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Web Site Update
5/1/03 - The HIV ReSources Web Site is updated.

New links are at: 
Herbal Information
Information On Hepatitis
Books On Complementary Treatments
Nutrición Y Recursos Del VIH
HIV/AIDS Among Women
Children's Nutrition Links
Information On Complementary Therapies

Reviewed pages include:
Feedback/Comment Form
Free Newsletter Issue

Ground Beef Recall

Antibiotic resistance among foodborne diseases such as Salmonella is increasing throughout the world as evidenced by reports from the U.S., Canada and Australia. Food recalls have become common, especially for meats. Recently, the USDA Food Safety And Inspection Service issued another ground beef recall noting that products from an Oregon firm may be contaminated with E. coli O157:H7. The products were distributed to a casino in Canyonville, Oregon. 

E. coli O157:H7 is a potentially deadly bacteria that can cause bloody diarrhea and dehydration. The very young, seniors and persons with compromised immune systems are the most susceptible to foodborne illness. 

Consumers with food safety questions can phone the toll-free USDA Meat and Poultry Hotline at 800/535-4555 from 10 a.m. to 4 p.m. (Eastern Time), Monday through Friday. Recorded food safety messages are available 24 hours a day. 

Access news releases and other information at the FSIS web site. 

Food Safety and Inspection Service (FSIS) News
 

The FSIS announced a Class I recall of bologna products on April 22, 2003. Balaton Hungarian & European Foods, Inc., a Brooklyn, NY, establishment, is voluntarily recalling approximately 330 pounds of ready-to-eat, fully cooked pork and veal bologna products that may be contaminated with Listeria monocytogenes. The products subject to recall were produced on April 10 and distributed to retail stores in Brooklyn, NY. They are: 
*       1 lb. chubs of "Balaton Hungarian & European Foods, Inc, BOLOGNA." 
*       1 lb. cryovac packages of "Balaton Hungarian & European Foods, Inc, VEAL BOLOGNA." 

Consumption of food contaminated with Listeria monocytogenes can cause listeriosis, an uncommon but potentially fatal disease. Healthy people rarely contract listeriosis. Listeriosis can cause high fever, severe headache, neck stiffness and nausea. Listeriosis can also lead to miscarriages and stillbirths, as well as serious and sometimes fatal infections in children, seniors and those with compromised immune systems. 

For further information visit the FSIS web site or telephone George Mitelman, company president, at 718/375-2958. 

Consumers with other food safety questions can phone the toll-free USDA Meat and Poultry Hotline at 1-800-535-4555. 

Integrating Nutrition Therapy into Medical Management of HIV 

A special supplement to Clinical Infectious Diseases, a journal of The Infectious Diseases Society of America, was published on April 1, 2003 (Clinical Infectious Diseases, Volume 36, Supplement 2). It contains a special report on current issues related to nutrition management and HIV infection. 

The supplement is a collaborative work of more than 50 authorities representing a wide range of expertise in conjunction with 5 federal agencies: the Health Resources and Services Administration, the Food and Drug Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, and the Department of Veterans Affairs. 

Nutrition is an important, but often overlooked aspect of HIV disease management. John Bartlett, of the Johns Hopkins University School of Medicine, states in the supplement's introduction: "...modern management of HIV infection now requires substantial expertise in dealing with nutritional issues and access to this expertise, despite the fact that there have been virtually no guidelines that specifically target the nutritional care of the HIV-infected population. This report on the nutrition management and concerns of HIV infection is consequently most welcome as timely, authoritative, and greatly needed. " 

Integrating Nutrition Therapy Into Medical Management Of Human Immunodeficiency Virus is now available. 

The topics covered in this special supplement are: 

*   Introduction: Integrating Nutrition Therapy into Medical Management of Human Immunodeficiency Virus

*   General Nutrition Management in Patients Infected with Human Immunodeficiency Virus

*   Assessment of Nutritional Status, Body Composition, and Human Immunodeficiency Virus-Associated Morphologic Changes

*   Weight Loss and Wasting in Patients Infected with Human Immunodeficiency Virus

*   Lipid Abnormalities

*   Body Habitus Changes Related to Lipodystrophy

*   Insulin and Carbohydrate Dysregulation

*   Lactic Acidemia in Infection with Human Immunodeficiency Virus

*   Emerging Bone Problems in Patients Infected with Human Immunodeficiency Virus

*   Food and Water Safety for Persons Infected with Human Immunodeficiency Virus

For access to Federal HIV/AIDS information on clinical research, HIV treatment and prevention, and medical practice guidelines for health care providers and consumers, visit the AIDSinfo Web site or contact their Help Line at 800/448-0440, International 301/519-0459, TTY/TDD 888/480-3739. 
 

