Nutrients and HIV: Part One - Beta Carotene and Selenium

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Nutrients and HIV: Part One - Beta Carotene and Selenium

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http://www.chiro.org/nutrition/ABSTRACTS/Nutrients_and_HIV_1.shtml

 

FROM: Alternative Medicine Review 1999 (Dec); 4 (6): 403–413 ~ FULL

TEXT

 

Lyn Patrick, ND

 

Introduction

 

HIV infection involves a progressive immune dysfunction and loss of

CD4 T cells leading to opportunistic infection, wasting syndrome,

malignancies, or CD4 depletion significant enough to qualify as CDC-

defined AIDS. Several research studies have indicated that the

apoptosis of CD4 cells contributing to HIV progression does not

result solely from HIV infection, but largely from antioxidant

imbalances in the host.1-3 Activation of latent HIV state can be

stimulated in the presence of reactive oxygen species (ROS) through

the stimulation of oxygen-responsive transcription factors,

specifically NF-kB, which induces HIV replication in the infected T-

lymphocyte. The number of reactive oxygen species can be reduced by

restoring proper redox balance through adequate availability of

antioxidants.

 

Micronutrient deficiencies are common in HIV, both in early and late

stages of the disease. Tomaka4 found in 129 patients with stratified

T-cell counts all cohorts had similar prevalences of nutrient

deficiencies. Among the three subgroups (CD4>500, CD4 200-500,

CD4<200), each had similar occurrence of deficiencies: 38, 41, and

42 percent, respectively. Beta carotene and selenium figure

prominently in these deficiency pictures. Their role as antioxidants

provides a logical explanation for the widespread deficiencies of

these nutrients seen in HIV and their therapeutic relevance.

 

 

Beta Carotene in HIV/AIDS

 

Beta Carotene Deficiency

 

Beta carotene, a fat-soluble antioxidant, is a well-known scavenger

of the singlet oxygen radical5 and can decrease free-radical induced

lipoperoxidation damage in HIV.6

 

Deficiencies of serum and plasma beta carotene and other carotenoids

(including lutein and lycopene) have been observed in multiple

studies in both HIV-positive and AIDS patients.4,7,8 Depression of

serum beta carotene levels is usually indicative of fat

malabsorption and diarrhea, common complications of AIDS, secondary

to general malabsorption, infection, and altered gut barrier

function.9 While pancreatic function appears to be normal in

HIV/AIDS,10 enterocyte function and villous atrophy occur even

without intestinal infection.11 Ullrich,7 in a cohort of 116 HIV-

infected individuals, found serum carotene concentration did not

differ significantly between AIDS-diagnosed individuals who had

diarrhea and those who did not: 77 percent of both groups had

abnormally low carotene levels. In addition, serum carotene levels

did not differ between HIV/AIDS patients with or without the

presence of infectious agents in the stool or on intestinal biopsy:

76-percent infected and 77-percent noninfected individuals had

abnormal serum carotene levels. The presence or absence of weight

loss, fever, or secondary extra-intestinal infection did not

correlate with alterations in serum carotene level. See Table 1.

 

In this study, CD4 percentages (r=0.364; 95% CI, 0.194-0.513;

p<0.001), CD4 count (r=0.28; 95% CI, 0.101-0.441; p=0.0013) and the

CD4/CD8 ratio (r=0.38; 95% CI, 0.212-0.526; P<0.001), (but not

leukocyte, lymphocyte, or CD8 counts) in peripheral blood correlated

with serum carotene levels.

 

Favier et al6 examined a cohort of 25 asymptomatic HIV-1

seropositive subjects in CDC stage II (mean CD4 396/mm3) and 18 HIV-

1 seropositive subjects in CDC stage IV (mean CD4 56/mm3) and

followed changes in their antioxidant status for six months. They

found severe deficiencies of plasma carotenoids and beta carotene in

both groups, and a significantly more rapid fall in the level of

beta carotene in the CDC II group than the CDC IV group. The authors

related this difference to increased levels of peroxidation in CDC

stage II patients. Their malondialdehyde (MDA) and hydroperoxide

levels were significantly higher (P<0.05) than in those subjects who

had more advanced disease (CDC stage IV). They concluded the

reduction in carotene levels was the result of increased antioxidant

activity at this stage of HIV infection due to overproduction of

oxygen radicals by polymorphonuclear leukocytes in CDC stage II. See

Table 2.

 

Whether carotene depletion is due to malabsorption or increased free

radical load or both, it appears to be consistently deficient in HIV-

positive subjects. Omene12 measured beta carotene levels in 15

African-American and Hispanic children. Those with HIV had 6.5 times

lower levels of serum beta carotene than age-matched HIV-negative

controls; the children with AIDS had a 13-fold lower level than HIV-

negative controls. There were no significant differences in the

levels of serum vitamin A or E in any of the groups. Periquet et

al13 looked at 21 HIV-1 positive children and found deficiencies of

plasma levels of both lycopene (p=0.002) and retinol (p=0.023) but

not beta carotene in the AIDS-diagnosed children (n=10).

 

Serum beta carotene and vitamin A levels were measured in 74

pregnant HIV-1 positive women in the first trimester and compared to

pregnant HIV-negative women, also in the first trimester.14 HIV-

infected women with CD4 counts below 200 had 37-percent lower mean

serum vitamin A and beta carotene levels when compared to controls

(p<0.001). Both serum beta carotene and vitamin A levels correlated

with percentage of CD4 lymphocytes, CD4 counts, and CD4/CD8 ratios

(p<0.001). Lacey8 found a significant depletion of plasma

carotenoids in 35 HIV-positive individuals compared to controls

(p<0.001). Plasma levels of four of the individual carotenoids were

correlated with CD4 count, but beta carotene, and vitamins A, C, and

E were not.

 

An evaluation of nutrient supplementation in 64 HIV-1 infected

adults15 revealed that even though 63-73 percent claimed they were

taking some form of multi-vitamin, plasma levels of total

carotenoids were still lower than the HIV-negative controls

(p=0.009). Lower CD4/CD8 ratios were correlated with lower carotene

levels (p=0.02). Although the patients in this study who were taking

antioxidant supplements had consistently fewer low concentrations of

antioxidants no matter what their disease stage status (p=0.0006),

29 percent still had subnormal levels of one or more antioxidant.

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