitions of terms associated with HIV/AIDS and related  conditions. It is available from the U.S. Department of Health and Human Services via the Internet.

The Henry J. Kaiser Family Foundation offers email alerts on new additions to their web site. Send an email to subscribe to the email alert list.

HAART And Adverse Effects On Bone Health

A recent article in the FDA Consumer magazine reminds us that more than 10 million Americans have osteoporosis. (1) The use of HAART (highly active antiretroviral treatment) has increased the incidence of osteoporosis and other bone disorders in HIV-positive men and women. Diminished levels of testosterone can also cause secondary osteoporosis in men and women. More than two million American men have osteoporosis and it is recognized as an important public health issue. As noted in the March 1, 2002 HIV Nutrition News Update, even people with untreated HIV infection are prone to bone disorders. Osteoporosis usually progresses without any symptoms until it is diagnosed following a fracture. Hip osteonecrosis (necrotic degeneration of hip bones) is also increasing in people living with HIV.

HIV-positive men and women should be evaluated and treated before significant bone loss occurs. The bone mineral density test, is a safe, accurate, quick, painless, and noninvasive way to diagnose bone problems, monitor the effectiveness of treatments, and predict the risk for future fractures. To treat osteoporosis, FDA recently approved teriparatide (Foreto), which we highlighted in the Sept/Oct 2002 HIV Nutrition Update. The National Institute on Aging, National Institute of Arthritis and Musculoskeletal and Skin Diseases recently reported on a promising new treatment for osteoporosis. 

Read an interview with Dr. Mary Romeyn published in Issue 26 of the HIV ReSource Review to learn more about bone disorders in people with HIV/AIDS. To limit the risk of bone disorders:

* Don't smoke * Avoid alcohol * Perform weight- bearing activities regularly and * Eat a balanced diet rich in calcium.

A study of more than 900 Californians suggests that people who consume increased vegetable protein, as opposed to animal protein, may have less calcium in their bones. However, the amount of calcium in the diet along with exercise habits can also be a predictor of bone mineral density. As noted in our Building Healthy Bones handout a number of nutrients including calcium and vitamins D and C are needed for healthy bones.

For additional information on bone disorders visit MEDLINEplus. The NIH Osteoporosis and Related Bone Diseases~National Resource Center is also a great place to learn about bone disorders. Along with Spanish-language fact sheets on osteoporosis, they offer information on the new U.S. Prevention Services Task Force recommendations on screening for osteoporosis.

Sources

1. Lewis C. Osteoporosis and Men. FDA Consumer magazine, 2002;36(5): 15-17. 

AIDS Awareness Stamps

The United Nations postal administration recently issued three commemorative AIDS Awareness Stamps and three semi-postal souvenir sheets. The AIDS Awareness Stamps include the phrase "UNAIDS Awareness" down the side and are available for use in the United States, Austria and Switzerland. The semi- postal stamps cost more than a regular stamp at 43 cents for a 37-cent stamp in the U.S. Funds raised from the extra cost will go to the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

Holiday Shopping

If you are still looking for a great gift to give someone on Christmas Day please consider checking out our recommended books, music and software links to Amazon.com. A small amount of your purchase will help us to continue sending these updates. 

Happy Holidays!

Focus On Food Safety

As we welcome the holiday season many of us begin to prepare holiday treats for guests and make plans to eat out with others. Although research shows improvements in safe food handling by consumers, many of us still need to be aware of foodborne illness and how to avoid it. The Gateway to Government Food Safety, MEDLINEplus and the Food and Drug Administration (FDA) offer a wealth of links to food safety information. "Food Safety-Food Freshness and 'Smart' Packaging" can be accessed on the FDA web site as well as "Keep Your Food Safe". Links to additional information on foodborne pathogens are at the HIV ReSources Food Safety Resources web page. 

Listeriosis is an infection caused by eating food contaminated with the bacterium Listeria monocytogenes. It is a serious disease that sometimes occurs among severely immunosuppressed people living with HIV. Contaminated food products can cause miscarriages and stillbirths among pregnant women, serious or fatal infections in newborns, frail or elderly people, and others with weakened immune systems. Healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea. Consumers experiencing these symptoms should contact their physician immediately.

The incidence of listeria infections has been increasing recently. In June 2002, the CDC recommended several methods to avoid the risk of contamination from Listeria monocytogenes. (1) The Centers for Disease Control and Prevention (CDC) offers early information on the Internet about a listeriosis outbreak investigation. Recent epidemiologic data indicates that precooked, sliceable turkey deli meat was the cause. 

The FDA and Food Safety Inspection Service (FSIS) offer the following information and advice to people at risk for listeriosis and their family members or individuals preparing food for them:

* Cook hot dogs, luncheon meats and leftover foods until steaming hot before eating.
* Avoid soft cheeses such as Feta, Brie and Camembert, blue-veined cheeses, and Mexican-style cheeses such as "queso blanco fresco."
* Eat canned or shelf-stable pâtés and meat spreads NOT refrigerated pâtés or meat spreads. 
* Eat canned or shelf-stable smoked seafood NOT refrigerated smoked seafood (unless it is contained in a cooked dish, such as a casserole). 
* Drink only pasteurized milk NOT raw (unpasteurized) milk or foods that contain unpasteurized milk.
* Avoid foods such as prepared salads, meats or cheeses from delicatessen counters or heat/reheat these foods until steaming before eating.

Resources

1. Appendix: Recommendations To Help Patients Avoid Exposure to or Infection from Opportunistic Pathogens. Morbidity and Mortality Recommendations and Report. 14 June 2002; 51(RR08);47-52. 

HIV And Women

HIV infection in women has increased more than it has in men and globally women account for more than 50% of those newly infected with HIV. Although 58% of those with HIV are women in Sub-Saharan Africa, women account for only 7% of the HIV population in Australia and New Zealand. As noted in previous HIV Nutrition News Updates, the main mode of transmission for women is heterosexual sex. View the United Nations Press Release on World AIDS Day.

