Have you ever felt really run down and fatigued but when you front up for the results of your three-monthly blood test the doctor says; “Everything’s fine! Your viral load is undetectable and your CD4s are great”?
Or the opposite. Several months ago I spoke with a woman who was taking Bactrim but had decided, against her doctor’s advice, to not take any anti-HIV drugs for the time being. Her highest CD4 count in the last 12 months had been 120 but she felt fine, had no symptoms or illness and had a full-time job. What going on?
While it’s true that CD4 counts and viral load are good indicators of how things are going for you — and the best predictors we have of the future — research has shown that there are many other factors that also influence the outcome of infection with HIV.
A good example is glutathione (GSH). GSH is the most important antioxidant inside the body’s cells. It’s crucial in the repair of DNA, neutralizes lots of cancer-causing and toxic chemicals and enhances the immune system. So it’s not surprising that low levels in people with HIV lead to poor outcomes.
In one study, a two to three year follow-up of 246 people with HIV found that GSH levels had a huge impact on survival, over and above the effect of a low CD4 count1. People in this study who had a CD4 count below 200 had a very high risk of death, but only if they also had a low GSH level. Only 17 percent of people with both low CD4s and low GSH survived the study period. But a more normal GSH level meant that a low CD4 count wasn’t nearly so serious — 87 percent of people with low CD4s but normal GSH survived.
From this study GSH levels emerges as a predictor in its own right of the outcome of infection with HIV — a predictor that’s independent of CD4 count. That doesn’t mean that CD4 counts aren’t important, only that other factors can influence disease progression.
Other nutritional factors that affect survival with HIV, independently of CD4 count, are low levels of vitamin B122 and of the mineral selenium3.
Other studies have found other independent predictors of survival, including liver enzymes, such as AST and ALT, that are more than twice the upper limit are strongly associated with an increased risk of death. Even mild to moderate elevations are also associated with poorer outcome4.
Researchers examining the effect of raised liver enzymes on survival among people with HIV have found that they “are a major determinant of survival and should be carefully considered in all phases of HIV therapy.”[4]
Dehydroepiandrosterone (DHEA) is an important steroid hormone. One study which examined the importance of this hormone among men with HIV over a five-year period found that low DHEA levels were associated with more HIV-related illnesses.
The study concluded that “DHEA levels less than 7 nmol/l proved to be an independent predictor for development of illness and disease progression in HIV-1-infected men.”[5]
The main point about nearly all these factors is that you can do something about them. For example, when 93 people took 200ug of selenium/day for two years as part of a clinical trial it meant that, on average, they generally halved their risk of being hospitalised for a HIV-related reason and of their CD4s dropping by more than 506.
Likewise, when a group of people with chronic hepatitis B took 300mg of vitamin E twice a day for three months many of them managed to get their ALT liver enzymes back to normal. Nine months after the trial finished 60 percent of them had normal ALT levels, compared to only 12 percent of those who hadn’t taken vitamin E7.
And, when the people in the GSH study mentioned above increased their GSH levels by taking n-acetyl-cysteine (NAC) they significantly increased their survival1.
Unfortunately, people with HIV are rarely given information about these kinds of treatments, despite the fact that more than 40 percent of people with HIV who completed the “HIV Futures 3” survey agreed that “Medicine’s focus on anti-HIV drugs is very limited.”
Jim Arachne is the Complementary Therapy Treatment Officer for the Victorian AIDS Council.
References:
1 Glutathione deficiency is associated with impaired survival in HIV disease. Proc Natl Acad Sci U S A 1997 Mar 4;94(5):1967-72. Herzenberg LA, De Rosa SC, Dubs JG, et al.
2 Low serum vitamin B-12 concentrations are associated with faster human immunodeficiency virus type 1 (HIV-1) disease progression. J Nutr. 1997 Feb;127(2):345-51. Tang AM; Graham NM; Chandra RK; Saah AJ
3 High risk of HIV-related mortality is associated with selenium deficiency. J Acquir Immune Defic Syndr Hum Retrovirol, 15(5):370-4 1997 Aug 15. Baum MK; Shor-Posner G; Lai S; et al
4 HIV survival: liver function tests independently predict survival. XIV International AIDS Conference, Barcelona, abstract MoOrB1058, 2002. Justice AC et al.
5 Dehydroepiandrosterone as predictor for progression to AIDS in asymptomatic human immunodeficiency virus-infected men. Mulder JW; et al. J. Infect Dis. 1992 Mar;165(3):413-8.
6 Impact of a selenium chemoprevention clinical trial on hospital admissions of HIV-infected participants. HIV Clin Trials. 2002 Nov-Dec;3(6):483-91. Burbano X, Miguez-Burbano MJ, McCollister K, et al.
7 Vitamin E as treatment for chronic hepatitis B: results of a randomized controlled pilot trial. Antiviral Res. 2001 Feb;49(2):75-81. Andreone P, et al.