Diabetes

Diabetes has become more prominent in the HIV population since the use of highly active antiretroviral therapy. We know that people with diabetes are at higher risk for heart disease and other chronic conditions. A practical tool to predict type 2 diabetes risk has been designed by investigators living in Finland. (1) The Diabetes Risk Score is designed to determine individuals at increased risk for type 2 diabetes without using laboratory tests. It includes variables such as age, body mass index, waist circumference, history of high blood glucose, and daily consumption of fruits and vegetables. Investigators note, the tool is "simple, fast, inexpensive, noninvasive, and reliable" 

In Issue 27 of the HIV ReSource Review issue we noted that glycosylated hemoglobin (HbA1c) is recommended for use as a monitoring tool. Wolever and colleagues reported carbohydrate, starch, and the glycemic index all affect the HbA1c level. (2) Recently the Food and Drug Administration approved the first over-the-counter test that measures HbA1c to help diabetics monitor how well they are managing their diabetes. Additional information

The direct medical and indirect productivity-related costs attributable to diabetes are high with medical expenditures in 2002 estimated at more than one-billion dollars. (3) Effective treatment benefits diabetics and the health care system as well. Eliminating or reducing health problems caused by diabetes can significantly improve the quality of life for diabetics and their families. 

For additional information on diabetes view the MEDLINEplus topic Diabetes.

References

1. Lindström J, Tuomilehto J. The Diabetes Risk Score. A practical tool to predict type 2 diabetes risk. Diabetes Care 2003;26:725-731. 

2. Wolever TMS, Hamad S, Chiasson JL, Josse RG, et al. Day-To-Day Consistency In Amount And Source Of Carbohydrate Intake Associated With Improved Blood Glucose In Type 1 Diabetes. J Am Coll Nutr. 1999; 18(3):242-247. 

3. Report From The American Diabetes Association Economic Costs of Diabetes in the U.S. in 2002. Diabetes Care 2003;26:917-932. 
 

Food Recalls

Macknight Smoked Foods of New Britain, PA has issued recalls for its Long Sliced Smoked Salmon because it has the potential to be contaminated with Listeria monocytogenes. Symptoms of Listeria monocytogenes include high fever, severe headache, stiffness, nausea, abdominal pain, diarrhea, and miscarriages and stillbirths among pregnant women. For information on how to avoid Listeria monocytogenes visit the web site. 

Dietary Supplement Health Claims for Selenium 

Although recent research from UK-based Institute of Food Research notes that sulforaphane and selenium are recognized for their ability to fight cancer, the Food and Drug Administration (FDA) maintains an opposing viewpoint. In a recent communication, the FDA compliments information found in the HIV Nutrition Update feature article on selenium in Issue 41. "Letter Regarding Dietary Supplement Health Claim for Selenium and Certain Cancers" notes that evidence of reduced cancer risk and the anticarcinogenic effects of selenium "...is limited and not conclusive." It also stresses that, "...a daily intake exceeding 400 micrograms of selenium per day, which the National Academy of Sciences/Institute of Medicine (NAS/IOM) report concluded is the tolerable upper intake level (UL) from foods and supplements, is likely to pose no risk of adverse health effects in almost all people. The agency notes that the same NAS/IOM report indicates that current intake of selenium from foods is estimated to be 100-200 micrograms per day and that 800 micrograms selenium per day is the no-observed-adverse-effect level (NOAEL)." 

Animal studies using rats indicate that plasma total homocysteine is decreased in selenium deficiency but it increases with selenium supplementation. A New Zealand study, however, notes that selenium supplements do not increase plasma total homocysteine concentrations in humans.

Patients should always discuss any dietary supplements with their physician or primary health care provider.

More On Metabolic Syndrome

The following web site was in a recent e-newsletter from the Center for Human Nutrition, which offers the latest information on obesity and the metabolic syndrome along with current issues in nutrition. 

As noted in previous updates, protease Inhibitors (PI) are associated with a variety of conditions including Diabetes Mellitus a potential cause of morbidity and mortality. In one study, the risk of diabetes increased threefold in HIV- positive women who were treated with a PI. (1) Investigators advise routine diabetes screening especially for older and heavier patients using PI therapy.

References

1. Fantry LE. Protease inhibitor-associated diabetes mellitus: a potential cause of morbidity and mortality. J Acquir Immune Defic Syndr. 2003;32(3):243-4. 
 

Recalls 

Acyclovir And Metformin Tablets: Alpharma Purepac has recalled Acyclovir Tablets and Metformin Hydrochloride Tablets because they contain fibers and may contain iron and zinc particles. 

Antacids: Aaron Industries, Inc. in Lynwood, California is recalling antacids due to microbial contamination with Enterobacter cloacae, Citrobacter freundii, Klebsiella terrigena, Flavimonas oryzihabitans and Salmonella arizonae. The products are distributed and sold by a variety of companies under various brand names.

HIV Nutrition Update - Newszine Issue 41

The March/April HIV Nutrition Update Newszine has been published. The feature article in this issue is an expansion of a literature review of selenium completed by members of the Macronutrients, Micronutrients, and Non- Essential Dietary Supplements sub-group of the National HIV Nutrition Guidelines Working Group. Additional information has been added to assist the reader in understanding all of the aspects of selenium supplementation. Results of additional literature reviews on other subjects studied by this group will be in future issues. 

The issue also includes: 
* Program Spotlight column- New Horizons Family Health Service-Greenville, SC; 
* Update Central column- information on lipodystrophy and leptin; 
* Nutrition Forum column- selenium; 
* Resource Corner- leads to Internet, client and clinician resources; 
* Med Watch column- Pravachol (Pravastatin); 
* Conference Update. 

