Can anyone tell me why I should not use the Atkins diet to lose weight? Your help appreciated. Thanks. 
Ann Deer 

Subject: Atkins
Date: Wed, 27 Aug 2003 17:21:55 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

This just mentioned today: 
Atkins dieters warned of bowel cancer risk 
Source: Daily Mail 
Date: 26/08/2003 
Report: The Digestive State of the Nation, which highlights the increase in the problem of constipation among Britons as highlighted by the huge leap in the sales of laxatives such as Senokot and Fybogel. 
Constipation is a key factor in causing bowel cancer and leading bowel expert Roger Leicester claims that the Atkins diet is leading to increased constipation problems. 

Also, there is information on this diet from many organizations such as the American Heart Association, the American Institute for Cancer Research, the Wheat Council, and the USDA. Use the search function to find the information that you want.
 

Forwarding this from the Nutrition News Focus

January 22, 2001
NUTRITION NEWS FOCUS
"Nutrition news is important.  We help you understand it!"

Today's Topic: Coffee - The Drink We Love To Hate

Several scientific studies have been published recently that studied a possible link of coffee or caffeine intake with adverse health effects.  The December 21, 2000 issue of the New England Journal of Medicine carried an article that concluded that coffee providing more than 500 mg of caffeine daily (5 cups of American coffee; fewer cups in countries that drink stronger coffee) doubles the risk of
spontaneous abortion during the first trimester or pregnancy.

This study asked 562 women in Sweden who had spontaneous abortions and 953 pregnant women who did not abort about several habits. Pre-pregnancy caffeine consumption was almost the same in both groups at around 340 mg, which is high compared with caffeine consumption in most countries.  The effect of high coffee consumption on abortion was only observed in nonsmokers.  In other words, smoking independently increased the risk of abortion.  Coffee intake was lower in women who experienced nausea more frequently and early in their pregnancies.

HERE'S WHAT YOU NEED TO KNOW: Despite the fact that this study was done in Sweden, the news stories described the number of American cups that were needed to find a detrimental effect.  This refers only to the size of the cup but was never explained.  The authors conclude that there are a number of limitations of this study, and there have been mixed results from many previous studies, so their results should be interpreted cautiously.  Not what the media are good at.

Tomorrow: Is Caffeine Bad For Bones?
********************************************************************
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DISCLAIMER: The information in Nutrition News Focus is intended only to help you understand the Nutrition News.  We do not recommend any treatment, food or supplement.  It is not intended to replace the advice of a physician.  If you read something in this newsletter that in any way contradicts what your physician tells you, TAKE YOUR PHYSICIAN'S ADVICE, NOT OURS.

Copyright 2001 Nutrition News Focus Inc. To subscribe to this list visit the web site. 
 

Forwarding this from the Nutrition News Focus

January 23, 2001
NUTRITION NEWS FOCUS
"Nutrition news is important.  We help you understand it!"

Today's Topic: Is Caffeine Bad For Bones?

Some, but not all, studies have found caffeine increases excretion of calcium in the urine.  Most previous experiments have studied bones of postmenopausal women.  A new study looked at 177 young adult women at a university in the U.S. and found average caffeine intake of 100 mg a day.

Since many factors are known to influence bone density, these were adjusted for statistically.  After adjusting for height, body-mass index, age at menarche, calcium intake, protein consumption, alcohol
intake, and tobacco use, caffeine did not predict bone mineral density of the hip or spine.  No source of caffeine (coffee, tea, cola) was associated with lower bone density.  The article appeared in the November 2000 issue of Preventive Medicine.

HERE'S WHAT YOU NEED TO KNOW: There seemed to be a decrease of density of the spine with high caffeine intake only when combined with low calcium intake.  However, there was no effect on
the hip. Some studies have found a detrimental effect of high caffeine intake on bone density in older women, but the majority of studies have not.  Remember that this type of study is limited in its
ability to show cause and effect.

Tomorrow: Coffee, Caffeine, and Coronaries

********************************************************************
Subscriber report: 29,328 readers in 103 countries.
DISCLAIMER: The information in Nutrition News Focus is intended only to help you understand the Nutrition News.  We do not recommend any treatment, food or supplement.  It is not intended to replace the advice of a physician.  If you read something in this newsletter that in any way contradicts what your physician tells you, TAKE YOUR PHYSICIAN'S ADVICE, NOT OURS.

Copyright 2001 Nutrition News Focus Inc. To subscribe to this list visit the web site. 

I just got rid of the Sircam virus yesterday. Microsoft's products are the usual target. I don't think it sends out messages if you use Netscape but then again you never know. More  information and a fix for those with Norton Antivirus. Based on my experience, it is easier to download the fix and use it to get rid of the virus instead of running the antivirus software before you get the file. Also, if you must send a file to someone sending it in Rich Text Format (rft), which is an option for both PC and MAC users, is safer. For those of you with Norton, update your antivirus software at least every week. 

After I opened a file attachment, I got suspicious because the file did not look right. I ran my Norton Antivirus software. It found the file and put it in quarantine then asked me what to do with it. I deleted it then ran the virus check again and found two files in quarantine and two in my recycle bins. After that, every time I tried to open a program to download the update or delete the file the virus infected it and stopped my computer from working. I had to resort to using another computer to download the manual instructions on how to delete the virus in DOS. After I deleted it all nearly 5 hours later I was then able to download the software fix from my usual computer. 

I certainly do not recommend that anyone attempt to run their virus checker if it is not updated at least weekly. I usually do update mine once a week. Last week, I forgot :-( 

Fortunately, since I use Netscape, not the Microsoft programs that most of these viruses target, no one on my massive list got the virus. 

Here is some information on the "my life" virus. Information found Symantec for more information.

MyLife Worm - Virus Description
First discovered by MessageLabs in the early hours of March 7, 2002, the MyLife worm arrives in an email that reads as follows:
                       Subject: my life ohhhhhhhhhhhhh
                       Hiiiii
                       How are youuuuuuuu?
                       look to the digital picture it's my love
                       vvvery verrrry ffffunny :-)
                       my life = my car
                       my car = my house

The email carries an attachment named My Life.scr. When opened, the worm copies
itself to the Windows system directory and modifies the registry to load on startup. MyLife worm them mails itself to all addresses found in the Outlook address book. The worm also displays the picture shown at left.

MyLife includes a destructive payload. According to F-Secure, MyLife deletes files with .com and .sys
 extensions from the root of the local C:\drive, files with .com, .exe, .ini, and .sys extensions from the Windows folder, and files with .dll, .exe, .sys, and .vxd from the Windows System folder.

Visit Symantec  to learn how to remove the worm. Few incidents of MyLife have been reported and
the worm is considered a low risk. If the MyLife email is received, it should simply be deleted from
the system. The worm cannot infect unless the receiver deliberately opens the attachment.

A recently discoved virus is circulating on the Internet now, the W32.Bugbear@mm worm:

W32.Bugbear@mm is a mass-mailing worm. It can also spread through network shares. It has
keystroke-logging and backdoor capabilities. The worm also attempts to terminate the processes of various antivirus and firewall programs. Symantec Security Response has posted a tool to remove
infections caused by W32.Bugbear@mm.

My Norton antivirus deleted two copies of the W32.YahaF@mm, which were in my email AFTER I had scanned all of the email and deleted files on the server that I thought iffy! Learn about this virus at the Symantec web site. 

Virus filled spam is so prominent now. They send it with catchy headers and even use your own address to get you to open it. Even though I have the most up-to-date anti-virus software, I still delete most of my email through the server before downloading it to my computer. Usually, you can spot a virus from the large size of the unexpected file or it's unusual name or sender name. And then there are the ones that you click on and it takes you to another web site. For those I usually, click on stop or my browsers back button to stop the forwarding.

