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vitamine C daily
Jan 28, 2005

Is it safe to use 3times daily 1000mg vitamine C together with Kaletra, Viramune and Epivir? I have read that vitamine C is good to give you more T cells and works against the toxic side effects? Thanks and good luck with your site.

Response from Dr. Frascino

Hi,

It may come as a shock to many readers and an ongoing disturbing reality to many of us in the HIV healthcare field that there have been very few clinical studies to date focused on the potential interactions between vitamins, minerals, herbal medicines and other supplements and HIV medications! This is difficult to understand, considering the massive number of us "virally enhanced" folks who use these complimentary medicines. Certainly knowing if and how these substances interact with our HIV medicines is critical to ensuring the optimal efficacy and safety of our complex regimens. OK, I'll step off my soapbox now and try to answer your question!

A single 1000 mg dose of vitamin C per day is approximately 12 times the U.S. recommended daily allowance, but well within the dosing range of many pozitoids here in the U.S. many HIV experts say taking up to 1000 mg per day is most likely quite safe, and I would tend to agree; however, I really don't have hard scientific facts and clinical studies to support my gut feeling on this. Also, I should point out there is at least one study done on HIV-negative volunteers that documented an interaction between 1000 mg of vitamin C and the protease inhibitor Crixivan. The vitamin C resulted in a 20% reduction in peak Crixivan blood levels (and a 32% reduction in minimum Crixivan blood levels). Will high-dose vitamin C ultimately be proven to significantly affect protease inhibitor levels in HIV-positive folks? Only a well-designed clinical trial will be able to answer this question. Perhaps it will join St. John's Wort, garlic and a few other supplements that have been shown to have a significant impact on HIV drug levels by affecting certain enzymes (the cytochrome P450 CYP3A4 isoenzymes). One thing that's for certain is that we don't need any easily avoidable factors contributing to the failure of our treatment regimens!

So, for now, my best guess is to keep your daily vitamin C supplement to 1000 mg per day maximum, at least until we have more information.

By the way, there is no solid evidence the massive doses of vitamin C "give you more T-cells" or "work against toxic side effects."

Stay well.

Dr. Bob


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