Leptin And Lipodystrophy 

Investigators have studied the actions and effects of the fat cell secreted hormone leptin on obesity reduction and most recently on lipodystrophy. According to information in the current HIV Nutrition Update issue noted above, leptin therapy may be helpful to treat HIV-positive individuals with lipodystrophy. Review more information to compliment that found in the Update Central column by reading the following two articles: 

1. Simha V, Szczepaniak LS, Wagner AJ, DePaoli AM, Garg A. Effect of leptin replacement on intrahepatic and intramyocellular lipid content in patients with generalized lipodystrophy. Diabetes Care. 2003 Jan;26(1):30-5.

2. Simha V, Zerwekh JE, Sakhaee K, Garg A. Effect of subcutaneous leptin replacement therapy on bone metabolism in patients with generalized lipodystrophy. J Clin Endocrinol Metab. 2002 Nov;87(11):4942-5.

Conferences And Community Events 

A free public health fair was held in Wilton Manors, Florida on Saturday, April 5th. StatScript Pharmacy at 2605 North Dixie Highway (954/568-3789) offered opportunities for free testing and screening for: Hepatitis, HIV, Syphilis, Kidney Disease, Blood pressure, Cholesterol and Bioelectrical Impedance Analysis (BIA). Referral services for drug assistance and medical care were available. 

The 15th Annual Conference of the Australasian Society for HIV Medicine (ASHM) was held on October 22-25, 2003 at the Cairns Convention Centre in Australia. For information on conferences visit the web site. 

The International Research Conference on Food, Nutrition and Cancer was held on July 17 and 18, 2003 at the Capital Hilton Hotel in Washington, DC. The conference was sponsored by the American Institute for Cancer Research and World Research Fund International. For information on conferences visit the web site. 

Email to announce your community events and meetings.

Recalls And Safety Alerts 

Reiter dairy has recalled its Topps Vitality Fat Free Chocolate Milk because it contains a significantly higher-than-labeled level of vitamin A. Consumers holding Topps Vitality Fat Free Chocolate Milk should return the product to the distributor.

The California State Health Department announced a voluntary recall of canned diced red bell peppers due  to the risk of botulism. Consumers holding Ful-Flav-R Food Diced Red Bell Peppers manufactured by Ful-Flav-R Foods of Oakland, CA should immediately return the product to the distributor or to Ful-Flav-R Food Products Company. 

The Food and Drug Administration is warning the public about misrepresentations in marketing claims related to the recently approved cancer treatment Mitozytrex (MitoExtra- mitomycin for injection). The manufacturer exaggerates the efficacy of Mitozytrex and fails to include a list of the significant risks associated with its use. For additional information visit the web site . 

A Salmonellosis outbreak in Oregon has prompted a voluntary recall of Harmony Farms brand alfalfa sprouts from retail outlets in Oregon and Southwest Washington. 

Resources Related To HIV/AIDS And/Or Nutrition 

++ The free Guide To Avoiding & Managing Side Effects offers good advice on how to deal with medication side effects such as diarrhea, nausea and vomiting. Download the PDF version. 

++ The Acupuncture And Oriental Medicine National Coalition (AOMNC) is an acupuncture and Oriental medicine professional organization that in addition to other benefits offers Acupuncture and Oriental medicine news. Visit the AOMNC web site to join the coalition. 

++ Aids Africa is a list serve with members from all over the world.

++ The new information portal on gender and HIV/AIDS offers timely information for researchers, policy makers and practitioners. 

++ People to People is an AIDS organization that offers a virtual HIV/AIDS clinic to provide free doctor consults about HIV/AIDS. 
 

Protecting The Food Supply 

As we go to war, protecting the food supply is more important than ever before. The U.S. Food and Drug Administration (FDA) now has four guidance documents designed to help manufacturers minimize the risk of tampering or other malicious, criminal or terrorist actions. FDA is responsible for the safety and security of 80% of the nation's food supply. FDA also announced increased surveillance of domestic and imported foods, and enhanced collaboration with other government agencies, as part of its LibertyShield initiatives.

Operation LibertyShield is a comprehensive national plan designed to increase protections for America's citizens and infrastructure while maintaining the free flow of goods and people across the U.S. border with minimal disruption to the economy and way of life.

Guidance documents released on Wednesday, March 19, 2003, cover each segment of food and cosmetic operations. Two of the guidances are revised, final documents, and two are proposed guidances. The proposals cover food stores and food service establishments such as bakeries, bars, cafeterias, commissaries, convenience stores, fairs, grocery stores, food service for airlines and trains, restaurants, and vending machine operators as well as cosmetic establishments. They also identify preventive measures that operators can do to minimize the security risks to their products. 

A copy of the documents listed below can be obtained electronically. 

Docket #03D-0092: draft guidance
++   Retail Food Stores and Food Service Establishments:  Food Security Preventive Measures Guidance 

++   Cosmetics Processors and Transporters:  Cosmetics Security Preventive Measures Guidance 

Docket #01D-0583: final guidance
++   Food Producers, Processors, and Transporters:  Food Security Preventive Measures Guidance 

++   Importers and Filers:  Food Security Preventive Measures Guidance 

Requests for single copies of these documents within the U.S. should be submitted to: John Kvenburg, Office of Compliance (HFS-600), Center for Food Safety and Applied Nutrition, Food and Drug Administration, 5100 Paint Branch Parkway, College Park, MD  20740. A self-addressed adhesive label should be included to help process the request. 