HIV ReSources Web Site

The HIV ReSources Web Site is updated. 

New Pages Include: 
Issue 39 HIV Nutrition Update

New Links Are At: 
Supplement Cautions And Warnings
Recommended Easy Reading Books
Conference Information
Prescription Drug Adverse Effects
Books for People Living with HIV
Nutrition Related Conditions
Dietary Supplement Information
Books on HIV Prevention/Education
Prescription Drug Information
Food And Recipe Resources
Diabetes Information

Updated Pages Include: 
Food Safety Resources
Books On Nutrition and Nutrition and HIV

Food-Drug Interactions

The current issue of the HIV Nutrition Update includes Part Two of "Food-Drug Interactions In HIV/AIDS" written by Zaneta M. Pronsky, MS, RD, FADA and Sister Jeanne P. Crowe, PharmD, RPh. "Food-Drug Interactions In HIV/AIDS" offers specific information on HIV medications, nutrient and other interactions. The article builds upon he information offered on the FDA web site titled "Think It Through: A Guide to Managing the Benefits and Risks of Medicines". To learn general information on managing the benefits and risks of medications visit the FDA web site.

Reference: Think It Through: A Guide to Managing the Benefits and Risks of Medicines. FDA Consumer Nov/Dec 2002;36(6):24-25.

NTZ In The News 

Investigators recently reported on another study of Nitazoxanide (NTZ), which was shown to be effective for the treatment of cryptosporidiosis in children. Readers of the HIV ReSource Review will recall that we published a comprehensive review of this compound in the March/April 1999 issue (Issue17). The article's abstract reads: " AIDS activists often note the seriousness of contamination with Cryptosporidium parvum, a parasite found in the feces of infected humans or animals. It's a life-threatening disease for HIV-positive people occurring each year in an estimated 10- 20% of those who have diarrhea. According to researcher Dr. Rosemary Soave, at the New York Hospital Cornell Medical Center, the disease often results in disturbed sleep patterns, decreased quality of life, dehydration, loss of appetite and subsequent wasting. Many cases of human cryptosporidiosis go unrecognized in people living with HIV. 

Cryptosporidium is mainly localized to the gastrointestinal tract and persistent infection causes watery diarrhea that is very severe and leads to dehydration. Besides the diarrhea, symptoms include stomach cramps, rectal urgency and incontinence, fatigue, diminished appetite, nausea and vomiting, weight loss, or a slight fever. The management of cryptosporidia can include Azithromycin, bismuth subsalicylate, Lomotil, Loperamide, Paromomycin, paregoric,  Octreotide, hyperimmune bovine colostrum or Nitazoxanide (NTZ). This article reviews the use of NTZ for the treatment of cryptosporidiosis." 

The recent randomized prospective trial conducted by Amadi and colleagues assessed the effect of NTZ on morbidity and mortality in 100 Zambian children with diarrhea due to Cryptosporidium parvum. Children received either 100 milligrams of NTZ twice daily orally or a placebo for three days. Children who did not respond received NTZ for an additional three days. Researchers found that the standard 3-day course of NTZ had no effect in HIV-positive children but additional treatment in this group was effective. Romark, NTZs manufacturer, funded the study. For information on previous trials using NTZ refer to the HIV ReSource Review issue mentioned above.

Reference

Amadi B, Mwiya M, Musuku J, Watuka A, et al. Effect Of Nitazoxanide On Morbidity And Mortality In Zambian Children With Cryptosporidiosis: A Randomised Controlled Trial. Lancet 2002;360(9343):1375-1380. 

World AIDS Day on Sunday, December 1st 

This year's theme for World AIDS Day is "Live and Let Live". World AIDS Day will be observed on Sunday and will feature activities around the world aimed at highlighting the HIV/AIDS epidemic. As noted in previous HIV Nutrition News Updates, estimated worldwide HIV infections are now at nearly 49 million people and 42 million people are living with AIDS. Visit the following web sites for more information on AIDS and HIV or to gather World AIDS Day resources: 

Kaisernetwork.org
AIDSinfo
Office of Minority Health
Black Entertainment Television 

HIV Nutrition Update Newszine - Issue 39

The Nov/Dec HIV Nutrition Update Newszine is now available. Subscribers with Internet access can view the issue using their assigned username and password. Issue 39 includes part two of an article written by Zaneta M. Pronsky, MS, RD, FADA and Sister Jeanne P. Crowe, PharmD, RPh titled "Food - Drug Interactions In HIV/AIDS". The issue also includes a: 
* Program Spotlight column on the University of Michigan HIV/AIDS Treatment Program located in Ann Arbor, MI; 
* Update Central column with information on homocysteine and heart disease; 
* Resource Corner with leads to Internet, client and clinician resources, webcasts and product samples; 
* Med Watch column on Trizivir; 
* Nutrition Forum column on Kaletra and food considerations. 
 

Testing For HIV/AIDS 

Estimated worldwide HIV infections are now at nearly 49 million people. (1) An estimated one-fourth of the approximately 900,000 HIV-infected people in the U.S. are not aware that they are infected. Heterosexual transmission of HIV continues to increase in the U.S. and many sexually active people are at risk of infection, even with few sexual partners. In addition to the standard hospital practice of HIV testing based on high-risk behaviors, routine HIV testing among hospital inpatients may help to assist in finding a solution for this issue. (2) 

Another means to increase the number of Americans who are aware of their HIV status has recently been approved by the U.S. Food and Drug Administration (FDA). The FDA approved a new rapid HIV diagnostic test kit that provides results in as little as 20 minutes. Using less than a drop of blood, this new test can quickly and reliably detect antibodies to HIV-1, the HIV virus that causes infection in most cases in the U.S. The OraQuick Rapid HIV-1 Antibody Test, manufactured by OraSure Technologies, Inc. in Bethlehem, PA, can be stored at room temperature and requires no specialized equipment. It is hoped that the newly approved HIV test will increase the number of people who receive their test results, allowing them to get the care they need and to take precautionary measures to help prevent the spread of HIV. 

