HIV and AIDS

HIV and AIDS

Acquired immune deficiency syndrome or AIDS is a worldwide health problem. AIDS is caused by the human immunodeficiency virus (HIV) which attacks white blood cells. About 20 million people throughout the world—heterosexuals and homosexuals alike—are infected with HIV. A massive research effort has produced better treatments resulting in longer survival and improved quality of life for those with access to the treatments. But there is still no vaccine or cure. The only real defense against AIDS is prevention.

Signs and Symptoms

Fever
Weight loss
Night sweats
Skin lesions or rashes
Fungus infection in the mouth
Shortness of breath cough or chest pain
Diarrhea abdominal pain or vomiting
Blurred vision
Headache
Depression
Confusion
Herpes
Kaposi's sarcoma
Malignancies

What Causes It?

Infection by the human immunodeficiency virus (HIV) causes AIDS. Seventy percent of HIV transmission occurs through sexual contact. Intravenous drug users transmit HIV by sharing needles. Blood transfusions and blood products caused many infections in the early years of the epidemic but screening procedures have nearly eliminated this risk in the United States and other developed countries.

What to Expect at Your Provider's Office

If your health care provider suspects HIV infection he or she will order a blood test to detect the presence of the virus. A stool sample may be requested. You may be sent for a chest X-ray since a common complication of AIDS is pneumonia. If you have any neurological symptoms your provider may recommend a computed tomography (CT) scan or analysis of your spinal fluid.

Treatment Options

Treatment Plan

Strong drugs slow the progression of the HIV virus to full-blown AIDS. A combination of these drugs works more effectively. Antibiotics and other drugs treat specific complications you might have. Review alternative treatments to help support the immune system and avoid severe weight loss.

Drug Therapies

Prescription

Antiretrovirals used in combination with protease inhibitors—help slow the infection; be sure to take as directed to avoid a stronger viral strain; significant serious side effects
Antibiotics—for complication of pneumonia; various side effects
Prednisone—for complication of pneumonia; various side effects
Amphotericin B with flucytosine—for complication of meningitis; various side effects
Clotrimazole— for complication of oral candidiasis; various side effects

Over the Counter

N/A

Complementary and Alternative Therapies

These may be effective at slowing the progression from HIV infection to AIDS and to treat some related infections.

Nutrition

Avoid megadoses of nutrients unless prescribed by your provider.

Multivitamin: two to six capsules a day
Vitamin C (1 to 6 g a day—to bowel tolerance) beta-carotene (150 000 to 300 000 IU a day) and zinc (30 mg a day)
N-acetyl cysteine (1 500 to 2 000 mg a day): protects the lungs
Selenium (100 to 400 mcg a day): important antioxidant
Vitamin E (400 to 800 IU a day): antioxidant
Vitamin B complex (50 to 100 mg a day): depleted during stress
Vitamin B₁₂ (1000 mcg via intramuscular injection): one injection a month to counter medication side effects
Magnesium (500 to 750 mg a day): important in protein biosynthesis
Coenzyme Q10 (10 mg a day): may improve cell ratios
L-glutamine (30 to 40 g per day in five doses of 6 to 8 g each for at least 7 to 10 days): fuel for cells lining the gastrointestinal tract
L-carnitine (2 000 mg a day): with wasting or high triglyceride levels

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts).

To stimulate immune function and provide antiviral support: Licorice (Glycyrrhiza glabra) 1/4 to 1/2 solid extract twice a day inhibits HIV reproduction in lab tests; helps regrow liver cells. Do not take licorice if you have high blood pressure. St. John's wort (Hypericum perforatum) at 250 mg three times a day inhibits binding and entry of HIV into host cells and elevates mood. However using St. John's wort with antiviral agents like indinavir and other protease inhibitors is not recommended. There is the possibility of an interaction between this herb and these medications that could undermine the effectiveness of the antiviral medications. Huang qi (Astragalus membranaceus) 250 to 500 mg powdered solid extract inhibits HIV-1 replication and stimulates the appetite. Use one to two of these.
To stimulate digestion and prevent diarrhea take one to three of the following herbs which stimulate the appetite (15 to 60 drops three times a day with meals): gentian (Gentiana lutea) tonic historically used as an antiparasitic to be avoided if you have ulcers; dandelion (Taraxacum officinale) cholagogue historically used for liver problems; goldenseal (Hydrastis canadensis) as an anti-inflammatory mild laxative do not exceed recommended dose for long-term use
Garlic (Allium sativum) is a strong antioxidant enhances natural killer cell activity in people with AIDS
Siberian ginseng (Eleutherococcus sentecosus) (30 to 60 drops three times a day or 1 cup tea three times a day) increases T-cell NK cell and cytotoxic killer cell function
Milk thistle (Silybum marianum): supportive treatment for toxic liver damage especially important with medications used in HIV/AIDS
Acidophilus (two to five million organisms three times a day): beneficial gut bacteria that are depleted when you take a lot of antibiotics