Additional information about provisions of the Bioterrorism Act under FDA’s jurisdiction and the agency’s implementation plans is available. Additional information on other agency bioterrorism activities can be found at the Bioterrorism Home Page noted above. 

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

New links are at:
Food And Recipe Resources
Nutrition Links And Resources

Reformatted pages include: 
HIV ReSource Review Issue 27
HIV ReSource Review Issue 24

Reviewed pages include: 
HIV ReSource Review Previews: 
Issue 20
Issue 23
Issue 25
 

Strategies For Metabolic Syndrome

A recent review of the mechanisms underlying the metabolic syndrome (Syndrome X), which raises the risk of heart attack and diabetes, confirms that hyperinsulinemia and insulin resistance play a key role in its development. (1) As noted in HIV ReSource Review Issue 27: "Syndrome X is a combination of clinical and laboratory findings including glucose intolerance, central obesity, increased triglycerides, low levels of high-density lipoprotein (HDL), increased low-density lipoprotein (LDL), hypertension, increased prothrombotic and antifibrinolytic factors and a propensity for atherosclerostic vascular disease. The disorders may appear with only one or two conditions clinically evident." (2) 

Generally, insulin resistance may be reduced using a low saturated fat diet, weight reduction, exercise and medications. (3) Avoiding excess weight gain may be the most effective means to prevent insulin resistance. Refined grains greatly increase the glycemic and insulinemic responses and eating highly refined foods will hasten the development of glucose intolerance. Substituting whole grains for refined foods can decrease the risk of diabetes. 

For additional information on metabolic syndrome visit the Center for Human Nutrition and Health and Age. 

Sources
1. Minehirab K, Tappyab L. Dietary And Lifestyle Interventions In The Management Of The Metabolic Syndrome: Present Status And Future Perspective. Eur J Clin Nutrition 2002;56(12):1264-1269.

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

3. Wittenbrook W, Tinnerello D, Meyer SA. Blood Glucose Abnormalities In HIV-positive People: Part Two. HIV ReSource Review 2001;5(4):1, 10-17, 23.

Conference Alert

Natural Remedies for Psychiatric Disorders Considering the Alternatives was held in Boston, Massachusetts on April 25-27, 2003. For additional information on conferences visit the  web site. 

The Second Annual Conference of the International Society of Behavioural Nutrition and Physical Activity was held in Québec City, Canada from July 17 to 20, 2003. For conference information visit the web site. 

The 11th International Conference for People Living with HIV/AIDS was held October 26-30, 2003 in Kampala, Uganda. For further information visit the  web site. 

The International Workshop on HIV Persistence during Therapy was held in Saint Martin, French West Indies on December 10-12, 2003. Further information. 

Subscribe or unsubscribe; visit the HIV Nutrition News Update List.

Funding Announcement 

The US Department of Health and Human Services, Public Health Service (PHS), National Institutes of Health (NIH) invites applications for infrastructure grants in support of research on mind-body interactions and health (RFA-OB-03-004). Applicant institutions may request up to five years of funding to support infrastructure and research. A central goal of this program is to facilitate interdisciplinary collaboration and innovation in mind-body and health research while providing essential and cost-effective core services in support of the development, conduct, and translation into practice of mind-body and health research based in centers or comparable administrative units. Topics of interest specific to the Institutes that have joined with OBSSR in supporting this initiative include HIV/AIDS issues. The grant application form (PHS 398) is available. For additional information visit the  web site. 

Cholesterol And Plant Sterols 

As noted in numerous issues of the HIV ReSource Review and HIV Nutrition Update, elevated levels of cholesterol are becoming increasingly commonplace with the use of highly active antiretroviral therapy. We first mentioned the use of plant sterols to reduce cholesterol levels in the March/April 1997 HIV ReSource Review issue. Additional information in Issue 23 of the HIV ReSource Review issue noted that a spread of free soyabean-oil sterols is effective in lowering both total and low-density lipoprotein cholesterol levels. Since that issue, other studies (some of which are included here) have been conducted on the usefulness of plant sterols to lower cholesterol. (1-4) Sudhop and others note however, that plant sterols may be a risk factor for coronary heart disease. (5) For more information on types of margarine-like spreads containing stanol esters visit Benecol® and Take Control™. To review articles on plant sterols and cholesterol published since the March/April 2000 issue, visit PubMed and use the search terms, "plant sterols AND cholesterol AND diet AND margarine". Also, refer to the weekly HIV Nutrition News Update dated May 3, 2002 for more on plant sterols and cholesterol. Unfortunately, none of the studies addressed the HIV population. 

References
1. Cleghorn CL, Skeaffa CM, Mann J, Chisholm A. Plant sterol-enriched spread enhances the cholesterol- lowering potential of a fat-reduced diet. Eur J Clin Nutr 2003;57(1):170-176.

2. Ntanios FY, Homma Y, Ushiro U. A Spread Enriched with Plant Sterol-Esters Lowers Blood Cholesterol and Lipoproteins without Affecting Vitamins A and E in Normal and Hypercholesterolemic Japanese Men and Women. J Nutr 2002;132 3650-3655.