As with all screening tests for HIV, if the OraQuick test gives a reactive test result, that result must be confirmed with an additional specific test. Currently, the OraQuik test can only be given in CLIA (Clinical Laboratory Improvements Amendments of 1988)- approved labs by CLIA-certified laboratory technicians or medical staff. In the future, the test may be given in many more health care facilities outside of traditional laboratory or clinical settings. Additional Information

Sources

1. Estimated Worldwide HIV Infections: 48 916 879 At 2.52pm On Thursday October 10, 2002. Mail & Guardian (Johannesburg) 11 October 2002. Distributed by AEGiS.

2. Walensky RP, Losina E, Steger-Craven KA, Freedberg KA. Identifying undiagnosed human immunodeficiency virus: the yield of routine, voluntary inpatient testing. Arch Intern Med. 2002;162:887-892. 

3. FDA Approves New Rapid HIV Test Kit, FDA Press Release, 7 Nov 2002.

Addressing Metabolic Complications

Metabolic complications brought about from the use of HAART (highly active antiretroviral therapy) continue to plague people with HIV. A recently released paper alerts physicians of these phenomena and offers recommended guidelines. The full text version of "Management of Metabolic Complications Associated With Antiretroviral Therapy for HIV-1 Infection: Recommendations of an International AIDS Society-USA Panel" can be downloaded from the International AIDS Society-USA web site.

The paper was authored by a panel of experts led by Morris Schambelan, MD and appears in the November issue of the Journal of Acquired Immune Deficiency Syndromes. The 19-page report addresses the management of glucose abnormalities (nutritional aspects covered in Issue27 and Issue 28 of the HIV ReSource Review) and recommends following the guidelines for diabetes mellitus. For lipid and lipoprotein abnormalities (nutritional aspects covered in Issue 22 and Issue 23 of the HIV ReSource Review), like the HIV ReSource Review article, the panel suggests a low fat, low cholesterol diet with increased fiber and use of plant sterols. Emphasis should also be placed on increasing exercise in sedentary people. The panel also suggests exercise (covered in Issues 4, 5, and Issue 26 of the HIV ReSource Review) for body fat abnormalities. 

National Diabetes Awareness Month

November is National Diabetes Awareness Month. Readers of the HIV ReSource Review will recall that Issue 27 and Issue 28 highlighted the many issues surrounding glucose abnormalities in HIV-positive people. Glucose abnormalities in HIV-positive people are a common complication of medical treatment. These problems were largely due to medications used to treat life threatening opportunistic infections and malnutrition that occurred early in the HIV epidemic. Glucose abnormalities are now one of the metabolic complications of protease inhibitor therapy. Patients already taking multiple combinations of potent medications several times a day may now have another type of combination therapy to manage if they are diagnosed with diabetes. The two-part article builds upon previous information and reviews current knowledge of diabetes, glucose intolerance and insulin resistance. It also offers treatment information for diabetes in both HIV-positive and HIV-negative persons. Part Two of the article in Issue 28 offers information on dietary measures and supplement use for HIV-positive diabetics. 

To learn more about diabetes visit the Centers for Disease Control and Prevention web site. Learn about preventive-care practices among U.S. persons with diabetes. Information on a diabetes study is at the National Institute of Diabetes web site. The NIH reports on progress in diabetes research. You can also read "Effects of Vitamin E on Cardiovascular and Microvascular Outcomes in High-Risk Patients With Diabetes". 

World AIDS Day 

Planning for World AIDS Day, December 1, is underway for many AIDS Service Organizations. World AIDS Day is commemorated around the globe with news and events to highlight progress made in the battle against the epidemic and to remind people of how much still needs to be done. Women are at special risk of HIV and often have less control over when, where and whether sex takes place. As noted by Dr. Robert Luchi, geriatrician at the Huffington Center on Aging at Baylor, the risk of AIDS is also still rising for adults over the age of 50. HIV infection is increasing at twice the rate of those people under the age of 50 and sexual activity is cited as the most common cause. 

After 21 years, discrimination still affects the quality of life for HIV-positive people and makes both care and prevention efforts more difficult. To address this issue, the National AIDS Trust is running a campaign against HIV prejudice. Visit the web site for more information and resources to help you plan your World AIDS Day events. 

The Discovery Health Channel will present three television programs devoted to the changing demographics of people impacted by HIV/AIDS. (1) Actor James Woods hosts Born With HIV: Little Warriors, a program featuring children who
share their personal experiences with HIV/AIDS, at 8:00 PM (ET/PT) on Sunday, December 1. AIDS in the 21st Century premiering at 5:30 PM (ET/PT) is a half-hour documentary that looks at the U.S. AIDS crisis through the eyes of those infected, AIDS activists and health experts. At 9:00 PM (ET/PT) the Discovery Health Channel will present AIDS at 21 a documentary that examines a number of dimensions of the 21-year old AIDS epidemic. For more information visit the Discovery Health Channel. 

Other World AIDS Day planned events include a concert with Dave Matthews Band and other musical artists for MTV. 

Source

1. Discovery Health Channel presents special programs on World AIDS Day, December 1. Press Release 5 Nov 2002. Distributor: PRWeb

Substance Abuse And HIV/AIDS 

The National Institute on Alcohol Abuse and Alcoholism offers "Alcohol Alert: Alcohol and HIV/AIDS". Also, information on the recreational drug crystal meth at the Body Positive web site compliments two articles published in HIV ReSource Review Issue 24 and Issue 25, which were on the nutritional aspects of substance abuse. There's also information on other recreational substances in previous HIV Nutrition News Updates at  Archive 1  and  Archive 2 . 

