Vitamins in the treatment of AIDS

Townsend Letter for Doctors and Patients, June, 2006 by Melvyn R. Werbach

Vitamin A Deficiency

With HIV infection, serum vitamin A concentration is lowered. (1) Moreover, depletion increases with the progression of the infection leading to AIDS. (1) Normalization of vitamin A nutriture is associated, among other things, with higher T-cell counts. (2) An overly high intake of vitamin A may, however, increase the risk of progression to AIDS in HIV-positive patients. (3)

[ILLUSTRATION OMITTED]

Vitamin B Complex Deficiencies

The concentration of reduced homocysteine, a toxic amino acid, may be elevated, suggesting possible deficiencies of vitamins B6, B12, and folic acid. Increased homocysteine can promote the formation of reactive oxygen species and accelerated immunologic deterioration as well as increased HIV replication. (4)
Indeed, there is evidence of deficiency for all three of these B vitamins. Vitamin B6 may be deficient despite adequate intake which, in turn, is associated with decreased immune function. (5) Supplementation of the vitamin may substantially reduce the risk of progression to AIDS. (6) It may also help reduce the effects of psychological stress (7) and increase T-lymphocyte levels in HIV-positive patients. (8)

Decreases in vitamin B12 status in HIV-infected patients have been associated with peripheral neuropathy and myelopathy, (9) as well as with increasing immune dysfunction. (2) Supplementation of vitamin B12 in deficient patients has improved memory, (10) reduced dementia, (11) decreased peripheral neuropathy, (9) and increased depressed T-helper cell counts. (2)
Advertisement

Finally, folic acid may be reduced, (12) sometimes severely enough to cause neurological degeneration, (13) although zidovudine (AZT) treatment may increase red cell folate levels. (14) The hematological toxicity of zidovudine (AZT) has been a problem. There is reason to be believe that adequate folic acid and/or vitamin B12 repletion may reduce the risk, although controlled clinical trials remain to be done. (15)

Nutriture of other members of the vitamin B complex may also be reduced. Niacin, riboflavin, and thiamine intakes may be inversely related to the risk of AIDS in HIV-positive patients, and one study found that the highest quartile of intake of each was independently associated with improved survival over an eight-year follow-up period. (6) Moreover, neuropathological changes characteristic of Wernicke's encephalopathy (which results from thiamine deficiency) have been described post-mortem in non-alcoholic AIDS patients. (16)

Vitamin C

Plasma levels of vitamin C may be reduced in ARC, AIDS, and asymptomatic HIV-positive patients. (17) Furthermore, intake may be inversely related to the risk of AIDS in HIV-positive patients. (3) In vitro, ascorbate diminishes HIV viral protein production in infected cells and reverse transcriptase stability in extracellular virions (complete viral particles). (18) In clinical settings, ingestion of vitamin C until diarrhea is induced (often referred to as the "ascorbate flush") has been found to improve symptomatology and slow the decline of--or even improve--killer T-cell activity and T-helper/T-suppressor ratios. (19-21) Similarly, the application of a vitamin C paste up to four times daily, while simultaneously prescribing massive oral doses of ascorbate, has been reported to successfully treat early lesions of Kaposi's sarcoma. (19)

Vitamin D Deficiency

The count of CD+ cells may be the most important marker of immunodeficiency in HIV-infected patients and can be used to predict survival and progression to AIDS. Serum vitamin D levels have been found to be directly associated with this count, (22) suggesting that supplementation to restore normal serum levels may be an effective treatment.

Vitamin E Deficiency

Both plasma or serum levels of vitamin E have been shown to be reduced in HIV-infected patients. (23) There is evidence that supplementation with the vitamin may enhance immunocompetence (24) and boost plasma glutathione levels. (25) Moreover, animal studies suggest that supplementation may increase the therapeutic efficacy of AZT while reducing its toxicity. (26-27)

Multivitamin Supplementation

The New England Journal of Medicine recently published the results of a randomized trial of multivitamins for HIV-infected pregnant women in Tanzania. Multivitamins (vitamins B, C, and E) were compared to vitamin A (preformed vitamin A and beta carotene) and both in regard to the progressive of HIV disease. While the effects of vitamin A were not impressive, the multivitamins successfully delayed the progression of the disease. (28)

Melvyn R. Werbach, MD

4751 Viviana Drive

Tarzana, California 91356 USA

818-996-0076; Fax 818-774-1575

References

1. Kafwembe EM et al. Vitamin A levels in HIV/AIDS. East Afr Med J. 2001;78(9):451-3.

2. Baum MK et al. Micronutrients and HIV-1 disease progression. AIDS. 1995;9:1051-6.

3. Tang AM et al. Dietary micronutrient intake and the risk of progression to Acquired Immunodeficiency Syndrome (AIDS) in Human Immunodeficiency Virus Type 1 (HIV-1) infected homosexual men. Am J Epidemiol. 1993;138:937-51.