3. Jenkins DJA, Kendall CWC, Faulkner D, et al. A dietary portfolio approach to cholesterol reduction: Combined effects of plant sterols, vegetable proteins, and viscous fibers in hypercholesterolemia. Metabolism Clinical and Experimental 2002;51(12):1596-1604. 

4. Cicero AF, Fiorito A, Panourgia MP, et al. Effects of a new soy/beta- sitosterol supplement on plasma lipids in moderately hypercholesterolemic subjects. J Am Diet Assoc 2002;102 (12):1807-11. 

5. Sudhop T, Gottwald BM, von Bergmann K. Preliminary Report: Serum plant sterols as a potential risk factor for coronary heart disease. Metabolism 2002;51(12): 1519-1521. 

Complications of HAART 

Investigators interested in adverse drug side effects experienced by people with HIV/AIDS continue to study the many complications that arise from using highly active antiretroviral therapy (HAART). Recent studies have shown that body changes associated with lipodystrophy may present numerous issues such as decreased self-esteem, depression and anxiety. (1) Impaired quality of life appears to be more likely in homosexual patients and patients taking medications such as methadone, tranquilizers or antidepressants. 

A cross-sectional study of 614 patients revealed numerous HAART-related issues (isolated peripheral atrophy 21%, isolated fat accumulation 17%, mixed syndrome 24%, glucose metabolism alterations 23%, hypertriglyceridemia 28% and hypercholesterolemia 57%). (2) Age was significantly associated with different phenotypes of lipodystrophy and metabolic alterations. The French investigators noted that exposure to stavudine was associated with lipoatrophy while exposure to ritonavir was associated with hypertriglyceridemia. Researchers stress the importance of detection and management of these conditions to prevent additional complications. 

A recent retrospective study of the risk of heart disease among patients with HIV on HAART for up to four years did not reveal a correlation between the use of nucleoside analogues, protease inhibitors, or nonnucleoside reverse- transcriptase inhibitors and the hazard of heart disease. (3) The long-term risks of HIV drugs, however, are unknown and patients may have to be followed for several years before we learn the full extent of their use. Subscribers to the HIV Nutrition Update may to Issue 40 to read information on highly active antiretroviral therapy (HAART) and heart disease in the Update Central column. 

A recent Press Release From Roche notes that pharmaceutical companies will continue their research into metabolic and cardiac complications associated with antiretroviral medications for at least another year. Information on Fuzeon
complimenting that given in our current issue is available in a Roche Press Release. 

To deal more effectively with metabolic alterations due to HAART, HIV ReSource Review subscribers may review previous newsletter issues 15 and 16 on lipodystrophy, 22 and 23 on food choices for people on HAART, and 27 and 28 on diabetes. 

Sources

1. Blanch J, Rousaud A, Martínez E, et al. Impact of Lipodystrophy on the Quality of Life of HIV-1-Infected Patients. J Acquired Immune Deficiency
Syndromes 2002;31: 404-407. 

2. Savès M, Raffi F, Capeau J, et al. Factors Related to Lipodystrophy and Metabolic Alterations in Patients with Human Immunodeficiency Virus Infection Receiving Highly Active Antiretroviral Therapy. Clinical Infectious Diseases 2002;34:1396-1405. 

3. Bozzette SA, Ake CF, Tam HK, et al. Cardiovascular and Cerebrovascular Events in Patients Treated for Human Immunodeficiency Virus Infection. N Eng J Med 2003; 348(8): 702-710.

Food And Drug Administration (FDA) Supplement Seizure 

U.S. Marshals seized dietary supplement products from Global Source Management and Consulting, Inc., in Sunrise, Florida after FDA determined that these unapproved products claimed to treat a variety of medical conditions. The products were being sold to consumers under the names Vitamin Hut and RX for Health through retail booths and by mail order. For additional information visit the FDA web site. FDA has now established a review team for botanicals to help them review applications to market and test such products. 
 

Food Fight 2003

The Association of Nutrition Services Agencies (formerly AIDS Nutrition Services Alliance - ANSA) held their yearly conference in Vancouver, British Columbia, Canada. FoodFight 2003 - ANSA's 10th Annual Nutrition Services and Meal Provider's Conference was held on September 4-7 on the weekend after Labor Day. The conference provided a wonderful opportunity for clients, caregivers, health care professionals, and others to learn, network, and enjoy themselves. Visit the  ANSA web site for information on future conferences. 
 

HIV and The Corrections System Resources

The number of diagnosed AIDS cases in the U.S. has increased for the first time since 1993. U.S. incarceration rates have tripled over the past two decades and increased even more rapidly among women than men. Researchers recently associated continuity of medical care by a single healthcare provider with decreased likelihood of incarceration in HIV-positive and high-risk HIV- negative women. (1) A number of resources are available to help the general public learn more about the corrections system and HIV-positive inmates. The Centers for Disease Control and Prevention (CDC) has "HIV/AIDS Surveillance in Women - through 2001" a slide set that reviews the AIDS incidence in women and adolescent girls. The slide set is at the CDC, Divisions of HIV/AIDS Prevention web site. View the Federal Bureau of Prisons Clinical Practice Guidelines: Management of HIV Infection dated February 2002. Also, refer to Issue 40 of the HIV Nutrition Update to read an original research article of foodservice in corrections by Barbara Wakeen, MA, RD, LD. 

