In a test of his theory that patients given aggressive nutritional support and hormone replacement therapy would do better than those given standard care, Jon Kaiser, M.D., of The Wellness Center in San Francisco, performed a retrospective comparison study of 148 HIV-positive patients from two similar clinics (poster 184). Seventy-four patients from his practice were closely matched for age, sex, socioeconomic status, baseline CD4 counts and viral loads with patients from a nearby medical practice.

Over the two years analyzed, both groups received antiretroviral drugs when declining CD4 count or increasing viral load indicated the need. The Wellness Center patients also received nutritional counseling to improve their diets, along with micronutrient supplementation (including twice daily doses of a multivitamin and minerals plus additional B-6 (100 mg), vitamin C (2000 mg), vitamin E (400 IU), coenzyme Q-10 (30 mg) and acidophilus). In addition, hormone levels of DHEA-sulfate and testosterone were checked every six months. If DHEA was low, patients received sufficient oral supplementation of the hormone to achieve a level in the upper half of the normal range (300-600 microg/dl for men and 100-300 microg/dl for women). When necessary, topical testosterone was also used to maintain levels in the high normal range (500-1000 ng/dl for men, and 50-100 ng/dl for women). Quarterly bioelectrical impedance analysis (BIA) testing was used to monitor body cell mass, and additional supplementation with the anabolic steroid oxandrolone and/or human growth hormone helped to maintain body cell mass at 100% of ideal levels.

When compared to the control group, Wellness Center patients experienced a greater average rise in CD4 cells (45% vs. 25%), a slightly greater average drop in viral load (86% vs. 72%), fewer opportunistic infections (one vs. three), and fewer hospitalizations (zero vs. one). Interestingly, these improvements were achieved using less antiretroviral medication, and less total medication, than were used by the control group. Dr. Kaiser believes that this type of program promotes a more potent immune response that assists in suppressing HIV.

But there may be more to nutrient supplementation than just strengthening immune defenses: In perhaps the most talked about presentation of the conference, Orville Levander, Ph.D., from the USDA's Human Nutrition Research Center, reported on the effects of micronutrient deficiencies on a different sort of RNA-based virus, the coxsackievirus. He and his colleague Melinda Beck, Ph.D., from the University of North Carolina at Chapel Hill, studied a strain of coxsackievirus that normally does not cause disease in mice. They found that this strain does cause heart damage when given to mice deficient in selenium or vitamin E.

When viruses from the nutrient-deficient mice were then introduced into nutrient-adequate mice, the viruses remained virulent, causing heart damage. "Everyone always thought that the diet affected the immune system but we found that the genetic makeup of the virus was involved," Dr. Levander said in an interview. He continued: "It's very speculative to say that HIV's evolution could be similarly channeled to more virulent forms, but preliminary evidence shows that this does occur in other RNA virus." After years of reports concerning micronutrient deficiencies in people living with HIV, this research caused considerable consternation at the conference.

Back to the GMHC Treatment Issues March 1999 contents page.