A Comprehensive Treatment Approach to HIV

During the past decade, the treatment of HIV has evolved in many ways. We now have over 25 drugs with which to treat this infection. Laboratory testing includes "ultra" sensitive viral load tests and phenotype resistance evaluations. And the frequency of taking antiviral medication, in many cases, is down to a few pills just once per day. Many of us present at the beginning of the epidemic only dreamed these advances might someday come true.

While there has clearly been remarkable progress, significant problems still exist. Two important questions include:

  1. How can the progressive toxicity these medications often cause be lessened?
  2. How can I make sure that the antiviral medications I am taking remain effective for as long as possible?

First, there is unquestionable evidence that the longer a person takes antiviral medication without interruption, the greater the risk of developing significant side effects. These can include heart disease, liver problems, body fat changes, lipid abnormalities, nerve pain, and insulin resistance. Therefore, the current practice of using continuous antiviral therapy as the sole way we treat this condition leaves much to be desired.

Reducing Toxicity

So, are there ways to lessen the cumulative toxicity that comes with taking antiviral drugs for very long periods of time? I believe there are. The measures discussed below can make a big difference in your quality of life, as well as in helping minimize or eliminate the risk of specific side effects that many people experience when they take antiviral medication.

Heart Disease: While studies have shown that the risk of having a heart attack or stroke increases the longer a person takes antiviral meds, these studies also show that smoking and poorly controlled high blood pressure pose a far greater risk. Therefore, if you are taking HIV medications and continuing to smoke you are more than doubling any increase in heart attack risk from your meds alone. Of course, eating a low fat diet, keeping your cholesterol level well-managed, and exercising regularly can also decrease your risk of cardiovascular-related side effects.

The key point is this: using natural therapies such as a healthy diet, regular exercise, and smoking cessation can make a big difference in whether or not you experience cardiovascular disease as an antiviral-related side effect. This is one example of how utilizing a combination of natural and standard medical therapies can give you the best possible results.

Lipodystrophy: Another example of how using natural therapies can help minimize antiviral drug side effects is in the case of the abnormal body fat changes called lipodystrophy. Body fat changes often occur due to a number of factors that can be identified and addressed. These factors include a high triglyceride level, a low testosterone level, and a sedentary lifestyle. When these three factors are combined, there is an increased risk of lipodystrophy, particularly an accumulation of fat in your belly or neck. In order to address or prevent lipodystrophy, make sure that you are eating a low-fat, low-sugar diet, that your testosterone level is in the upper part of the normal range (usually between 500-1000), and that you are getting regular exercise (at least two or three times per week).

At this moment in time, very few of my patients who follow the above guidelines have experienced lipodystrophy. In addition, this set of recommendations will also offer protection against diabetes, heart disease, and a loss of your muscle mass. Using natural therapies such as a healthy diet, hormone supplementation, and regular exercise can make a big difference in whether or not you experience lipodystrophy as an antiviral-related side effect.

Intestinal Health: Some of the most common complaints among people with HIV include intestinal symptoms such as gas, bloating, and diarrhea. Many people (and docs as well) believe these symptoms are just a part of living with HIV, but I do not!

Gas, bloating, and diarrhea are symptoms that are often ignored or just treated symptomatically with meds such as Imodium or Lomotil. This is unfortunate because these symptoms are usually caused by a combination of unhealthy bugs in the gut (intestinal parasites), low levels of healthy intestinal bacteria (acidophilus and bifidus), and poor dietary choices (too much grease and sugar). By cleaning up your diet (i.e. eating less fat and sugar as well as more fruits, grains and veggies), taking a daily probiotic supplement to boost acidophilus levels, and experimenting with digestive enzymes to help boost your digestive juices (available in pharmacies and health food stores), most intestinal symptoms can be eliminated. This approach can also improve your quality of life and help you tolerate your meds much better.

I recommend that everyone who is HIV-positive get screened for intestinal parasites once a year. In my experience, 30% to 50% of people with HIV are presently walking around with parasites and don't know it. These bugs in your gut affect your digestion, inhibit the proper absorption of nutrients, and place increased stress on your immune system (causing unwanted immune activation).

Including Micronutrients

The daily intake of a micronutrient supplement (that includes vitamins, minerals, and antioxidants) can also provide a beneficial support to the immune system. One of the most important of these supports is to help every cell of your body effectively neutralize free radicals. These are the toxic byproducts of normal energy production that have been shown to be at higher than normal levels in the cells of people with HIV whether they are taking antiviral medication or not. By properly supporting the micronutrient needs of your cells, conditions such as neuropathy, lipodystrophy, heart disease, liver failure, and CD4 cell decline can possibly be prevented.