Other Tips to avoid virus infection include:
1. Always scan your email as you download it.
2. Don't use Microsoft as your email program.
3. Check daily for updates to your antivirus software.
4. Try to view your email on the server and delete suspicious email before you download it.
5. Check your saved "sent" file to see if there are any messages you did not send in it.

The following abstract adds to information in the July/Aug 1998 HIV ReSource Review articles on creatine. The full article for this abstract is at the Kager Publishers web site.

Original Paper: Creatine Supplementation Affects Glucose Homeostasis but Not Insulin
                 Secretion in Humans.
                 Kieron B. Rooney, Janet M. Bryson, Alison L. Digney, Caroline D. Rae, Campbell
                 H. Thompson. Human Nutrition Unit, School of Molecular and Microbial Biosciences,
                 University of Sydney, Australia. Annals of Nutrition & Metabolism 2003;47:11-15.

 Abstract
                 Aims: In this study, it was investigated whether the glucose homeostasis is affected
                 by dietary creatine supplementation. For this purpose, the plasma glucose
                 concentration and the plasma insulin response to an oral glucose load were
                 measured in creatine-supplemented vegetarians. Methods: The subjects were
                 supplemented with either 5 g of creatine monohydrate (creatine-treated group,
                 CREAT) or 5 g of maltodextrin (control group, CON) per day for 42 days. On
                 days 0 and 43, blood samples were collected before as well as 10, 20, and 30 min
                 following an oral glucose load and analyzed for plasma creatine, insulin, and
                 glucose levels. Results: Creatine supplementation resulted in an increase in plasma
                 creatine (CREAT 92.7 ± 14.6 µM vs. CON 31.2 ± 3.2 µM; p = 0.001). There
                 was a trend (p = 0.07) towards elevated fasting plasma glucose levels following
                 creatine supplementation, while the plasma glucose response to the glucose load
                 was enhanced (CREAT 168.2 ± 5.3 mM· min vs. CON 129.6 ± 14.7 mM ·min; p
                 = 0.05). There was no difference observed in the plasma insulin response to the
                 glucose load between the groups. Conclusion: This study shows that creatine
                 supplementation may result in abnormalities in glucose homeostasis in the absence
                 of changes in insulin secretion.

                 Copyright © 2003 S. Karger AG, Basel

13 November 2003
Edwin J. Bernard

Cheap multivitamin pill increases survival in those with low CD4 counts

A multivitamin and mineral supplement with a local cost of about 60p a month has been found to enhance survival of HIV-positive people with less than 200 CD4 cells unable to access HAART, according to a Thai study published in the latest issue of the journal, AIDS. 

The Thai study is the first ever double-blind placebo-controlled randomised trial to assess the clinical significance of vitamins and minerals in people with HIV, and offers some small comfort to those people living in countries where access to HAART is limited or non-existent. 

The study was undertaken by a multinational team spearheaded by the Department of Infectious and Tropical Diseases at the London School of Hygiene and Tropical Medicine in co-operation with the Thai Ministry of Public Health. 

Just under 500 people with CD4 counts between 50 and 550 cells/mm3 were enrolled in the trial at Siriraj Hospital, Bangkok between March 2000 and January 2001. 242 were randomly assigned to the supplement arm and 239 to the placebo arm. Neither doctor nor patient knew which pills they were
receiving, since both supplements and placebo were prepared to look exactly the same. The pills were taken twice a day after food. 

The total daily vitamin/mineral doses contained within the pills were: 

     Vitamin A 3000 µg
     Beta-carotene 6 mg
     Vitamin D3 20 µg
     Vitamin E 80 mg
     Vitamin K 180 µg
     Vitamin C 400 mg
     Vitamin B1 24 mg
     Vitamin B2 15 mg
     Vitamin B6 40 mg
     Vitamin B12 30 µg
     Folacin 100 µg
     Pantothenic acid 40 mg
     Iron 10 mg
     Magnesium 200 mg
     Manganese 8 mg
     Zinc 30 mg
     Iodine 300 µg
     Copper 3 mg
     Selenium 400 µg
     Chromium 150 µg
     Cystine 66 mg

CD4 counts were taken at baseline from all participants, and the first consecutive 140 (71 in active and 69 in placebo arm) participants also had measurements of plasma viral load and vitamin E and selenium levels. 

At the end of 48 weeks, 23 (5%) had died and 379 (79%) were known to have survived. The rest were lost to follow-up. Eight deaths occurred in the supplement and 15 in the placebo arm. The mortality rate was significantly lower in the supplement arm in those who began the study with CD4 counts below 200 cells/mm3. For those with CD4 counts between 101-200 cells/mm3 the mortality hazard ratio was 0.37; 95% CI 0.13-1.06; p=0.052, and for those with CD4 counts below 100 cells/mm3 the mortality hazard ratio was 0.26; 95% CI 0.07-0.97; p=0.03. 

No impact was seen, however, on hospital admissions, CD4 cell count or plasma viral load, which, say the study's authors "highlights the need to measure impact against clinical endpoints rather than on surrogate markers, as the beneficial effects would have been missed if only surrogate markers had been measured." 

Whether the same supplements would make a difference to survival in countries where macronutrient malnutrition is endemic - in particular, sub-Saharan Africa - is difficult to ascertain given that all previous studies on micronutrient supplementation have taken place in well-fed populations. 

This week an editorial by Professor JP van Niekerk in the South African Medical Journal criticises a diet rich in many of the micronutrients studied in Thailand that is being touted by South Africa's Health Minister, Manto Tshabalala-Msimang Manto, as a way to improve HIV survival. "We should eat garlic because of its antibacterial and anti-fungal properties, lemon because of Vitamin C and olive oil as a source of Vitamin A and E," she told an audience in Gauteng in August this year. "All these vitamins are good antioxidants and they are good for everybody." 

But Tshabalala-Msimang's is being criticised less for her lemon, garlic and olive oil diet - although these ingredients have not been proven to impact HIV disease progression - more because they were suggested as an alternative to the S.A. government providing antiretrovirals to their people many of whom cannot always afford basics like bread and clean water. "When the poor purchase the product, its price limits the purchase of other wholesome foods, which in turn is likely to adversely affect (the poor's) nutritional status," writes Professor van Niekerk. 

Nevertheless the authors of the Thai study strongly suggest that a trial of multivitamin-mineral supplements begin urgently in Africa "because if micronutrient supplementation can provide a small amount of benefit and defer the initiation of highly active antiretroviral therapy, this could have high public health importance in Africa." 

Further information on: Nutrition - booklet in the award winning information for HIV-positive people series (pdf); Vitamins and minerals - overview; High doses of vitamin C lower indinavir levels - news story at the web site noted above.

Reference 

Jiamton, et al. A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok. AIDS 2003;17:2461-2469.

Interesting paper on dietary supplements at the Lancet web site. The article is Mary E Palmer, Christine Haller, Patrick E McKinney, Wendy Klein-Schwartz, Anne Tschirgi, Susan C Smolinske, Alan Woolf, Bruce M Sprague, Richard Ko, Gary Everson, Lewis S Nelson, Teresa Dodd-Butera, W Dana Bartlett, Brian R Landzberg. Adverse events associated with dietary supplements: an observational study. Lancet Online  361, 9352     11 January 2003

The Summary: Background Adverse events associated with dietary supplements are difficult to monitor in the USA, because such products are not registered before sale, and there is little information about their content and safety.