More On Garlic 

A recent meeting of officials from several branches of the National Institutes of Health (NIH) helped to identify gaps in knowledge on herbs such as garlic and cardiovascular disease research. In previous HIV Nutrition News Updates we noted that garlic supplements can impede HIV medications. Information from the NIH meeting builds on that published in our comprehensive literature review of garlic in Issue 14 of the HIV ReSource Review. As noted in our literature review, cooking garlic decreases allicin formation but breakdown products created during drying and cooking garlic may possess beneficial effects for the heart. 

Some investigators question the value of garlic supplements on the market. Testing completed by ConsumerLab.com on 14 garlic supplements found that product labeling was often poorly indicative of strength (based on allicin yeild), which varied by 1,500% among non-aged garlic products. Additional information is at the ConsumerLab.com web site . 

CATIE And CATIE - The Difference 

The Health Resources and Services Administration (HRSA) recently launched the CARE Act Technical Information and Education (CATIE) web site. The HRSA CATIE web site is designed to help Ryan White grant recipients and other providers as well as offer the latest service and treatment information. The web site should not be confused with the Canadian AIDS Treatment Information Exchange (CATIE) funded by Health Canada, under the Canadian Strategy on HIV/AIDS. The popular Canadian CATIE web site offers a wide variety of resources including many treatment articles authored by the late Chester D. Myers, PhD who was an editor for the HIV ReSource Review as well. 

FDA Issues Alert On Cantaloupes From Mexico

The Food Drug Administration (FDA) has issued an import alert on cantaloupes from Mexico because of unsanitary conditions that have resulted in four Salmonellosis outbreaks in the last three years in the United States. These outbreaks were responsible for many illnesses including two deaths and at least 18 hospitalizations. The import alert recommends that officials detain without physical examination cantaloupe from Mexico offered for entry at all U.S. ports. FDA sampling of imported produce found some samples of cantaloupe from most growing regions in Mexico tested positive for Salmonella. 

Salmonella is an organism that can cause serious and sometimes fatal infections in young children, elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections, endocarditis (an infection of the lining of the heart) and arthritis. 

FDA continues to recommend that consumers take the following steps with cantaloupe and other produce to reduce the risk of food borne illnesses: 

*       Purchase produce that is not bruised or damaged. If buying fresh cut produce, be sure it is refrigerated or surrounded by ice. 
*       After purchase, put produce that needs refrigeration away promptly. (Fresh whole produce such as bananas and potatoes do not need refrigeration.) Fresh produce should be refrigerated within two hours of peeling or cutting. Leftover cut produce should be discarded if left at room temperature for more than two hours. 
*       Wash hands often. Hands should be washed with hot soapy water before and after handling fresh produce, or raw meat, poultry, or seafood, as well as after using the bathroom, changing diapers, or handling pets. 
*       Wash all fresh fruits and vegetables with cool tap water immediately before eating. Don't use soap or detergents. Scrub firm produce, such as melons and cucumbers, with a clean produce brush. Cut away any bruised or damaged areas before eating. 
*       Wash surfaces often. Cutting boards, dishes, utensils, and counter tops should be washed with hot soapy water and sanitized after coming in contact with fresh produce, or raw meat, poultry, or seafood. Sanitize after use with a solution of 1 teaspoon of chlorine bleach in one quart of water. 
*       Don't cross contaminate. Use clean cutting boards and utensils when handling fresh produce. If possible, use one clean cutting board for fresh produce and a separate one for raw meat, poultry, and seafood. During food preparation, wash cutting boards, utensils or dishes that have come into contact with fresh produce, raw meat, poultry, or seafood. 
*       Do not consume ice that has come in contact with fresh produce or other raw products. 
*       Use a cooler with ice or use ice gel packs when transporting or storing perishable food outdoors, including cut fresh fruits and vegetables. 

Use Of Complementary And Alternative Medicine 

Sales of complementary therapies continue to increase. As noted in HIV ReSource Review Issue 21: 

"Many people living with HIV infection (PLWHIV) consider complementary therapies an important part of treatment and care. The popularity of herbal medications as adjunctive therapy for HIV and AIDS has grown significantly in the past several years. Studies continue to show that PLWHIV and AIDS spend a significant part of their money on complementary treatments such as botanicals and other supplements. One look at the shelves of a local drug or grocery store serves to show that since passage of the 1994 Dietary Supplement and Education Act (DSHEA), the popularity of dietary supplements has
skyrocketed. Even major pharmaceutical companies are now participating in this rapidly growing industry. Total sales for dietary supplements in 1998 totaled almost $12 billion and are projected to increase to $14 billion by the year 2000. Retail botanical sales within the U.S. were $1.5 billion in 1995 and industry experts predict that by the year 2000, consumers will be buying more than $5 billion in herbal products. (8) Considering ongoing research on the benefits of various phytochemicals in our food supply, it is not hard to imagine that the chemical compounds from herbs could also be helpful in the therapy of HIV disease. Healthcare providers must provide patients with accurate scientific information about these products noting what has promise, what is useless and what is potentially harmful. This article provides a summary of botanical use within the HIV population and offers information on the future of dietary supplements." Part Two of the article mentioned above is in Issue 22 of the HIV ReSource Review. 

The NIH recently announced an Institute of Medicine (IOM) study of complementary and alternative medicine (CAM). The study will be conducted by the IOM and will look at the scientific and policy implications of the use of CAM by the American public. 

Some health care insurers currently cover chiropractic service, which is included in the realm of CAM. Recent results from a survey of selected chiropractors reveals that many of them offer nutritional counseling, supplementation, or written materials on nutrition . Methods used to assess nutrition needs included hair analysis, applied kinesiology, and subluxation pattern. For information on Chiropractic History, Theories, and Current Practices visit Chirobase. 

