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recurring thrush? (VITAMINS AND MINERALS, 2010)
Jun 27, 2010

hello Dr. I am a 34 gwm diagnosed with AIDS a year ago. At that time my CD4's were 63, VL 115,000. I was very fatigued, and had bouts of recurring thrush. I began HAART (Reyataz, Truvada, Norvir) and also Mepron (due to a Dapsone allergy)and Diflucan 200mg daily, and a prenatal vitamin. I have had very good results. A few labs came back undetectable >48 copies per mL. My lastest labs were about a month ago, and were; CD4 274, VL 10 copies per mL. Dr. seems to think that I am doing very will and says that my lifespan will be measured in decades now.

Because of increasing burning in my stomach and diarrhea, my specialist discontinued the Mepron after 2 labs with CD4's above 250, and those side effects have subsided.

My Dr. has been very disbelieving that I actually have recurring thrush; however over the past year, every time I stop taking the Diflucan...the thrush comes back, despite my increase in CD4's. So, now I have been taking Diflucan 200mgs daily for several months. If I do not this medication sandwich it with food, I feel really lousy and have some abdominal inflammation and nausea.

I would like to know your thoughts on this thrush. Will I always have to take medicine for it? or will one day when my CD4's get higher will my immune system be able to keep it under control?

Also, do you believe that there is any benefit in taking prenatal vitamins? I was told by the nurse that they are loaded with folic acid, and that this was a good thing, but don't really know how beneficial they are, and am wondering if they could be causing some of my nausea.

Thank you very much for your time sir.

Response from Dr. Frascino

Hello,

There is no doubt your combination antiretroviral therapy has been extremely beneficial both immunologically (CD4 count rising from 63 to 274) and virologically (viral load plummeting from 115,000 to undetectable).

I don't know why your physician is "very disbelieving" regarding your recurrent bouts of thrush. It's not that difficult to diagnose, and if you have it, you have it! Although thrush often subsides as immune function improves, your counts are only in the mid-200s. It is possible there are some holes in your immune repertoire that increase your likelihood of having thrush. I see no reason why you shouldn't stay on Diflucan prophylactically for a while, allowing for additional immune reconstitution over time. You could then try discontinuing the Diflucan to see if it's still needed. Should you continue to improve immunologically, I would anticipate you will eventually be able to discontinue your Diflucan.

As for vitamins, a multivitamin is recommended. It doesn't have to be a prenatal vitamin. (See below.)

Dr. Bob

Vitamins and Minerals January 22, 2010

Why Are Vitamins and Minerals Important?

Vitamins and minerals are sometimes called micronutrients. Our bodies need them, in small amounts, to support the chemical reactions our cells need to live. Different nutrients affect digestion, the nervous system, thinking, and other body processes. Micronutrients can be found in many foods. Healthy people might be able to get enough vitamins and minerals from their food. People with HIV or another illness need more micronutrients to help repair and heal cells. Also, many medications can create shortages of different nutrients.

What Are Antioxidants?

Some molecules in the body are in a form called oxidized. These molecules are also called free radicals. They react very easily with other molecules, and can damage cells. High levels of free radicals seem to cause a lot of the damage associated with aging. Free radicals are produced as part of normal body chemistry. Antioxidants are molecules that can stop free radicals from reacting with other molecules. This limits the damage they do. Several nutrients are antioxidants.

Antioxidants are important for people with HIV, because HIV infection leads to higher levels of free radicals. Also, free radicals can increase the activity of HIV. Higher levels of antioxidants can slow down the virus and help repair some of the damage it does.

How Much Do I Need?

You might think that all you have to do to get enough vitamins and minerals is to take a "one-a-day" multivitamin pill. Unfortunately, it's not that easy. The amounts of micronutrients in many of these pills are based on the Recommended Dietary Allowances (RDAs) set by the U.S. government. The problem with the RDAs is that they are not the amounts of micronutrients that are needed by people with HIV. Instead, they are the minimum amounts needed to prevent shortages in healthy people. HIV disease and many AIDS medications can use up some nutrients. One study of people with HIV showed that they needed between 6 and 25 times the RDA of some nutrients! Still, a high potency multivitamin is a good way to get basic micronutrients.

Which Nutrients Are Important?

There has not been a lot of research on specific nutrients and HIV disease. However, one study showed that pregnant women in Tanzania benefited greatly from multivitamin supplementation. Also, many nutrients interact with each other. Most nutritionists believe in designing an overall program of supplements. People with HIV may benefit from taking supplements of the following vitamins and minerals:

B Vitamins: Vitamin B-1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin B12 (Cobalamin), and Folate (Folic Acid). Antioxidants, including beta-carotene (the body breaks down beta-carotene to make Vitamin A), selenium, Vitamin E (Tocopherol), and Vitamin C. Magnesium and Zinc

What About Other Supplements?

In addition to vitamins and minerals, some nutritionists suggest that people with HIV take supplements of other nutrients: Acidophilus, a bacterium that grows naturally in the intestines, helps with digestion. Alpha-lipoic acid is a powerful antioxidant that may help with neuropathy and mental problems. Carnitine (also called acetyl-L-carnitine) may help prevent wasting and provide other immunologic and metabolic benefits, Coenzyme Q10 may help with immune function. Essential fatty acids found in evening primrose oil or flaxseed oil can help with dry skin and scalp. N-Acetyl-Cysteine, an antioxidant, can help maintain body levels of glutathione. Glutathione is one of the body's main antioxidants. Omega 3 fatty acids can help decrease triglycerides Niacin can help increase good cholesterol and decrease bad cholesterol

Can Nutrients Be Harmful?

Most vitamins and nutrients appear to be safe as supplements, even at levels higher than the Recommended Dietary Allowances (RDAs). However, some can cause problems at higher doses, including Vitamin A, Vitamin D, copper, iron, niacin, selenium, and zinc. A basic program of vitamin and mineral supplementation should be safe. This would include the following, all taken according to directions on the bottle:

A multiple vitamin/mineral (without extra iron), An antioxidant supplement with several different ingredients, and A trace element supplement. There are seven essential trace elements: chromium, copper, cobalt, iodine, iron, selenium, and zinc. Some multivitamins also include trace elements. Any other program of supplements should be based on discussion with a doctor or nutritionist. Remember that higher price may not mean better quality.

For More Information

You can get more information on nutrition and HIV from these web sites and books: Vitamins and Supplement web links, http://sis.nlm.nih.gov/hiv/nutrition.html#a3

Nutrition and HIV: A New Model for Treatment by Mary Romeyn, M.D., published by Jossey-Bass, Inc, telephone 1-415-433-1740.

A Clinician's Guide to Nutrition In HIV and AIDS, by Cade Fields-Gardner and others, $31 published by the American Dietetic Association, P.O. Box 97215, Chicago IL 60678-7215; or 800-877-1600, ext. 5000.



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