Reference

1. Sheu M, Hogan J, Allsworth J, Stein M, et al. Continuity of Medical Care and Risk of Incarceration in HIV-Positive and High-Risk HIV-Negative Women. J Women's Health 2002;11(8):743-750. 
 

Traditional Chinese Medicine 

As noted in HIV Nutrition Update Issue 40, "Anyone considering the use of Chinese herbal medicine should consult with a qualified Chinese herbalist." Among other benefits, this action serves to lessen the chance of receiving adulterated herbs or experiencing ill effects. 

New Zealand recently banned 11 traditional Chinese medicines after an investigation revealed that they contained prescription medicines or toxic substances. Three traditional Chinese medicines containing aristolochia (Guan Xin Su He capsules, Long Dan Xie Gan Wan pills, and Zhiyuan Xinqinkeli sachets), which can cause severe kidney damage and urinary tract cancer, were banned along with several other traditional Chinese medicine products. The products containing prescription medicines were: 
1. Wei Ge Wang tablets containing the prescription medicine sildenafil (Viagra) 
2. Sang Ju Gan Mao Pian tablets containing Diclofenac (a non steroidal anti-inflammatory) and Chlorpheniramine (an antihistamine) 
3. Yen Qiao Jie Du Pian capsules containing Chlorpheniramine, Diclofenac and Paracetamol (a pain reliever) 
4. Niu Huang Jie Du Pian tablets containing arsenic 
5. Xiaoke Wan pills containing Glibenclamide (an antihyperglycaemic) 
6. Shuen Feng cream containing Ketoconazole (an antifungal ) and Clobetasol Propionate (a cortcosteroid) 
7. Zentel Albendazole SK&F tablets containing Albendazole 
8. Dezhong Rhinitis drops containing ephedrine hydrochloride 

In Issue 32 of the HIV Nutrition Update Richard A. Freiberg, D.O.M., D.Ac., A.P., Board Certified Diplomate notes that herbal preparations may be pre-prepared in Chinese Materia Medica to inhibit toxicity. Even with these additional preparation methods however, herbs need to be administered by a well-trained practitioner to avoid any serious complications or adulteration. 

When seeking the services of a practitioner check their credentials to see if they are a graduate of an accredited school and/or if they are qualified as being well trained in all aspects of Chinese medicine. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) National Board certification or Diplomat at this time is primarily a soft measurement of higher level of training. Consumers should see practitioners that apply principles such as 'least invasive' and 'first doing no harm' while at the same time 'getting objective results'. Also, the therapy should make sense and questions should be answered in understandable layman’s terms. 

Conference Update 

* The Hepatitis C Professional Certification Course sponsored by Chicken Soup Chinese Medicine and Quan Yin Healing Arts Center is continuing education training for Licensed Acupuncturists. It took place on May 9-11, 2003 in San Francisco, California. The Hepatitis C Help Book was used as the course text.

* The 6th Commonwealth Congress on Diarrhoea and Malnutrition was held on  May 19-21, 2003 in the Drakensberg Mountains, South Africa.  Visit the web site  for additional conference information. 

* The 4th National Conference on HIV/AIDS and Aging: Bridging the Age Gap: Prevention, Care and Management of HIV Over Fifty was held on September 5-6, 2003 in Scottsdale, Arizona. The conference was sponsored by the National Association on HIV Over Fifty (NAHOF). For information on additional conferences visit the web site. 

* The United States Conference on AIDS (USCA) 2003 was held in New Orleans, Louisiana on September 18-21, 2003. The conference was sponsored by the National Minority AIDS Council (NMAC), which offers a limited number of scholarships. For more information on conferences and scholarship opportunities visit the web site. 
 

Body Composition 

As most clinicians know, body composition changes vary among people with HIV/AIDS. Fat redistribution syndrome that includes subcutaneous lipoatrophy, abdominal obesity and metabolic disorders continues to occur in those patients on highly-active antiretroviral therapy (HAART). Wasting also continues to occur despite antiretroviral treatment. Factors contributing to wasting syndrome include low food intake, poor nutrient absorption, increased resting energy expenditure and increased protein turnover. 

We know that body composition changes during HIV infection are different from those seen in starvation. In a cross-sectional study of 1,669 pregnant women, HIV-positive women (31.5%) with higher viral loads had lower weights compared with uninfected women. (1) Elevated serum 1-antichymotrypsin (an acute phase protein), a strong independent predictor of anthropometric variables, was associated with lower average body weight. Arm fat and muscle areas, reflecting body fat and fat-free mass, declined with increasing viral loads. 

Study results of patients with HIV-associated weight loss disclosed that in men with less than 32% body fat the loss of fat-free mass is dependent on the initial percentage of body fat. (2) The loss of fat-free mass in men with high body fat stores and in women with normal-to-high body fat was independent of the initial percentage of body fat.

Investigators have also looked at patterns of change in both fat-free mass and fat mass in presumed HIV-negative older adults (53 men - 78 women). (3) They measured body composition and the level of physical activity on two occasions separated by several years. Fat mass increased similarly in both sexes while fat-free mass decreased only in the men. Physical activity decreased more in men over the follow-up period. In women, baseline age and level of physical activity were inversely and independently associated with changes in fat mass. While fat-free mass accounted for 19% of body weight in participants who gained weight, weight-stable participants lost fat-free mass. Participants who lost weight had a loss of fat-free mass despite physical activity levels. 