Although the nearly 2-year IOM study is not designed to offer scientific information about complementary products such as chiropractic service, a panel of experts will assess research findings, hold workshops, and invite speakers to address the panel, along with other activities. The panel's task is to: 

* Provide a comprehensive overview of the use of CAM therapies by the American public; 
* Identify significant scientific and policy issues related to CAM research, regulation, integration, training, and certification; and
* Develop a conceptual framework to help guide decision making on these issues and questions. 

The end result from this new study should be more useful information to guide scientific and policy issues that will better inform research decisions. It should also help the public as they choose which therapies to try. 

University of California San Francisco Seminar 

The Interplay of Innate Immunity and HIV Infection seminar sponsored by the University of California San Francisco  will be held on November 18, 2002. During the two-hour seminar UCSF researchers, Dr. Lewis Lanier and Dr. Jay Levy, will present recent research on aspects of Host Immunity in HIV Infection and it's role in disease progression. For more information telephone Jennifer Plumb at 415/379-5602, ext 1 or e-mail.
 

HIV Incidence And Healthcare

Estimated worldwide HIV infections are now at nearly 49 million people. (1) HIV is an increasing concern and could devastate Russia, China, India, Nigeria and Ethiopia if not adequately addressed. (2) Some infected people do not even know they are HIV-positive. In America, HIV incidence continues to rise but people are living longer due to successful drug therapies. This further strains the health care system as more people require health care each year. It also increases out-of-pocket costs for many people with HIV who require health care including highly active antiretroviral therapy (HAART) to keep the virus at bay.

Adverse side effects of HAART continue to be reported as more HIV-positive people develop glucose abnormalities, heart disease and osteoporosis. Recently investigators noted that the prevalence of these adverse effects varies from between 18- 70% after several years of HAART. (3) Although there are few therapeutic options for lipodystrophy, we do know that a change in dietary habits may help to lessen the occurrence of glucose abnormalities, heart disease and osteoporosis. For more information on the nutritional treatment of these abnormalities readers can refer to several later issues of the HIV ReSource Review.

The printed report "Health, United States, 2002" with "Chartbook on Trends in the Health of Americans" is available for viewing. This year's report on the health status of the Nation includes trend tables organized around health status and determinants, health care use, health care resources, and health care expenditures. It shows the decreased incidence of AIDS and death rate for people with HIV over the past several years. It also illustrates the increasing number of adults without a usual source for health care particularly for Hispanics and Latinos. 

Researchers recently discovered another case of second HIV infection with a different strain of virus than the initial infection. (4) The patient contracted the second HIV infection two years after he became HIV-positive. This development raises questions as to the efficacy of an AIDS vaccine to protect against more than one strain and also supports the practice of safe sex for those already infected with HIV. A variety of tests to detect HIV are necessary to increase the number of people who get tested and are aware of their illness. (5)

Sources

1. Estimated Worldwide HIV Infections: 48 916 879 At 2.52pm On Thursday October 10, 2002. Mail & Guardian (Johannesburg) 11 October 2002. Distributed by AEGiS. 

2. Garrett L. AIDS Seen As Threat to World: Experts say five countries may soon be decimated. Newsday 15 October 2002. Distributed by AEGiS.

3. Oette M, Juretzko P, Kroidl A, Sagir A, et al. Lipodystrophy Syndrome and Self-Assessment of Well-Being and Physical Appearance in HIV-Positive Patients. AIDS Pt Care STDs 2002;16(9):413-417. Abstract distributed by CDC HIV/STD/TB Prevention News Update. 22 October 2002. 

4. Jost S, Bernard MC, Kaiser L, Yerly S, et al. Brief Report: A Patient with HIV-1 Superinfection. N Eng J Med 2002;347(10):731-736.

5. Variety of HIV Test Choices Are Needed, Editorial Says. Kaiser Daily HIV/AIDS Report. 2002 17 October.
 

Hepatitis C And HIV Coinfection 

Coinfection with HIV and Hepatitis C (HCV) is a major concern and nutritional status can be adversely affected. A large study (n=1955) did not find that HCV infection substantially alters the risk of developing AIDS or responding immunologically to HAART. (1) Results from a recent small trial (n=21) note that HCV genotype 1 is associated with advanced liver disease and
HCV/HIV coinfection may aggravate the course of hepatitis. (2) View the 2000-2002 Strategies for the Management of HIV/HCV Coinfection monographs. 

Readers of the HIV ReSource Review can learn about the various nutritional issues related to HIV/HCV coinfection by reviewing the March/April (Issue 29) and May/June 2001(Issue 30) issues. For more on HCV visit one of the list archive pages. 

Sources

1. Sulkowski MS, Moore RD, Mehta SH, Chaisson RE, Thomas DL. Hepatitis C And Progression Of HIV Disease. JAMA 2002;288(2):199-206. 

2. Delladetsima J, Touloumi G, Vgenopoulou S, Karafoulidou A. Significance Of Immune Status, Genotype And Viral Load In The Severity Of Chronic Hepatitis C In HIV Infected Haemophilia Patients. Haemophilia 2002;8(5):668-73. 

HIV ReSources Web Site Update 

10/14/02 - The HIV ReSources Web Site is updated. 

New Links Are At: 
Homepage Del VIH ReSources
Recursos de nutricion
Mary Fisher's Address On AIDS
Networking, Toll Free Numbers And Resources
Freebies, Movies & Game Links

Updated pages include: 
Interview With Jules Levin
HIV Information Links
Nutrition Feature Abstracts - Issues 1-13
Ideal Ratio Of Registered Dietitians To Clients

Upcoming Conferences 

Dr. Kaiser presented an HIV Treatment Update in San Francisco on October 23rd at the San Francisco Lesbian/ Gay/Bisexual/Transgender Center. Telephone 877/DR- KAISER for additional information on future conferences. 