Methods In 1998, 11 poison control centres in the USA recorded details of 2332 telephone calls about 1466 ingestions of dietary supplements, in 784 of which patients had symptoms. We used a multitiered review process (kappa 0·42) to select 489 cases for whom we were at least 50% certain that their negative events were associated with dietary supplements. We aimed to assess the effects of multiple ingredients and long-term use, and collated data for patterns of use and information resources.

Findings A third of events were of greater than mild severity. We noted both new and previously reported associations that included myocardial infarction, liver failure, bleeding, seizures, and death. Increased symptom severity was associated with use of several ingredients, long-term use, and age. Paediatric exposures were more often unintentional than were adult ingestions, and treatment of disease was the reason for supplement use in at least 28% of reports. Most products and ingredients were not identified in the information database (Poisindex) used by poison control centres, and specific adverse events were reported variably among five additional sources.

Interpretation Dietary supplements are associated with adverse events that include all levels of severity, organ systems, and age groups. Associations between adverse events and ingredients are difficult to verify if a product has more than one ingredient, and because of incomplete information systems. Research into hazards and risks of dietary supplements should be a priority.
Lancet 2003; 361: 101-06

Here's some more info:
'Safety research should become a priority in investigations of dietary supplements to clarify hazards and possible risks for this recently defined class of foods'. Adverse events associated with dietary supplements are difficult to monitor in the USA, because products are not registered before sale
and information about their content and safety is not comprehensive. In an observational study, Mary Palmer and colleagues recorded information from calls to US poison control centres about ingestions of dietary supplements. They noted that a third of adverse events were hazardous, and that fewer   than half of products and ingredients identified were in the information database used at poison control centres. The authors summise that the number and severity of adverse events recorded in the study warrant mandatory reporting of adverse events and a more comprehensive register of dietary supplements.
 

HI.  I have been searching for a dietician in the Fort Myers area who has a lot of experience and knowledge regarding HIV.  Most of the people I have contacted were very nice and helpful but did not seem really confident with their experience with HIV.  They suggested I check in a bigger city where there is a larger HIV population. 

I have a friend in the Pembroke Pines area so I go over there from time to time.  It only takes about 2 hours.  I decided to check with a couple of dieticians and see if they thought they could help me and if they were accepting new clients.  One dietician recommended you in particular. If you are accepting new clients and you have the time would you mind answering some questions for me?  If not maybe you could recommend someone?

Do you work with suggesting some of the more "untested" supplements and herbal stuff like CoQ-10, milk thistle, L-Glutamine or do you stick to the basics like A, C, E? 

I know I am asking a lot.  I see from your credentials you are very knowledgable and therefore 
probably extremely busy.  I don't mean to seem arrogant like I just assume you have time for these questions, perhaps someone else on the bulletin board could answer the questions. I am just trying to gather as much info as I can to make an informed decision.  I am in great health and I don't dwell on my affliction but I DO want to take the best possible care of myself.  I am also a good guy.  Thanks again for your time!  sincerely, DAVE 
 

Date: Thu, 07 Jun 2001 13:57:26 -0400
Subject: I was referred to you by a dietician in SW FLA...
From: HIV Nutrition Discussion List - Sharon Ann Meyer

It's great that you are interested in keeping up your nutritional status before issues arise. Unfortunately, I no longer do counseling but focus my efforts on mass education (visit the main web site).

I don't know of any RDs in the Fort Myers area. There are a few within the tri-county area here that I can recommend. (Note: as of 3/7/06, none of the four dietitians mentioned were still in the firel of HIV/AIDS).

One thing, be careful with the supplements. Remember, everything that you consume goes to your liver to be processed (including alcohol and 'party drugs') and used by the body. A wide variety of enzymes (cytochrome P450s) within the liver do the work. Many substances may compete with others and delay or speed up processing. I don't know if you are on medications or if you have hepatitis but that affects your liver and the substances you consume greatly. The supplements I have seen most recommended by knowledgeable clinicians are listed below. These are suggested for healthy individuals who are not on meds, do not have hepatitis or any other limiting conditions.

Over-the-counter vitamin/mineral (without iron) 1-2x/day
Antioxidant 1x/day
Stress B-complex 1x/day

Stay Well
 

Natural Medicine News® March 23, 2001
___

            Published by Natural Medicine Information & Education
                                 Forrest Batz, PharmD, Editor

Instructions for subscribing and unsubscribing are provided at the end of this newsletter.

Three years of oral ipriflavone (200 mg, 3 times daily) plus calcium (500 mg/d) was no better than calcium alone for preventing bone loss, new vertebral fractures or affecting biochemical markers of bone metabolism in a group of postmenopausal women with osteoporosis. In addition, 12% of women
treated with ipriflavone developed subclinical lymphocytopenia.

Alexandersen P, Toussaint A, Christiansen C, et al. Ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trial. JAMA 2001;285(11):1482-1488.
**

Oral administration of Lactobacillus GG (6 billion colony-forming units twice daily for the duration of hospital stay) reduced the risk of nosocomial diarrhea and rotavirus gastroenteritis in a group of children hospitalized for reasons other than diarrhea.

Szajewska H, Kotowska M, Mrukowicz JZ, et al. Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. J Pediatr 2001;138(3):361-5.
**

Extended-release niacin (Niaspan, 1 gm/d) for 16 weeks increased HDL cholesterol in a group of patients with type 2 diabetes and uncontrolled dyslipidemia, many of whom were already treated with 'statin' drugs. A higher niacin dose (Niaspan, 1.5 gm/d) increased HDL cholesterol and decreased triglycerides and LDL cholesterol. 16% of those treated with placebo, 19% treated with niacin 1 gm/d, and 29% treated with niacin 1.5 gm/d required adjustment of anti-diabetes drug therapy.

Grundy SM, ega GL, McGovern ME. Effects of extended-release niacin on lipoproteins and glycemic control in patients with type 2 diabetes mellitus: results of a randomized, double-blind, placebo- controlled multicenter trial. 50th Annual Scientific Session of the American College of Cardiology, March 18-21, 2001, Orlando, FL;Abstract 1128.
**

Eight weeks of grapeseed extract (100 mg twice daily) initiated 2-4 weeks before the onset of ragweed pollination was no better than placebo for improving symptom diary scores, rescue antihistamine use, quality of life scores or peripheral eosinophil counts in a group of people with seasonal allergic rhinitis.

Bernstein CK, Deng C, Shuklah R, et al. Double blind placebo controlled (DBPC) study of grapeseed extract in the treatment of seasonal allergic rhinitis (SAR). J Allergy Clin Immunol 2001;107 (2 part 2):362-374 (abstract 1018).
**

Six months of oral magnesium oxide (Magnosolv, 1200 mg/day) improved exercise duration and quality of life in a group of men and women with stable coronary artery disease (CAD).

Shechter M, Merz CN, Stuhlinger HS, et al. Oral magnesium supplementation improves exercise duration and quality of life in patients with coronary artery disease. 50th Annual Scientific Session of the American College of Cardiology, March 18-21, 2001, Orlando, FL;Abstract 1055.
**

Oral vitamin B12 (1 mg/d) plus a multivitamin containing folic acid (1 mg/d) reduced homocysteine levels in a group of hemodialysis patients with hyperhomocysteinemia. Addition of high-dose folic acid (5 mg/d or 20 mg/d) did not further reduce homocysteine levels.