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

Weight training may be helpful in maintaining muscle mass.

Acupuncture

May be very helpful to treat infections and stimulate immune system.

Massage

Massage can enhance the immune system and decrease anxiety.

Following Up

Complications are common but they can be treated. HIV has a long "dormant" period; the median time for progression to AIDS is 11 years from infection. Patients with AIDS itself generally survive one to two years. Those time spans are beginning to increase as treatments improve.

Special Considerations

If you are HIV-positive and pregnant taking AZT is the only way to reduce the likelihood of transmitting the virus to your baby. Depending on your own condition you and your health care provider may decide to postpone treatment until after your first trimester to reduce the risk of birth defects.

Supporting Research

Auerbach J Oleson T Solomon G. A behavioral medicine intervention as an adjunctive treatment for HIV-related illness. Psychology and Health. 1992;6:325–334.

Blumenthal M ed. The Complete German Commission E Monographs. Boston Mass: Integrative Medicine Communications; 1998:119–120 134 169–170.

Dubin J. HIV Infection and AIDS. Emergency Medicine Online. 1998. Accessed at www.emedicine.com/emerg/topic253.htm on February 13 1999.

Dworkin BM. Selenium deficiency in HIV infection and the acquired immunodeficiency syndrome (AIDS). Chem Biol Interact. 1994;91:181–186.

Fawzi WW Mbise RL Hertzmark E et al. A randomized trial of vitamin A supplements in relation to mortality among human immunodeficiency virus-infected and uninfected children in Tanzania. Pediatr Infect Dis J. 1999;18:127–133.

Gruenwald J Brendler T Jaenicke C et al eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998:626–627 866–867 903–904 1138–1139 1174–1175.

Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. U.S. Department of Health and Human Services. December 1 1998.

Hamilton Nunnelley EM. Biochemistry of Nutrition: A Desk Reference. New York NY: West Publishing Company; 1987:183–184.

Hanna L. Complementary and alternative medicine: exploring options and making decisions. Bulletin of Experimental Treatments for AIDS. January 1998.

Hayashi K Hayashi T Kojima I. A natural sulfated polysaccharide calcium spirulan isolated from Spirulina platensis: in vitro and ex vivo evaluation of anti-herpes simplex virus and anti-human immunodeficiency virus activities. AIDS Res Hum Retroviruses. 1996;12:1463–1471.

Lissoni P Vigore L Rescaldani R et al. Neuroimmunotherapy with low-dose subcutaneous interleukin-2 plus melatonin in AIDS patients with CD4 cell number below 200/mm3: a biological phase-II study. J Biol Regul Homeost Agents. 1995;9:155–158.

Nerad JL Gorbach SL et al. Nutritional aspects of HIV infection. Infect Dis Clin North Am. 1994;8:499–515.

Noyer CM Simon D Borczuk A Brandt LJ Lee MJ Nehra V. A double-blind placebo-controlled pilot study of glutamine therapy for abnormal intestintal permeability in patients with AIDS. Am J Gastroenterol. 1998;93:972–975.

Patarca R Fletcher MA. Massage therapy is associated with enhancement of the immune system's cytotoxic capacity. Int J Neurosci. February 1996;84:205–217.

Piscitelli S Burstein AH Chaitt D et al. Indinavir concentrations and St. John's wort [letter]. Lancet. 2000;355:547-548.

Remacha AF Cadafalch J. Cobalamin deficiency in patients infected with the human immunodeficiency virus. Semin Hematol. 1999;36:75–87.

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.