Medical Management of AIDS: A Comprehensive Review of HIV Management was held on December 14-16, 2002 at the Palace Hotel in San Francisco, CA. This symposium was sponsored by the Office of Continuing Medical Education, University of California, San Francisco. Find more information on other educational opportunities.

The 15th National HIV/AIDS Update Conference was held in Miami, FL on March 30 to April 2, 2003. Visit the amfAR web site for information on medications and conferences. 
 

Ecstasy

Researchers recently reported that ecstasy, a common recreational drug noted in Issue 24 and Issue 25 of the HIV ReSource Review, might cause permanent brain damage. Based on animal studies, investigators report that people who use ecstasy may be putting themselves at risk of developing neuropsychiatric disorders related to brain dopamine and serotonin deficiency. Use of ecstasy could also make a person more vulnerable to Parkinson's disease. Protease inhibitors or non-nucleoside reverse transcriptase inhibitors also interact with ecstasy and can increase the risk of anemia and drug toxicity. Other information on the effects of party drugs including ecstasy is in the list archives in Issue 1, Number 12 and 13  and Issue 2, Numbers 1, 9 and 16. 

Funding Information 

The following funding information is taken from the CDC National Prevention Information Network's (NPIN) Funding Database. For more funding information contact the CDC NPIN at 800/458-5231 or visit the above web site. 

Complementary and Alternative Medicine (CAM) Therapy in the Treatment of HIV/AIDS - Fund Number: 2160
Description: This initiative will support research to identify potential roles for the safe and effective use of CAM in the treatment of HIV/AIDS and its complications, or to ameliorate medication side effects. The National Center for Complimentary and Alternative Medicine (NCCAM) and the National Institute of Nursing Research (NINR) are especially interested in supporting well-designed studies to characterize and investigate traditional medicine practices used in the treatment of HIV/ AIDS. In this context, traditional medicine practices are derived from systems that have evolved their own coherent bodies of knowledge, and are differentiated from conventional or biomedical systems. The objectives of this initiative are to: (1) Identify safe and effective CAM therapies that have potential roles in treating HIV/AIDS and its complications, or to ameliorate medication side effects; (2) Establish possible synergistic combinations of CAM and conventional treatments for HIV; and (3) Understand mechanisms of action of CAM therapies that have the potential for contributing to the treatment of HIV/AIDS and its complications, or to ameliorate medication side effects. Sponsor(s): US Department of Health and Human Services, Public Health Service, National Institutes of Health, National
Institute of Nursing Research AND National Center for Complimentary and Alternative Medicine Information Center.
Funder's Fund ID: RFA: AT-03-001 

Additional information Letter of Intent Due Date: 11/11/2002 - Application Due Date: 12/10/2002 

Application Process: Applications must be prepared using the PHS 398 research grant application instructions and forms (rev. 5/2001). 

Award Notes: The NCCAM intends to commit approximately $750,000 total funding in FY 2003 to fund two to four new and/or competitive continuation grants in response to this RFA. The NINR intends to commit up to $750,000 total funding in FY 2003 to fund two to four new or competitive continuation grants in response to this RFA, as well. For an R01 application, an applicant may request a project period of up to five years and a budget for direct costs of up to $375,000 per year.

Because the nature and scope of the proposed research will vary from application to application, it is anticipated that the size and duration of each award will also vary. For an R21 application, an applicant may request a project period of up to two years and a budget for direct costs of up to $125,000 per year. 
Application Contact Name: Brian Campbell.  Application Contact Address: Grants Management Branch, NCCAM, 6707 Democracy Blvd, Ste 401, Bethesda, MD 20892-5475, U.S. 

Stopping HIV Progression

Recent research concerning long-term HIV-positive individuals who have not progressed to AIDS has led to the identification of human proteins that may stop the progression of HIV. (1) Investigators note that these proteins, identified as defensins-1, -2, and -3, account for the anti-HIV activity of a soluble factor, termed CAF. The news gives rise to hopes that synthetic versions of this protein could lead to new treatments for HIV/ AIDS. Other researchers, however, fault both the study's methods and conclusion. (2) Several investigators note that
although they previously looked at defensins, the proteins were not thought to be solely responsible for blocking the replication of all HIV strains.

Sources 

1. Zhang L, Yu W, He T, Yu J, et al. Contribution of Human -Defensin-1, -2 and -3 to the Anti-HIV-1 Activity of CD8 Antiviral Factor. Science, published online September 26, 2002.

2. Maugh THII. Anti-HIV Find Is Revealed -- and Quickly Disputed. Los Angeles Times 27 Sept 2002. Distributed through AEGIS. 

ANSA Nutrition Guidelines

The Nutrition Committee of AIDS Nutrition Services Alliance (ANSA) has completed the revision of Nutrition Guidelines for Agencies Providing Food to People Living with HIV Disease. In March 1999, the ANSA Board of Directors approved the original Nutrition Guidelines for Agencies Providing Food to People Living with HIV/AIDS.  The purpose of the Guidelines was to educate agencies about how to provide their clients with quality assurance, quality food and services. 

Keeping with the spirit of the original document, the second edition builds upon the foundation of quality improvement and serves as a comprehensive guide to organizations whose primary mission includes the provision of nutritional services to people living with HIV disease. These services may include, but are not limited to: meal delivery; grocery items; and congregate-type meal programs; as well as nutrition counseling and education. These Guidelines are to be utilized by staff members of organizations who provide these services.

For further information on the revised Nutrition Guidelines for Agencies Providing Food to People Living with HIV Disease visit the web site of ANSA. 

Conference Information

An Symposium: Role of Iron in Alcoholic Liver Disease was held in Bethesda, Maryland on October 25, 2002. 