Manns B, Hyndman E, Burgess E, et al. Oral vitamin B12 and high-dose folic acid in hemodialysis patients with hyper-homocyst(e)inemia. Kidney Int 2001;59(3);1103-1109.
**

Concomitant ingestion of vitamin E (800 IU) or oatmeal (containing 3 gm beta-glucan) prevented endothelial dysfunction following intake of a high-fat meal in a group of healthy men and women.

Katz DL, Nawaz H, Boukhalil J, et al. Acute effects of oats and vitamin E on endothelial responses to ingested fat. Am J Prev Med 2001;20(2):124-129.
**

Four weeks of oral ferrous sulfate (256 mg/d) reduced coughing in a group of patients with angiotensin-converting enzyme inhibitor (ACEI)-associated cough.

Lee SC, Park SW, Kim JS, et al. Iron supplementation inhibits dry cough associated with angiotensin-converting enzyme inhibitors. 50th Annual Scientific Session of the American College of Cardiology, March 18-21, 2001, Orlando, FL;Abstract 1195.
**

A review article concluded that cranberry juice helps prevent recurrent urinary tract infections and that a trial with placebo, cranberry juice, and antibacterial prophylaxis is need to determine the degree of benefit. The authors also concluded that placebo-controlled trials are needed to determine the benefit of other forms of cranberry.

Lowe FC, Fagelman E. Cranberry juice and urinary tract infections: what is the evidence? Urology 2001;57(3):407-413.
**

Bruising and minor bleeding were reported in one-third of a group of patients with seizure disorder who followed a ketogenic (high fat, low protein, low carbohydrate) diet.

Berry-Kravis E, Booth G, Taylor A, Valentino LA. Bruising and the ketogenic diet: Evidence for diet-induced changes in platelet function. Ann Neurol 2001;49(1):98-103.
**

A literature review found that attentional behavior and visual analysis/hypothesis testing were negatively associated with prenatal cannabis exposure in children beyond the toddler stage. The review also concluded that global IQ is not impacted by prenatal marijuana exposure.

Fried PA, Smith AM. A literature review of the consequences of prenatal marihuana exposure - an emerging theme of a deficiency in aspects of executive function. Neurotoxicol Teratol 2001;23(1):1-11.
**

An Internet search identified 81 hallucinogen-related web sites containing extensive information of variable accuracy on how to obtain, synthesize, extract, identify and ingest hallucinogens, including commercially available legal hallucinogenic plants. Much of the information is not yet found in
textbooks and U.S. government agency web sites offer little cautionary information about hallucinogen use.

Halpern JH, Pope HG. Hallucinogens on the internet: a vast new source of underground drug information. Am J Psychiatry 2001;158(3):481-483.
**

In a US survey, more than half of respondents with anxiety or depression reported using complementary or alternative medicine (CAM) therapies compared to one-third who sought conventional mental health care. The authors recommend that practitioners ask patients about their use of CAM therapies to prevent adverse effects and maximize potential usefulness.

Kessler RC, Soukup J, Davis RB, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatry 2001;158(2):289-294.
**

The National Nutritional Foods Association (the largest US dietary supplements industry group) issued a guidance encouraging manufacturers to eliminate all neurological bovine materials from their products and to choose raw materials in a manner that will minimize the risk of transmitting bovine spongiform encephalopathy (BSE) to humans.
**

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FDA/BRISTOL MYERS SQUIBB ISSUES CAUTION FOR HIV COMBINATION THERAPY WITH
ZERIT AND VIDEX IN PREGNANT WOMEN

Please share with your constituents.

FDA and Bristol Myers Squibb are warning health care professionals that pregnant women may be at increased risk of fatal lactic acidosis when prescribed the combination of the HIV drugs stavudine (Zerit) and didanosine (Videx or Videx EC) with other antiretroviral agents. Lactic acidosis occurs when cells of the body are unable to convert food into usable energy.  As a result, excess acid accumulates in the body and vital organs such as the liver or pancreas may be damaged.  Severe lactic
acidosis is an infrequent, but well-described complication of the class of HIV drugs known as nucleoside analogues. Pancreatitis is also a well-described complication of Videx and Zerit.

This new warning follows three reported cases of fatal lactic acidosis, with or without pancreatitis, that occurred in pregnant women taking Zerit and Videx in combination with other drugs used to treat HIV.  Two of the cases were reported from ongoing clinical trials of an investigational HIV drug, and one was identified through worldwide post marketing surveillance.  In addition FDA has received several nonfatal reports of lactic acidosis, with and without pancreatitis, occurring in pregnant women receiving only Videx and Zerit.  Although data have suggested that women may be at increased risk
for the development of lactic acidosis and liver toxicity, it is unclear whether pregnancy potentiates these known side effects. 

On January 5, 2001, Bristol Myers Squibb issued a letter to alert health care professionals to the potential increased risk of lactic acidosis and liver damage in pregnant women treated with the combination of Zerit and Videx.  Bristol Myers Squibb recommends that the combination of the two
drugs should be prescribed for pregnant women only when the potential benefit clearly outweighs the potential risk.  One situation where the benefit may outweigh the risk is the use of didanosine plus stavudine in women who have exhausted other treatment options.  The letter points out that decisions about using the drugs for pregnant women should be made by health care professionals experienced in treating HIV infection.

Because of these reports, the FDA will strengthen the existing black box warnings to include this new prescribing information.  Women who are prescribed the combination drug therapy should be closely monitored for clinical or laboratory signs of lactic acidosis and liver damage.  This syndrome may develop abruptly, and in the absence of abnormal laboratory values in the weeks preceding its development.  Therefore, it is imperative that healthcare providers maintain a high index of suspicion when monitoring these patients.  Healthcare providers are encouraged to report any adverse events related to stavudine and didanosine to Bristol Myers Squibb Company (800-426-7644).  Reports may be submitted to FDA by telephone (800-FDA-1088), fax (800-FDA-0178), online or by mail to:
MedWatch (HF-2)
Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857

Richard Klein
Office of Special Health Issues
Food and Drug Administration

"Another Person Ill After Eating Raw Oysters" - Associated Press (08.14.01) 

Vibrio vulnificus, a rare bacteria found in oysters, has felled a sixth person who was listed in stable condition at a hospital Monday, said Diana Bonta, health director for the California Department of Health Services. A Riverside man, whose name was not immediately released, is the first person outside of Los Angeles County affected by the outbreak. The bacteria is generally found in raw oysters from the Gulf of Mexico and most severely affects people with AIDS, cirrhosis, hepatitis, cancer and diabetes. Heavy drinkers and people undergoing chemotherapy are also at risk. The infection, which is fatal in 50 percent of all cases, causes septic shock, skin lesions and gangrene that 
often requires amputation of limbs. Hispanics are more likely to be exposed to the infection, officials said, because Gulf Coast oysters are particularly popular in the Latino community.
 

"Raw Oysters Linked to Deaths from Rare Bacteria" - Los Angeles Times (8/9/1)::Charles Ornstein

Los Angeles County public health officials are warning people with certain chronic diseases to avoid raw shellfish after two deaths this month linked to a rare bacterium. Three other people in the county have been hospitalized with the Vibrio vulnificus infection since late June. All of the five patients 
were Latino men ages 44 to 56 with liver disease. The bacterium is typically found in raw oysters from the Gulf of Mexico and affects people with diseases including cirrhosis, hepatitis, cancer, diabetes and AIDS.

Public health officials speculate that Latinos are more likely to purchase Gulf Coast oysters and therefore are more likely to be exposed to the infection. Two of the hospitalized patients purchased oysters from pushcarts, one of them as part of a marinade called campechana. Two others, including the man who died Aug. 2, bought oysters from restaurants, one in ceviche. Officials do not know how the fifth man, who died Tuesday, developed the infection because they found him unconscious.

