HIV Lecture
Family Name Genus Name Species Name
Origins:
Transmission:
a) List methods by which transmission occurs-
b) List methods by which transmission does not occur (Refer to CDC Website &
“Search- HIV”)
Clinical Outcome of HIV:
Overview of HIV structure and functions: Draw this out!
Life Cycle and explain significance (You Tube Video:
http://www.youtube.com/watch?v=9leO28ydyfU)
1.
2.
3.
4.
5.
6.
7.
8.
Potential Vaccines:
Vaccine attempts-
Future Outlook for vaccines-
Alternative Strategies:
AIDS-
Prions:
Who discovered?
What are prions?
What diseases are prions linked to?
What two forms do prions come in?
In which hosts do prion diseases develop?
ground flaxmeal and/or “All-1” powder added
Lunch and Dinner
Season sardines in water (green and white label), green salad.
*
Swordfish steak, grilled onions, green salad with flax oil dressing.
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Flank steak, baked potato, green salad with flax oil dressing.
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Broiled red snapper, steamed broccoli, baked yams.
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Large mixed green salad w/ oil and lemon juice, small can of tuna, chopped yellow and
sweet red pepper.
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Flank steak or any meat, green beans with sliced almonds, brazil nuts, green salad with flax
dressing.
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Broiled mackerel, steamed broccoli, green beans or other vegetable.
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Beef, lentil and vegetable soup, (celery, carrots, onion, cabbage).
*
Chicken salad made with sugar-free mayonnaise, roasted vegetables, spinach salad.
Snacks
Fresh coconut, roasted garlic or almond butter on rice cake or celery, protein shakes with
freshly ground flaxseeds added, handful of raw almonds, hazelnuts, walnuts, brazil nuts, or
sesame seeds, an organic apple, pear, or grapes, sugar-free yogurt, rice cakes with nut
butter, 1 whole grain muffin with 1 tsp. No sugar added jam, guacamole and fat-free chips,
fresh or dried organic fruit of any kind, 2 oz. Cheese, lean hormone free meat with
mustard, hard boiled egg.
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Beverages
Green drinks: Green Magma, Kyogreen, or Green Kamut: (1 tsp. 1-3x day in water)
Herbal Teas: Chia Tea, Chamomile, Green Tea with Cinnamon Stick
Avoid
Sugar, alcohol, processed and refined foods, hydrogenated oils, safflower, sunflower,
corn oils, soft drinks
Suggestions And Goals
Drink at least 8 glasses of filtered water per day, engage in activities which will help keep a
positive mental attitude such as meditation, deep breathing, visualization, yoga, and prayer,
get lots of sleep, and exercise regularly (walking, tai chi, stretching).
Studies show that both forms of carnitine are of benefit for HIV patients. 6 grams per day
of carnitine has been shown to deliver benefit to those with AIDS in as little as 14 days.
AIDS patients who take the drug AZT (zidovudine) must take carnitine. AZT depletes
carnitine, causing a serious shortage in cellular energy. The symptoms of AIDS-- muscle
weakness, loss of lean tissue, fatigue, immune deterioration-- mimic the symptoms of
carnitine depletion.
Supplements
Selenium 400 mcg
Acidophilus and Bifidobacteria 1-6 capsules up to 1-3 Tbsp. of each
Vitamin C 1-50 grams (very individual)
Lipoic Acid 100-600 mg
Carnitine (esp. with AZT users) 1,000-3,000 mg (½ hour before meals)
Acetyl-L-carnitine 500-1500 mg
CoQ10 50-300 mg
N-Acetyl-Cysteine 1200-2400 mg
Taurine 1-3,000 mg
Glutamine 1-20 g (especially when diarrhea is present)
Vitamin E 400-800 IUs
Natural mixed carotenoids 50,000-100,000 IUs
Magnesium 400-600 mg in divided doses
Zinc 15-50 mg or as per ZTT
Folic acid and B12 1,000 mcg of each
EPA/DHA 500-3,000 (esp. useful in wasting syndrome)
GLA 240 mg 1-2 per day
Curcuminoids 100-500 mg
Chlorella and/or Spirulina 1-2 tablespoons per day if budget allows
B complex 50 mg
Thymus Polypeptide Extract 2-3 capsules per day
Helpful Herbs Reishi, Self Heal, Avena Sativa, Astragalus
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Research Review
Selenium Deficiency is an Independent Predictor of Survival in HIV
We researched immune parameters and nutrients known to affect immune function were evaluated at 6-
month intervals in 125 HIV-1-seropositive drug-using men and women in Miami, FL, over 3.5 years. Our
results indicate that selenium deficiency is an independent predictor of survival for those with HIV-1
infection.1
Vitamin C and E Reduce Free Radical Levels and Viral Load
Forty-nine HIV-positive patients were randomized to receive supplements of both DL-alpha-tocopherol
acetate (800 IU daily) and vitamin C (1000 mg daily), or matched placebo, for 3 months. The vitamin
group (n = 26) had an increase in plasma concentrations of alpha-tocopherol and vitamin C and a
reduction in lipid peroxidation measured by breath pentane, plasma lipid peroxides and malondialdehyde
when compared with controls (n = 23). There was also a trend towards a reduction in viral load.