Risks Associated With Eating Sprouts

The Food and Drug Administration (FDA- 888/INFO-FDA) is updating its health advisory on the risks associated with eating all raw sprouts because of a recent E. coli O157:H7 outbreak associated with alfalfa sprouts. This advisory is also being updated to specifically include raw and lightly cooked mung bean sprouts.  Since FDA issued its original health advisory on sprouts in 1999, there have been several reported foodborne illness outbreaks associated with sprouts. Persons in high risk categories (i.e., children, the elderly, and the  immunocompromised) should not eat raw or lightly cooked sprouts. Outbreaks of foodborne illness from all implicated raw sprouts have involved the pathogenic bacteria Salmonella or E. coli O157:H7 and have affected persons of all ages and both genders. Healthy persons infected with these bacteria
experience diarrhea, nausea, abdominal cramping and fever for several days. Those persons who wish to reduce their risk of foodborne illness should not eat raw sprouts. For people in high risk categories, an E. coli O157:H7 infection could lead to serious complications, including hemolytic uremic syndrome, which can result in kidney failure or death. Salmonella infection (i.e., salmonellosis) in these high risk groups can also cause serious illness. As stated in the 2002 Food Code, hospitals, day care centers, nursing homes and senior centers should not serve sprouts.

There have been four foodborne illness outbreaks associated with mung bean sprouts and two outbreaks associated with alfalfa sprouts in the U.S. between 2000 and 2002. All mung bean and one alfalfa sprout outbreak involved salmonellosis. The mung bean outbreaks have been associated with raw or lightly cooked sprouts. The most recent E. coli O157:H7 outbreak was associated with alfalfa sprouts in California. Some segments of the sprout industry have made significant strides to enhance the safety of their products by following recommendations in the 1999 Sprouts Guidance. However, adherence to these guidelines has not been universal, and outbreaks have continued to occur in association with raw and lightly cooked sprouts.

The FDA offers the following advice to all consumers concerning sprouts:
*Cook all sprouts thoroughly before eating to significantly reduce the risk of illness.
*Sandwiches and salads purchased at restaurants and delicatessens often contain raw sprouts. Consumers who wish to reduce their risk of foodborne illness should specifically request that raw sprouts not be added to their food.
*Homegrown sprouts also present a health risk if eaten raw or lightly cooked. Many outbreaks have been attributed to contaminated seed. If pathogenic bacteria are present in or on seed, they can grow to high levels during sprouting even under clean conditions.

The FDA will continue to closely monitor the safety of sprouts and will take further actions as necessary, including the establishment of preventive controls to protect consumers. Consumers who have eaten raw or lightly cooked sprouts and are experiencing diarrhea or other symptoms of foodborne infections are advised to consult their health care providers. Additional information

Psyllium, Magnesium And Type 2 Diabetes

Previous issues of the HIV ReSource Review highlighted the association between hearth health and fiber, particularly psyllium, which lowers the risk of heart disease and helps in the metabolic control of type 2 diabetics. (1-2) A recent small study that evaluated the effects of psyllium in type 2 diabetic patients noted significantly decreased glucose absorption, which was not associated with an important change in insulin levels. (3) Administration of psyllium also significantly reduced total and low-density lipoprotein cholesterol and uric acid. 

In Blood Glucose Abnormalities In HIV-Positive People: Part Two we also highlighted the relationship between magnesium and type 2 diabetes. Another recent report notes that magnesium deficiency may not only have a negative impact on glucose homeostasis and insulin resistance but also on the evolution of complications such as high blood pressure. (4) Based on the investigator's study of 197 patients, dietary magnesium intake is unlikely to contribute to the etiology of magnesium deficiency in type 2 diabetics.

Sources

1. Tinnerello D, Meyer SA. Heart Healthy Food Choices In The
Era Of HAART: Part Two. HIV Resource Review 2000;4(5):6.

2. Wittenbrook W, Tinnerello D, Meyer SA. Blood Glucose Abnormalities in HIV-Positive People: Part Two. HIV Resource Review 2001;5(4):12. 

3. Sierraa M, García JJ, Fernández N, Diez MJ, et al. Therapeutic Effects Of Psyllium In Type 2 Diabetic Patients. Eur J Clin Nutr 2002;56(9):830-842.

4. Wälti MK, Zimmermann MB, Spinas GA, et al. Dietary magnesium intake in type 2 diabetes. Eur J Clin Nutr 2002;56(5):409-414.

Hepsera (Adefovir Dipivoxil) Tablets Approved

The Food and Drug Administration (FDA) has approved Hepsera (adefovir dipivoxil) tablets for the treatment of chronic hepatitis B in adults with evidence of active viral replication and either elevations in serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST), or histologically active disease. Hepsera slows the progression of chronic hepatitis B by interfering with viral replication and causing DNA chain termination after its incorporation into viral DNA. FDA based its approval of Hepsera on the results of two randomized, double- blind, placebo-controlled studies. The major adverse events associated with the use of Hepsera include severe, acute exacerbation of hepatitis B after discontinuation of Hepsera and kidney toxicity. There is also a theoretical concern associated with Hepsera that HIV resistance could emerge in chronic hepatitis B patients with unrecognized or untreated HIV infection. For additional information on Hepsera visit Gilead Sciences Inc. of Foster City, Calif.

FDA Notice-VIDEX (Didanosine, ddI) 

The VIDEX (Didanosine, ddI) label has been revised to include new, precautionary information about co-administration of VIDEX and ribavirin (RBV) in HIV/HCV co-infected patients. Cases of patients receiving VIDEX who added treatment with ribavirin appeared to disclose a relationship between the time that ribavirin was initiated and the occurrence of toxicity, on average 4.8 months. In vitro data demonstrating that RBV increases the levels of the active Didanosine metabolite, dideoxyadenosine 5'-triphosphate (ddATP), and clinical reports suggesting the potential for didanosine-related toxicities led to the addition of new precautionary language in the VIDEX label. The following has been added to the "Precautions" section of the label:

Exposure to didanosine or its active metabolite (dideoxyadenosine 5'-triphosphate) is increased when didanosine is co-administered with ribavirin. Increased exposure may cause or worsen didanosine-related clinical toxicities, including pancreatitis, symptomatic hyperlactatemia/lactic acidosis, and peripheral neuropathy. Co-administration of ribavirin with VIDEX should be undertaken with caution, and patients should be monitored closely for didanosine-related toxicities. VIDEX should be suspended if signs or symptoms of pancreatitis, symptomatic hyperlactatemia, or lactic acidosis develop.