The Vibrio vulnificus infection is fatal in 50 percent of cases after it enters the bloodstream, experts say. It causes septic shock, blistering skin lesions and gangrene that often requires the amputation of limbs. For people with healthy immune systems, infection can cause diarrhea, abdominal pain and vomiting, but not death. For those with chronic diseases, symptoms typically begin within 24 hours of eating contaminated shellfish. Death can occur within two to three days. Linda Andrews, a food scientist with the Coastal Research and Extension Center of Mississippi State University, encourages people not eat raw oysters from the Gulf Coast in the summer unless the oysters have been treated. Andrews called the infection "an evil disease" and compared its effects to those of the Ebola virus. 
The California Department of Health Services is encouraging oyster companies to pasteurize or freeze products, which eliminates the bacteria. State health officials have considered a summertime ban on oysters from the Gulf but have never imposed one.

I would like to know if it is ok to have my hiv test a little over 10 weeks from my oral sex risky sexual encounter. I was with a female (oral) and am suffering now from anxiety and extreme emotional stress from this , wondering if I am positive or not. It happened on the 29th August and I was wondering if I could go for a test tomorrow which doesnt make it exactly 3 months yet. Please advise - I would much appreciate that.

Please also advise what you personally think my chances are - I am so scared!
Kind Regards, Mick. 
 

Re: Time for HIV test
Date: Thu, 22 Nov 2001 10:48:04
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Yes, I would go ahead and get tested and then take it from there. Oral is much less risky but getting tested will help you to work through your anxiety. Feel free to email again.

Happy Thanksgiving. 
 

8/2/01
The HIV ReSources Web Site is updated. New pages include:
Nutrition & HIV Discussion Archive-2

HIV Nutrition Update Newsletter Issue 31- Free Sample Gateway

This issue includes:
Lauric Acid-Rich Foods As Adjunct Therapy - PDF file

Research News - PDF file

Resource Corner - PDF file

Update Central - PDF file

Nutrition Forum - PDF file

Med Watch - PDF file

Program Spotlight - PDF file
 

I have seen some articles on using marijuana to gain weight. Can you tell me if it does help people with HIV? Thanks
Mike Kaster

Subject:  Re: marijuana and HIV
Date:    Mon, 27 Nov 2000 23:00:52 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

The following information may give you some insight on the use of marijuana. This adds to the information in issues 23 and 24 (PDF file) of the HIV ReSource Review. The reference is from Durban (taken from the AIDS Digest, Tuesday, September 12 2000, Volume 02 : Number 1558) on Dr. Abrams study:

Cannabinoids effect on HIV-1 viral load and appetite HIV Treatment Bulletin, HIV i-Base

Anecdotal benefits to appetite stimulation and stress relief (amongst other effects) ensure that a widespread use of marijuana amongst HIV-positive people in California (where there is also an established movement for legalisation for medical use). Donald Abrams and colleagues at University of California, San Francisco initiated a safety study based on a possible interaction with ARVs via CYP p450 or immune modulation via the CB2 receptor. The study looked at whether cannabis is associated with an effect on viral load, as well as short-term effects on endocrine function, appetite, energy intake and expenditure, body weight and composition. In this randomized, partially blinded, placebo
controlled 21-day study, 67 people (90% men) were randomised to either smoke cannabis, take oral dronabinol (a oral formulation of the active ingredient in cannabis) or take an oral placebo. All subjects were on a 'stable' combination, although only around 50% of people had undetectable viral loads at entry and 10% had counts about 10,000. Entry requirements for the study included previous use of marijuana - although not for the month prior to enrolment.

After three weeks, the study found small decreases in viral load (around 0.15 log reductions) in both the smoked and oral cannabis groups - although the broad definition of 'stable' treatment for entry criteria makes an interpretation of this result difficult. Still, it was an interesting finding, and most importantly viral load did not increase.

People on the placebo arm had a reduction in viral load of 0.06 log. What was more significant was the average calorie intake - 4700, 4100 and 3600 calories a day in the marijuana, dronabinol and placebo arms respectively. This lead to an average weight gain of 3.5, 3.1 and 1.3 kgs over the three week study period.

                    Calories/day                  Weight (kg)
                Mean    (95% CI)                change    (95% CI)
Marijuana       4771    (4630, 4911)            +3.51 (2.17, 4.86)
Dronabinol      4124    (4017, 4230)            +3.18 (2.24, 4.11)
Placebo         3619    (3545, 3692)            +1.30 (0.57, 2.03)

Three people left the study (1 receiving marijuana, two receiving dronabinol) due to neuropsychiatric symptoms. No adverse events were reported in the placebo arm.

Reference
D Abrams, R Leiser et al - Short-term effects of Cannabinoids on HIV-1 Viral Load. XIII International AIDS Conference, Durban, July 9-14, 2000. Abstract LpPeB 7053.
 

Just forwarding this from one of my other electronic listservs:

NMAC Releases Newly Revised: Patient¹s Guide to HIV Medications and Guidelines for Their Use

HIV/AIDS treatment information is constantly changing. As a result, this Patient¹s Guide to HIV Medicines and Guidelines for Their Use has been updated to include the February 5, 2001 update of the Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents. 

NMAC has produced this booklet for people living with HIV and AIDS who need the latest information on the types of treatment available, and help understanding more about the blood tests used to monitor HIV infection and treatment outcomes.  The booklet includes a patient self-assessment designed to encourage discussion between patient and doctor.

The booklet contains the following sections:

     Common Questions about HIV Medicines 
     Guidelines Assist in Making Treatment Decisions 
     Recommended Time for HIV Positive People to Start Treatment 
     Recommended Antiretroviral Medicines for Treatment of Established HIV Infection 
     Questions to Ask Your Doctor 
     Principles for the Treatment of HIV Infection (Summary)

Designed to help the patient and medical expert decide together on the most effective course of treatment, the Patient¹s Guide to HIV Medicines and Guidelines for Their Use is a user-friendly guide that will help PWAs and their caregivers chart the course to a better quality of life.  Download your copy today!

We want to thank DuPont Pharmaceuticals Company for generously underwriting this publication.

To Download, Visit the NMAC Web Site

The guide is a PDF document and requires Acrobat Reader to view. 

-- THE NATIONAL MINORITY AIDS COUNCIL
____________________________________
We want to thank our sponsors of this Web Page, Office of AIDS Research at NIH and Health Resources & Services Administration without their support we would be getting this information out to you via snail mail. This listserve's contents are solely the responsibility of NMAC and do not necessarily represent the official view of OAR/NIH or HRSA/HAB.

Information from NMAC On-Line and at www.nmac.org is drawn mostly from secondary sources; people living with HIV/AIDS should share information of interest to them with their primary care provider before making treatment choices. The presence of the name or image of any individual on NMAC  should not be construed as an indication of their HIV status or unless specifically stated. 
 

"Another issue is the absorption and utilization of medications in people with poor nutritional status. Getting free medications won't help someone with malnutrition. We need to get this message out. Millions of dollars are spent on medications that may be totally useless in the HIV-challenged individual with malnutrition or malabsorption."

Subject: Re: milk thistle
Date: Wed, 19 Jul 2000 19:27:44 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Hello Edwin,
We have a number of AIDS Service Organization's who subscribe to the newsletter. Since our articles are comprehensive and very time-consuming to research  we do not forward articles. The milk thistle article has more than 150 references. 