There is sound research to support the use of a micronutrient supplement as part of a comprehensive treatment of HIV. A recent study published in the New England Journal of Medicine (NEJM) in July 2004 stated: "Multivitamin supplements can delay the progression of HIV disease and provide an effective, low-cost means of delaying the initiation of antiretroviral therapy in HIV-infected women." A second study published in AIDS, the journal of the International AIDS Society, found that, "Administering a micronutrient supplement to HIV-infected men and women living in Thailand decreased HIV-associated mortality by 50% compared to the placebo arm."

I have also recently completed a double-blinded, placebo-controlled research trial in 40 people with HIV in the United States who were taking antiviral medication. This study was funded by the Bristol-Myers Squibb company. The study found that a micronutrient supplement could increase the CD4 count in people with HIV on antiviral medication by an average of 26% compared to no change in the placebo group. This study is currently under review for publication in a peer-reviewed journal.

It is my goal to perform further high quality research on this topic, and if micronutrient therapy continues to show significant benefit to people with HIV, to see that it is covered by insurance and government programs (i.e. Medicaid). The micronutrient supplement that was used in this study is now available under the brand name "K-PAX" and is presently covered by the NY State ADAP program with a prescription from your doctor.

Maintaining Effectiveness

The second question I posed at the beginning of this article was, "How can I make sure that the antiviral medications I am taking remain effective for as long as possible?"

The answer to this question includes the following four points:

  1. Don't miss doses of your meds
  2. Take the best possible care of your body
  3. Take a high potency daily micronutrient supplement
  4. Get tested for intestinal parasites and get rid of them if they are found

Don't miss doses of your meds: There have been many well done clinical trials that show a very strong correlation between missed doses of meds and the development of antiviral resistance. Anything less than taking 90% of your medication doses will likely shorten the length of time that the drugs you are taking will work.

Why is this a big problem? If your drugs wear out prematurely, you will go through the available list of drugs too fast and there will then be none left to use. However, if you always have effective treatment options available to use to treat this infection, you will most likely live the longest lifespan possible.

Take the best possible care of your body: This means not abusing your body by regularly consuming alcohol, cigarettes, crystal meth, and other recreational drugs that are proven toxins. If you want your body to stay healthy and treat you right, you've got to treat it right too!

Next, try to eat as healthfully as possible. As I stated before, the best diet to consume is one that includes plentiful fruits, grains and vegetables, as well as a minimum of fat and sugar. Also try to make sure that you get a good amount of protein at every meal. These are proven ways to help keep your immune system strong.

Regular exercise should include a mixture of weight training and cardiovascular activity two to three times per week. Even if you can't get to a gym to exercise, taking a daily walk, using the stairs instead of the escalator, and trying to do some push ups, sit ups and stretching on a regular basis can really help keep your body fit.

Take a high potency daily micronutrient supplement: As I discussed above, there is an increasing body of research that suggests a potent micronutrient supplement, taken on a daily basis, can help delay the need to start antiviral medication as well as provide a boost to your CD4 count if you have already started taking the meds. There is also sound evidence that shows a potential for antioxidants to lessen the risk of antiviral drug side effects. Do some research on the web or talk to your doctor or pharmacist to identify the micronutrient supplement that fits your needs and budget the best.

Get tested (and treated) for intestinal parasites: In my opinion, this is just as important as any of the above items. Many people harbor these bugs in their gut and don't know it. The only way to find out for sure is to ask your doctor to order a test called an "O&P times three." It requires collecting a sample from three separate bowel movements and then taking all three to the lab. For a complete review of the diagnosis and treatment of intestinal parasites visit www.jonkaiser.com.

In summary, I now hope you can see the important benefits that can be achieved by combining natural therapies with standard therapies in the treatment of HIV. If the above recommendations are taken to heart it is my belief that most people with HIV have the potential to live a normal, healthy lifespan. This is what I set as the goal my patients and during the past ten years of watching them follow my treatment guidelines, I see no reason to believe otherwise. I hope some of this information helps you to achieve the same!

c. 2005 Jon Kaiser, M.D.

Jon Kaiser, M.D. has been caring for people with HIV and other immune system disorders in San Francisco for the past fifteen years. The latest information on his treatment guidelines, as well as access to his quarterly newsletter and lecture schedule, can be found at www.jonkaiser.com.