Sources

1. Lafeuillade A, Hittinger G, Chadapaud S, The Lancet, Vol 357, Jan 27, 2001.
2. Salmon-Ceron D, Chauvelot-Moachon L, Abad S, et al., The Lancet, Vol 357, June 2, 2001.

HIV Nutrition Update Newszine - Issue 38

The Sept/Oct HIV Nutrition Update Newszine is now available (Internet access). Issue 38 includes an article written by Zaneta M. Pronsky, MS, RD, FADA and Sister Jeanne P. Crowe, PharmD, RPh titled "Food - Drug Interactions In HIV/AIDS". Issue 38 also includes book reviews and a:
* Program Spotlight: Lifelong AIDS Alliance - Seattle, WA; 
* Update Central column: information on medical marijuana;
* Resource Corner with leads to Internet, client and clinician resources and free tutorials and publications;
* Med Watch column on Teriparatide (Forteo);
* Patient Education Handout on Using and Choosing Supplements.

Free HIV Nutrition Discussion List

The HIV Nutrition Discussion List was originally housed on beseen.com in a bulletin board format. This list is dedicated to  issues surrounding nutrition and HIV and is sponsored by A1WebServer and HIV ReSources, Inc. It is open to anyone who chooses to subscribe. Only subscribers can post messages but messages can be freely shared with non-subscribers and are archived. Learn more about the list by visiting the web site.
 

Online Resources

Nutritiongov a federal source on general nutrition holds lots of links to food safety information, food assistance resources, research and food facts. 

The Distance Learning Project Of Teachers College Columbia University offers AIDS Education Online.

The Body offers information on natural vitamins and minerals through an article written by Jennifer Muir Bowers, PhD, RD, CNSD. Visit the web site above and go to the section on nutrition to find the article.

AIDS Treatment Data Network offers Glossary: Drugs and Treatments.

Nandrolone Decanoate

As noted in the revised edition of our handout Treatments For Unintentional Weight Loss, the U.S. manufacturer of nandrolone decanoate discontinued production of the drug. Fortunately, Watson (Steris) is now producing nandrolone decanoate injection 100 mg/ml. Contact them at 800/272-5525.

Water - How Much Is Enough?

Readers of the HIV Nutrition Update read in HIV-AIDS Dietary Treatment in Chinese Medicine by Richard A. Freiberg, D.O.M., D.Ac., A.P., Board Certified Diplomate: "Practitioners of Chinese Medicine believe it is incorrect even for healthy people to force themselves to drink 8-8 ounce (oz) glasses of water/fluid or more every day." (1) A recent review of the literature coupled with extensive consultation with nutritionists specializing in the field of thirst and drinking fluids, suggests that there is little evidence to support the advice of drinking this amount of fluid each day. (2) The author is seeking evidence from readers who are aware of pertinent publications. 

As noted by both Valtin and Friedberg however, large intakes of fluid are advisable under certain circumstances. Common sense should prevail as so many people who are living with HIV must take medications with a full glass of water and may also have more of a need for fluids due to warmer temperatures, exercise regimens, fevers, activity of 'latent-heat' due to viral activity, etc. 

Sources

1. Freiberg RA. HIV-AIDS Dietary Treatment in Chinese Medicine. HIV Nutrition Update; 2002;6(5):1-7,19. 

2. Valtin H. Drink at least eight glasses of water a day - Really? Is there scientific evidence for "8 x 8"? Am J Physiol Regu Physiol; 8 Aug 2002. 

Conferences

The Southeastern Conference on Alcohol and Drug Addiction (SECAD) was held from December 4-7, 2002 in Atlanta, GA. Featured topics included alcohol and drug abuse treatment, HIV/AIDS and Hepatitis C. The conference was sponsored by the National Association of Addiction Treatment Providers and the School of Medicine of the Medical College of Georgia. For further information, telephone 888/506-7394 or 770/579-2502. 

The First National Conference of HIV and Hepatitis Co- Infection was held from January 25-26, 2003 in Bombay, India. The Conference Secretariat, was Dr. J.K. Maniar, Conference Co-Chair, 69/2 Walkeshwar Rd, Bombay 400 006, India. 

Hepatitis C - NIH Consensus Statement

The Final NIH Consensus Statement on the management of hepatitis C is ready for viewing at their web site. The statement is an independent report of the panel and reflects the panel's assessment of medical knowledge available at the time the statement was written. Although it does not address nutrition, the statement does recommend routine screening for patients with documented HIV infection. Readers of the HIV ReSource Review may refer to Issue 29 and Issue 30 for information on nutritional issues to consider for HIV and hepatitis C co-infected individuals. The Issue 30 preview contains links to additional resources on hepatitis C. 

Viracept And Food

Issue 16 of the HIV ReSource Review highlighted Viracept a commonly used HIV medication. The Search for a Cure web site now adds to that information also stressing the need to eat when taking Viracept. 

Athletic Banned Substances & Kava Kava

ConsumerLab has a Athletic Banned Substances Screening Program meant to check supplements for ingredients that could cause disqualification of athletes from sporting events. Read about the nine products that passed this program. 

Along with Germany and Australia (see last months' updates), Canada has stopped the sale of supplements containing kava due to safety concerns. For further information visit the web site and read the August 21, 2002 advisory. 

Special Notice
The HIV Nutrition News Update will not be published next week due to our attendance at the annual ANSA conference in Hollywood, California.