A recent study of 486 HIV-positive persons enrolled in the Nutrition for Healthy Living program found that changes in lean body mass and total body weight were significantly related to changes in physical functioning in men but not women. (4) Investigators suggest that following total body weight without measuring body composition (fat mass and fat-free mass) is enough to understand the impact of changes in weight on physical functioning.

Bioelectrical impedance analysis (BIA) can be useful for detecting body composition changes in lipodystrophy patients when used along with anthropometry. (5) For more information on BIA, refer to the HIV Nutrition Update Nutrition Forum column in Issue 33. The BIA handout in Issue 34 is useful for patients.

References

1. Friis H, Gomo E, Nyazema N, Ndhlovu P, et al. HIV-1 Viral Load and Elevated Serum 1-Antichymotrypsin Are Independent Predictors of Body Composition in Pregnant Zimbabwean Women.

2. Forrester JE, Spiegelman D, Tchetgen E, Knox TA, Gorbach SL. Weight loss and body-composition changes in men and women infected with HIV. Am J Clin Nutr 2002 Dec;76(6):1428-34. 

3. Hughes VA, Frontera WR, Roubenoff R, Evans WJ, Fiatarone Singh MA. Longitudinal changes in body composition in older men and women: role of body weight change and physical activity. Am J Clin Nutr 2002;76(2):473-81. 

4. Wilson IB, Jacobson DL, Roubenoff R, Spiegelman D, et al. Changes in lean body mass and total body weight are weakly associated with physical functioning in patients with HIV infection. HIV Med 2002;3(4):263-70. 

5. Wanke C, Polsky B, Kotler D. Guidelines for using body composition measurement in patients with human immunodeficiency virus infection. AIDS Patient Care STDS 2002;16(8):375-88. 
 

Herbal Medicines 

The use of Chinese herbal medicine is increasing. Yet, herbal medicines are largely unregulated, associated with liver inflammation and may contain adulterants. (1) Both Jin bu huan and Dictamnus dasycarpus have been linked to cases of hepatitis. (2) And knowledge of fraudulent products such as the so-called herbal miracle cure for HIV/AIDS called Stree Tra Dokkoon make it more difficult for licensed Traditional Chinese Medicine practitioners to dispense their medicinal formulas. Anyone considering the use of Chinese herbal medicine should consult with a qualified licensed Chinese herbalist. 

As more consumers purchase dietary supplements or seek the services of complementary practitioners, reports of herb-drug and other dietary supplement interactions will increase. Concerns about quality control, contamination, safety and efficacy will continue to increase as well. Although Chinese medicinal herbal formulations are often not subjected to pre-market toxicity testing, new strategies formulated for the assessment of efficacy, effectiveness and toxicity can optimize the therapeutic and preventive potential of Chinese herbal medicine. (3) In the meantime, learning about Chinese medicinal herbal formulations will be helpful for both consumers and clinicians. 

References

1. Spaulding-Albright N, Meyer SA. Botanical use among people living with HIV or AIDS. HIV ReSource Review 1999;4(3):1, 2,3,11-13, 22.

2. McRaea CA, Agarwala K, Mutimerb D, Bassendinea MF. Hepatitis associated with Chinese herbs. Eur J Gastroenterol Hepatol 2002;14(5):559-562. 

3. Wang Z, Ren J. Current status and future direction of Chinese herbal medicine. Trends in Pharmacological Sciences 2002;23(8):347-348. 
 

HIV Nutrition Update - Newszine Issue 40

The Jan/Feb 2003 HIV Nutrition Update Newszine issue is available. View the issue. 

Issue 40 includes an original research article of foodservice in corrections by Barbara Wakeen, MA, RD, LD. The issue also includes an article on herbs used in Traditional Chinese Medicine by Richard A. Freiberg, D.O.M., D.Ac., A.P., Board Certified Diplomate.

Additional columns include:
* Program Spotlight column on the Oak Tree Clinic, Children’s and Women’s Health Centre of British Columbia (BC); 
* Update Central column with information on highly active antiretroviral therapy (HAART) and heart disease; 
* Nutrition Forum column on ecstasy (MDMA), LSD and the gastrointestinal tract; 
* Resource Corner with leads to Internet, client and clinician resources; 
* Book Review column; 
* Med Watch column on Fuzeon (T-20); 
* Medications And Nutrient Interactions Handout. 

HIV ReSources Web Site Updated 

New pages: 
Issue 40 HIV Nutrition Update

New links: 
Conference Information 
Complementary Treatment Information
Professional Resources
About HIV ReSources

Updated pages: 
Nutrition Reproducibles

Reformatted pages: 
Interview With Jules Levin

HIV Nutrition Discussion List 

The HIV Nutrition Discussion 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 or subscribe
 

Tequin (gatifloxacin) Labeling Changes 

Drug labeling changes for Tequin that note disturbances in blood glucose including symptomatic hyper- and hypoglycemia are noted at the Food and Drug Administration web site.