The bottom line is it looks like it may be useful however one should be aware of possible side effects. Read the article in Issue 18 (PDF file):

"SIDE EFFECTS AND CAUTIONS 

Although a phase I* German study of silymarin in six healthy male volunteers notes no adverse events, even up to a dose of 1,200 mg per day, some side effects are reported. (7, 9, 11, 27, 37, 144, 151) In mice and rats, both silybin and silymarin reduced intestinal transit time. (152) We know that silymarin should not be used by persons with gall bladder problems and it has a mild laxative effect in some users as well. (37) Some product distributors even note that silymarin may produce both a looser stool and cause mucosal irritation. (9) Complaints of nausea, epigastric discomfort, upset stomach or gas are eliminated by either taking less silymarin and then slowly increasing the dosage or stopping treatment. (1, 11) It is also possible that the herb may affect the absorption of other medications. (27) A search of the Food and Drug Administration's adverse reaction database notes a few reports of either swelling and rapid heartbeat connected with silymarin, or groin pain, elevated blood pressure or blood clot. (151) However, the nutritional products in question contained a number of other substances such as goldenseal, dahlulin, bayberry bark or root, spirulina, wheat grass, maitake, dandelion, niacinamide, gotu kola, and enzymes. It's vital to know that using silymarin without having a condition that causes ongoing stress may actually depress normal liver function. (153) People with liver problems and those who regularly take prescribed medications that may affect liver function, particularly PLWHIV or AIDS, should be monitored by a health  care professional when using silymarin. Women must know that the safety of milk thistle use during pregnancy and lactation is not established. (154)"

I heard that milk thistle is a antioxidant that is good for the liver. My liver enzymes are high so I am wondering if it might be good for me to take it. Any information would be helpful.
Thanks. Liz Breecher
 

Subject: Re: Milk Thistle
Date: Tue, 03 Sep 2002 12:36:12 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Silymarin is the major active component of the herb. A comprehensive literature review on milk thistle published in the HIV ReSource Review noted several things to think about before trying this drug including side effects:

-Not for use in persons with gall bladder problems
-Mild laxative effect so it can cause you to have looser stools
-Mucosal irritation
-Complaints of nausea, epigastric discomfort, upset stomach or gas are lessened by either taking less silymarin and then slowly increasing the dosage, or just stopping treatment.
-Milk Thistle may also affect the absorption of other medications.
-Safety of use during pregnancy and lactation is not established.

Would you have any review on use of probiotics in HIV patients? Regards.
Sandeep Saluja M.D. New Delhi 110017

Subject: Re: Probiotics
Date: Mon, 28 Mar 2005 06:55:13
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Visit Consumer Lab to get some information on this supplement. It is important to know that some of these products do not have enough bacteria in them to sustain colonization of the intestinal tract in taken in normal doses. Also, some species of probiotics have different effects and different uses. ConsumerLab recently announced their review of probiotics:

"Probiotics (Lactobacillus acidophilus, Bifidobacterium, and others)
ConsumerLab.com's Product Review of Probiotic Supplements (Lactobacillus acidophilus, Bifidobacterium, and others) revealed that one third of the products tested contained less than 1% of the expected number of viable bacteria with several products containing ten thousand times less than expected. 

Probiotics are commonly used to treat or prevent diarrhea due to various causes and have many other potential uses.  Twenty-five probiotic products were purchased and tested by ConsumerLab.com: 19 general use products, 3 products marketed for children, and 3 yogurts. Only 16 of the 25 products were found to contain the generally recommended 1 billion organisms or greater per daily 
serving."
 

I have been recommending 1 tsp psyllium BID with meals for people with glucose intolerance. Does anyone know if this should be taken separately from HAART?
Lisa 

Subject: RE: psyllium
Date: Thu, 31 Jan 2002 12:36:03 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Here's an excerpt from "HEART HEALTHY FOOD CHOICES IN THE ERA OF HAART: PART
TWO" published in Issue 23 of the HIV ReSource Review:

Recent studies indicate that psyllium* has a role in the management of hypercholesterolemia and high blood glucose. (95) One study found that consuming 5.1 mg of psyllium twice daily along with a low fat diet in men with type 2 diabetes lowered LDL cholesterol by 8.9% and serum fasting glucose by 11.0% compared to placebo. Olson and colleagues conducted a meta-analysis to determine the role of psyllium enriched cereals in blood cholesterol levels. (96) The research included more than 400 adults with mild to moderate hypercholesterolemia on low fat diets. Subjects who consumed a low fat diet and psyllium cereal such as All Bran or Bran Buds, had lower total cholesterol and LDL cholesterol. HDL cholesterol was unaffected in the psyllium group.

It is notable that consumption of psyllium husk fiber bars helps those with diarrhea caused by anti-HIV PI combination therapy. (97) Psyllium normally interferes with medications. By speeding gastrointestinal transit time bulk laxatives like psyllium can lower the absorption of some drugs. Very little is known however, about the effects of psyllium with common HIV medications. The liver's cytochrome P450 enzyme system* modifies other compounds in the body (refer to Nov/Dec 1998 Review issue). Jim Duke, Ph.D., notes, "There are close to 100 different types of detoxifying enzymes that regulate (induce or inhibit) cytochrome P450 and this is a brand new relatively unexplored field, very complex and disturbing. I predict that by the time we are through, we'll learn that all herbs and food plants contain P450 inducers and P450 inhibitors." (98) Indications are to take psyllium at least one hour after taking drugs that it might chelate (see below). (98, 99) Psyllium is contraindicated in bowel, esophageal or GI obstruction and there are reports of allergic reactions, some of them fatal. (98) It is contraindicated in diabetes that is difficult to control as it may reduce insulin needs in insulin dependent diabetes. People who use psyllium need to take at least five ounces of fluid per 5 grams psyllium to decrease the risk of esophageal obstruction, flatulence, and bowel obstruction. Bulking agents should not be taken when lying down or at bedtime. Known drug interactions reported with psyllium include:

Decreased absorption of calcium, magnesium, zinc, copper, vitamin B12
Decreased insulin needs
Decreased absorption of Digoxin/Cardiac glycosides, Coumarin derivatives, and
Lithium salts
Decreased absorption (rate/amount) of Carbamazepine

References
95. Anderson JW, Allgood LD, et al. Effects Of Psyllium On Glucose And Serum Lipid Responses In Men With Type 2 Diabetes And Hypercholesterolemia. Am J Clin Nutr. 1999;70: 446-73.

96. Olson BH, Anderson SM, Becker MP et al. Psyllium- Enriched Cereals Lower Blood Total Cholesterol And LDL Cholesterol, But Not HDL Cholesterol In Hypercholesterolemic Adults: Results Of A Meta-Analysis. J Nutr. 1997;127(10):1973-80.

97. Ronagh T, et al. Psyllium Husk Fiber Bars Are Efficacious In The Treatment Of Protease Inhibitor-Induced Diarrhea. 39th Interscience Conf Antimicrobial Agents Chemotherapy (abstract and poster session 1307), 1999; Sept 26-29.

98. Duke J. Ph.D., Ethnobotanist, ARS/USDA, Beltsville, MD. Personal communications, March 2000.

99. Herr S. Herb-Drug Interaction Handbook. Church Street Books: Nassau, NY. 2000:151-52.

Subject: RE: psyllium
Date: Wed, 22 Jan 2003 24:12:02 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Forwarding this:
Subject: NNF Classic - The Incredible Husk - Psyllium
Date: Wed, 22 Jan 2003 23:04:40 -0500

January 23, 2003
NUTRITION NEWS FOCUS
"Nutrition news is important.  We help you understand it!"

Today's Topic: The Incredible Husk - Psyllium

Psyllium is probably the single most effective dietary ingredient for lowering serum cholesterol.  Read that sentence again.  It's that important.

Psyllium is the husk of the seed from a shrub that grows in India and the Mediterranean.  It has been used in the U.S. for a hundred years as a treatment for constipation.  It is sold over the counter as a
laxative (Metamucil and other brands), in health food stores as a powdered product, and is in one breakfast cereal (Bran Buds).

Oat products also lower serum cholesterol.  But you have to eat a lot of oats (3-4 servings a day totalling 320-450 calories) to get a statistically significant effect.  Psyllium works at 10-12 grams per
day and by itself provides no extra calories.  A very small number of people are allergic to psyllium; most are health care workers who dispense a lot of psyllium and breathe in large quantities of dust
from the product.

HERE'S WHAT YOU NEED TO KNOW - The science on this is clear: consuming psyllium lowers blood cholesterol which can help reduce the risk of heart disease.  The bottom line is that taking
psyllium is good for many people.  The only side effect is that you poop more.  This clearly reduces occurrence of diverticular disease of the colon and possibly colon cancer.  Diverticula are small
balloonings of the wall of the large intestine and are found in about 50 percent of the elderly; high fiber diets can prevent these from forming and getting infected (diverticulitis).

(This story originally appeared in Nutrition News Focus on September 29, 1998.)

********************************************************************
Please recommend Nutrition News Focus to your family and friends. 

DISCLAIMER: The information in Nutrition News Focus is intended only to help you understand the Nutrition News.  We do not recommend any treatment, food or supplement.  It is not intended to replace the advice of a physician.  If you read something in this newsletter that in any way contradicts what your physician tells you, TAKE YOUR PHYSICIAN'S ADVICE, NOT OURS.

Copyright 1998, 2003 Nutrition News Focus Inc.
********************************************************************
*  NUTRITION NEWS FOCUS
*  We take the confusion out of the nutrition news
*  For a free subscription to our daily email newsletter: visit our website
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I have been told to take psyllium with meals for glucose intolerance. Does anyone know if it should be taken separately from HAART? Thanks 
Mary Hartford
 

Subject: Re: Psyllium
Date: Tue, 11 Mar 2003 13:16:53 -0500
From: HIV Nutrition Discussion List - Sharon Ann Meyer

If you plan on taking it, first let your doctor know. It can be taken with meals if no medications are taken at the same time. Psyllium is known to affect the absorption of drugs that need to be taken with a high fat meal such as Fortovase. It can affect other drugs and nutrients as well. Visit the Herb Drug Interaction Handbook web site for more information. For people with glucose intolerance it is best to take psyllium from 10-30 minutes before eating. 

"Effect of Concomitant HIV Infection on Presentation and Outcome of Rotavirus Gastroenteritis in Malawian Children" - Lancet (08.18.01) Vol 358; P 550-555::Nigel A Cunliffe; Carl D Kirkwood, Stephen M Graham; Ndina M Nhlane; Benson D M Thindwa; Winfred Dove; Robin L Broadhead; Malcolm E Molynexu; C Anthony Hart

Rotaviruses are the main cause of severe, dehydrating diarrhea in infants and young children throughout the world. By contrast with more-developed countries, in which rotavirus causes few deaths (<40 per year in the United States), an estimated 500,000 to 870,000 deaths annually are caused by rotavirus infection in less-developed countries. Infection with HIV is common among children in many countries in sub-Saharan Africa, and diarrheal disease is a leading cause of illness and death in HIV-infected children in these areas. The objectives of this study were to examine the effect of host HIV infection on the severity of rotavirus disease, and on the duration of fecal 
shedding of rotavirus and the serum immune response to rotavirus infection. Researchers enrolled 786 inpatients (median age 8 months, 34 percent of whom were HIV-1 infected) and 400 outpatients (median age 9 months, 16 percent of whom were HIV-infected) in the study.

Early rotavirus vaccines seemed to be less effective in tropical settings, but newer vaccines have shown similar levels of protection (80-100 percent) against the most severe outcomes of rotavirus infection in more-developed and less-developed countries. Most rotavirus vaccines in development include live, oral, attenuated strains, and concern exists regarding their use in infants who might be immunocompromised. Specifically, the CDC's Advisory Committee on Immunization Practices recommended that the (now suspended), tetravalent rhesus-human reassortant rotavirus vaccine should not be given to infants born to HIV-infected mothers (unless HIV infection in the infant has been excluded), and suggested further research in this area. Understanding the behavior of natural rotavirus infections in HIV-infected children is an important first step in this process. 

In this 2-year hospital-based study of rotavirus gastroenteritis, researchers found that rotavirus was less commonly identified among HIV-infected children than among HIV-negative children. In those with HIV infection, the contribution of rotavirus might have been diluted by the effect of other 
enteropathogens - e.g. parasites, bacteria and perhaps viruses such as astroviruses and picobirnaviruses, which have been associated with diarrhea in HIV-infected adults. Researchers were unable to find significant differences in the clinical severity of rotavirus diarrhea between hospitalized children with and without HIV infection. However, significantly more deaths occurred during follow-up after hospital discharge among HIV-infected children than among HIV-negative children, and death was related to low CD4 count on presentation.

In conclusion, rotavirus was detected less frequently among HIV-infected children, who were able to clinically resolve rotavirus infection irrespective of their immune status, and could mount a seroresponse similar to children without HIV infection. The finding of more frequent deaths among HIV-infected children during short-term follow-up after rotavirus infection requires further study, including assessment of the effect of rotavirus on HIV replication. The observation of (clinically 
inapparent) prolonged shedding in some HIV-infected children also merits further investigation, and would be best addressed in a large, longitudinal study with long-term follow-up.
 

"Seaweed Derivative Could Prevent HIV Infection: Researcher" - Australian Associated Press (10.09.01)::Rada Rouse

Dr. Peter Kilmarx of the CDC is coordinating early trials of a microbicide called Carraguard that is derived from the seaweed Chrondrus crispus. "This seaweed is used already in foods and cosmetics and has been shown in animal studies to have no significant problems of irritation," Kilmarx said. Studies showing that women are at risk of HIV because of their husband's extramarital sexual activities indicate the urgent need for female-controlled prevention, he said. 

According to US clinical researcher Professor Ken Mayer, about 50 different chemical cocktails are being studied worldwide for their potential ability to kill sexually transmitted infections, including HIV, but only four are ready for human trials. "The likelihood is that at least in the next few decades, even if we have a vaccine or a safe microbicide, neither is going to be 100 percent effective, so I think you probably want to have both on board, given how serious HIV is," Mayer said. "Women's empowerment is a very important aspect because if you had a product that a woman could use without her partner knowing it, it would be a way to slow down the progress of this epidemic globally," said Mayer, a professor at Brown University in Providence, R.I. 

Yet despite the urgent need for a topical gel or cream to fight HIV and STDs, the impetus to develop them comes from small biotech companies, private foundations and public research facilities, with little interest from multinational pharmaceutical companies, Mayer said. Megan Gottemoeller of the 
Global Campaign for Microbicides said that in the United States, microbicide research received only 1 percent of the overall public AIDS research budget. However, a bill recently introduced in Congress provides for the establishment of new microbicide research programs at the CDC and the National Institutes of Health.

The microbicide movement was dealt a setback when poor trial outcomes resulted in the abandonment of the compound N-9. But four other compounds appear promising, including a gel that keeps the acidity of the vagina so low it is toxic to HIV, and a family of compounds that work by inhibiting HIV from binding to cells.