As noted in the MedWatch column on page 16 in Issue 37 of the HIV Nutrition Update, "Disturbances of blood sugar, including symptoms of hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) have been reported in diabetic patients treated with Tequin and oral anti-diabetic drugs, with or without insulin. Other people at particular risk for serious hyperglycemia include those who may have unrecognized diabetes, decreased renal function, underlying medical problems, or people more than 75 years of age." 

HIV/AIDS And Nutrition Related Resources 

AIDSinfo E-News
The Nutrition Source: Knowledge for Healthy Eating
Food & Nutrition Research Briefs
Being Alive

Understanding Medicare

The Kaiser Family Foundation offers The Medicare Chart Book, which provides information critical to understanding the Medicare program, online.
 

New Health Fraud Web Site

The Food and Drug Administration, the Federal Trade Commission, and other law enforcement agencies joined forces in "Operation Cure.All" to stop Internet scams for supplements and other products that purport to cure cancer, HIV/AIDS and other life-threatening diseases. The Operation Cure.All web site offers information for consumers on how to recognize health fraud and guidance for businesses on how to market health products and services truthfully.
 

Metformin And Vitamin B12 Deficiency

Numerous people living with HIV/AIDS have vitamin B12 deficiency. Some take metformin as a part of their daily medication regimen to decrease blood glucose levels. A number of adverse effects are associated with the use of metformin. As noted in Issue 27 of the HIV ReSource Review, food decreases the absorption of metformin but individuals should take it with meals to decrease gastrointestinal distress. 

Another potential nutritional side effect now associated with the use of metformin is vitamin B12 deficiency. (1) Other causes for vitamin B12 deficiency besides the use of metformin are malabsorption due to enteropathy, malabsorption due to decreased secretion of stomach acid (hypochlorhydria) and intrinsic factor, and malnutrition due to appetite suppression during cachexia. 

To date, only case reports and small studies describe metformin associated vitamin B12 deficiency. (2) Type 2 diabetics receiving metformin at a daily dose of between 1400-2550 milligrams for 3-10 years in one study had metformin-associated vitamin B12 deficiency. It's notable that the time to develop the deficiency was less than 9 years. All patients had normal serum folate and creatinine levels and some had normal findings on Schilling test results. Investigators report metformin-induced low serum vitamin B12 levels are associated with an increase in homocysteine levels (see the January 25, 2002 HIV Nutrition Update News).

Sources

1. Gilligan MA. Metformin and vitamin B12 deficiency. Arch Intern Med 2002;162(19):484-485.

2. Metformin-Associated Vitamin B12 Deficiency. Arch Intern Med 2002;162(19):2251-2252.

HIV/AIDS Educational Campaign

KNOW HIV/AIDS is a joint endeavor between Viacom and the Henry J. Kaiser Family Foundation. The campaign includes television and radio advertisements, television and radio programming, free print publications, outdoor ads and online materials. Visit the web site or telephone the KNOW HIV/AIDS toll-free number 866/344-5669 for a free educational guide and additional information on HIV/AIDS.
 

Upcoming Conferences

* Diabetes Evolution 2003, a skills upgrade for healthcare practitioners was held at various locations within the United States. Chronic Disease Management was also held in various U.S, locations. Both seminars were sponsored by Academy Medical Systems, Inc. For further information visit the web site using the above link.

* The Center for Mind-Body Medicine, University of Minnesota and Georgetown University School of Medicine sponsored Food As Medicine for healthcare professionals. The course was be held on March 2-8, 2003 at the Marriott Bay Point Resort in Panama City, FL. Visit the web site for more conference opportunities.

* John Hopkins Medical Institutions 13th Annual Clinical Care of the Patient with HIV Infection was held on April 3-4, 2003 at the Stouffer Renaissance Harborplace Hotel in Baltimore, MD. For additional conference information visit the web site.

* HIV Management 2003: The New York Course was be held at the Roosevelt Hotel in New York City on May 2-3, 2003. For additional information on future conferences visit the web site.

HIV/AIDS Resources

* HIV i-base Treatment Bulletins
* National Nutrition Summit Web Site
* AEGIS On-line Forums
* MEDLINEplus web site
 

Spotlight On HIV/AIDS

Kaisernetwork.org now offers a new feature providing a gateway into HIV/AIDS policy developments, which features a wide variety of resources including web casts, interviews, facts about the epidemic and links to resources and organizations around the world. The page is available online.

Clinical Trials

The Canadian HIV Trials Network (CTN) in Vancouver, BC has information on HIV clinical trials.

** D4T or Abacavir plus Vitamin Enhancement (DAVE): The primary objective of this study is to determine the best way to treat people on d4T with high levels of lactic acid. For a full description of this trial visit the web site above.

** L-Acetylcarnitine as Treatment of Antiretrovrial-induced Peripheral Neuropathy - Compared to other trials, this trial is enrolling at only one location in Canada.

** CTN 175: Nevirapine to Lower Cholesterol (SCHMALTZ Study) The primary objective of this international study is to see if nevirapine helps to normalize the cholesterol levels in patients who have abnormal cholesterol levels due to the protease inhibitors (PI) they are taking. Further information

Nutrition Resources

* IBIDS Dietary Supplements Database
* Updated editions of the NIH ODS-clinical Center Vitamin and Mineral Fact Sheets