Hello, Can anyone offer any information on the drug noted above? Thanks in advance. Craig Peterson
 

Subject: Re: Thalidomide
Date: Tue, 03 Apr 2001 17:11:05 -0400
From: HIV Nutrition Discussion List - Sharon Ann Meyer

Just a disclaimer, we do not advocate the use of this drug. Please discuss Thalidomide use with your health-care provider.

* From Issue 2 of the HIV ReSource Review, in the Resources section- 
CLINICAL PRACTICE UPDATE
"Thalidomide has been found to inhibit tumor necrosis factor and therefore combat AlDS-related wasting. Patients enrolled in a clinical trial (800/-TRIALS-A) in 2001. You might find more information on thalidomide at the Food and Drug Administration or AIDSMeds web site. Thalidomide can also be used for oral or esophageal aphthous ulcers or genital ulcers at doses of 50-200 mg daily (Lancet 1996; 9006:974).

* From Issue 14 of the HIV ReSource Review, in the Feature column (Geneva Update)-
"Thalidomide may be used more as a means to promote the repletion of body cell mass soon. Studies with thalidomide show an increase in weight when used in HIV+ people who have oral ulcers. (1)
1. Kotler D, Shevitz A, Fenton M. Update On Wasting, Metabolism And Altered Body Shape In HIV/AIDS.  Tufts University School of Medicine: Boston, MA, distributors. World Wide Web:
Accessed 19 July 1998.

* From the HIV ReSource Reviw Issue 15 Med Watch- 
Thalidomide™ (Synovir®, Thalomid®) is a sedative that was used about 40 years ago for morning sickness and nausea in pregnancy, and for leprosy. It's now being increasingly considered as a second-line therapy for aphthous ulcers. It may also help weight loss in AIDS and tuberculosis (TB). The drug lowers TNF-alpha*, which can cause rapid, uncontrollable weight loss, HIV replication and disease progression, and progression of kaposi's sarcoma (KS). Although studies are clearly lacking some people use it for HIV infection, KS, diarrhea, multiple sclerosis, macular degeneration,
mycobacterium avium complex, TB, rheumatoid arthritis, cancer and other auto-immune diseases. Clinical trials of HIV+ people show it’s effective in decreasing the symptoms of aphthous ulcers and weight loss associated with AIDS (From: Project Inform).

DOSAGE & ADMINISTRATION: Optimal doses are still being studied. Most physicians prescribe 100- 300 mg,usually administered orally as a single dose at night, to limit side effects. A lower maintenance dose may be taken after initial problem resolution.

POTENTIAL SIDE EFFECTS: Toxicities are more common in HIV+ patients. They are: addiction, anorexia, buzzing in the ears, candidiasis, constipation, depression, dizziness, dry mouth, edema, fatigue, general sense of illness, headaches, hypoglycemia, hyperglycemia, hypersensitivity, increased appetite, increased viral load, lowered T-cell counts, mood-swings, nausea, nerve pain, nervousness,
neutropenia, peripheral neuropathy, rash, shivering, sedation, and stomach-aches.

PRECAUTIONS: Along with the possibility of severe birth defects if taken during pregnancy, women should note that this drug may interfere with the metabolism of birth control pills.

SOURCES
* Thalidomide. The HIV Drug Book. Second Edition. Project Inform. New York, NY:Pocketbooks; 1998:426.
* Jacobson JM, et al. Thalidomide For The Treatment Of Oral Aphthous Ulcers In Patients With Human Immunodeficiency Virus Infection. N Engl J Med 1997;336:1487-93.
* Clemmensen OJ, et al. Thalidomide Neurotoxicity. Arch Dermatol 1984;120:338-41.
* Aronson IK, et al. Thalidomide-Induced Peripheral Neuropathy: Effect Of Serum Factor On Nerve Cultures. Arch Dermatol 1984;120:1466-70.
* Celgene Corporation, Synovir® Product information. 888/423-5436.
* Taking Thalidomide For HIV-Related Oral Ulcers And Weight Loss. 1995; booklet, modified 12/96. New York City, NY: PWA Health Group. World Wide
Web: Accessed 25 Sep 1998.
* Haslett P, Freedman VH, Kaplan G. The Emerging Role of Thalidomide Therapy in HIV-Infected Patients. Infect Med 1997;14(5):393-398, 405-406. Accessed through Medscape on 28 Dec 1997.
* Thalidomide. Important Patient Information, Handout. HHS-PHS-FDA. DHHS Pub. No.(FDA) 96-3222. Sept 1997. World Wide Web: Accessed 6 March 1998.
 

* From the HIV ReSource Review, Issue 20 Feature article on pharmaceutical treatments for unintentional weight loss-
CYTOKINE INHIBITORS (IMMUNOMODULATORS) Cytokine inhibitors adjust the metabolic alterations associated with cachexia and are employed to assist those with weight loss in AIDS and
tuberculosis. (2, 279-282) Studies under the direction of Dr. Marc Hellerstein led the way for investigations into the effects of one such drug called thalidomide. (223) The drug lowers TNF-alpha activity by enhancing messenger RNA degradation and is safe and effective in PLWHIV who have wasting. (2) Thalidomide use results in a weight gain of predominately LBM. Reported potential nutritional side effects include increased appetite (see table one on page four). Along with the
possibility of severe birth defects if taken during pregnancy, women should note that this drug may interfere with the metabolism of birth control pills. Concern about possible adverse effects of the drug on HIV viral burden* stresses the need for co-treatment with a HAART regimen.

(2) 223. Hellerstein MK, Wu K, McGrath M, Faix D, et al. Effects Of Dietary N-3 Fatty Acid Supplementation In Men With Weight Loss Associated With The Acquired Immune Deficiency Syndrome: Relation To Indices Of Cytokine Production. JAIDS. 1996;11(3):258-70.

279. Gorbach SL, Khalsa JH, Kotler D, Shevitz A, Fenton M. Update On Wasting, Metabolism And Altered Body Shape In HIV/AIDS. Boston, MA: Tufts University School of Medicine: Distributors. World Wide Web: Aaccessed 19 July 1998.

280. A Randomized, Double-Blind, Placebo-Controlled, Phase I/II Trial of Nandrolone Decanoate in Women With HIV-Associated Weight Loss. NIAID ACTG 329. National Library of Medicine, AIDSTRIALS. World Wide Web: Accessed 23 July 1999.

281. Klausner JD, Makonkawkeyoon S, Akarasewi P, Nakata K, et al. The Effect Of Thalidomide On The Pathogenesis Of Human Immunodeficiency Virus Type 1 And M-Tuberculosis Infection. J AIDS. 1996;11(3):247-57.

282. Thomas S, Kook K, Fang JC. Open Label Use Of Thalidomide In Adults With HIV-Associated Wasting (Protocol W-002). Int Conf AIDS (12th). 1998 June 28 - July 3; 12:554 (abstract no. 32170).

* From HIV ReSource Review Issue 24 "Progressive Management of AIDS Wasting 2000" column-
"Kotler is currently involved in a study with investigators at the University of California in San Francisco (UCSF) using growth hormone and thalidomide (anti-cytokine) in AIDS patients with acute infections. The goal is to slow the wasting process. He says he has to warn himself that the body’s compensations are important and if we interfere with them we might do more harm than good."

As a reminder, the definition of TNF-alpha, NUCLEAR FACTOR-KAPPAB, NF-KAPPAB): Cellular
transcription factor that regulates a wide variety of cellular and viral genes. NF-KAPPAB plays an important role in the activation of HIV. Intracellular messengers, such as reactive oxygen intermediates, are involved in the inducible activation of NF-KAPPAB. Alpha-lipoic acid is a NF-KAPPAB inhibitor.