Supplements of vitamin E and C reduce oxidative stress in HIV and produce a trend towards a reduction
in viral load..2
Deficiency in antioxidant micronutrients have been observed in patients with AIDS. An increase in free
radical production and lipid peroxidation has been also found in these patients, and takes a great
importance with recent papers presenting an immunodeficiency and more important an increase in HIV-1
replication secondary to free radicals overproduction. In adults we observe a progressive decrease for zinc,
selenium, and vitamin E with the severity of disease, except that selenium remains normal at stage II.
However, the main dramatic decrease concerns carotenoids whose level at stage II is only half the normal
value. N-Acetyl cysteine or ascorbate have been demonstrated in cell culture to be capable of blocking the
expression of HIV-1 after oxidative stress and N-acetyl cysteine inhibits in vitro TNF-induced apoptosis
of infected cells. In our opinion it is now time to evaluate in humans the beneficial effect of antioxidants.
The more promising candidates for presenting synergistic effects when associated with N-acetyl cysteine
seem to be beta-carotene, selenium and zinc.3
Antioxidants such as vitamin E and selenium are important for keeping the virus from becoming more
virulent.4
Patients infected with HIV are at increased risk of atherosclerosis, and have evidence of endothelium
dysfunction and have increased needs for antioxidants. Taking 100 microg selenium daily and 30 mg beta-
carotene twice daily over the period of one year protected their endothelium.5
Lipoic Acid Inhibits HIV in Cell Culture Study Better than NAC
We also found that 0.2 mM LA could cause 40% reduction in the HIV-1 expression from the TNF-alpha-
stimulated OM 10.1, a cell line latently infected with HIV-1. On the other hand, 10 mM NAC was
required to elicit the same effect. Furthermore, the initiation of HIV-1 induction by TNF-alpha was
completely abolished by 1 mM LA. These findings confirm the efficacy of LA as a therapeutic regimen for
HIV infection and acquired immunodeficiency syndrome (AIDS).6
NAC Helps Restore Redox Potential in Cell Culture Study
Primary murine embryonic fibroblasts transfected with HIV-1 TAT demonstrated decreased levels of high
energy phosphates (ATP, GTP, UTP/CTP), adenine nucleotides (ATP, ADP, AMP), and both
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NAD+/NADH redox pairs, resulting in a substantial loss of redox poise. A greater than 50% decrease in
intracellular reduced glutathione (GSH) concentration was accompanied by the extracellular appearance of
acidic fibroblast growth factor (FGF-1). Addition of either N-acetyl-L-cysteine or glutathione ester (GSE),
but not L-2-oxothiazolidine 4-carboxylate, partially restored intracellular GSH levels and resulted in loss of
extracellular FGF-1. Collectively, these results suggest that HIV-1 TAT induces a condition of oxidative
stress, which mediates cellular secretion of FGF-1, an observation relevant to the pathophysiologic
development and progression of AIDS-associated Kaposi's sarcoma.7
Folic Acid
A total of 25 subjects with HIV were fasted and given 5 mg oral folic acid; blood samples were taken at
time zero and after 30, 60, 90 and 180 min. Absorption of folic acid appears to be significantly impaired in
HIV disease, irrespective of the stage of the disease and notwithstanding gastro-intestinal complaints,
pathogen-negative diarrhea or drug treatment. We here present functional data, complementary to
previously reported structural and biochemical findings, to support the hypothesis that the virus can cause
an enteropathy in the absence of opportunist infection.8
B12
HIV-positive patients frequently have absorption disorders, including vitamin B12 malabsorption. Current
evidence suggests that low vitamin B12 levels are more common as the HIV disease progresses. 9
Magnesium regulates immune function
Magnesium is closely tied to immune function HIV patients. One study demonstrated that the absolute
number of T4-lymphocytes was directly correlated with the serum Mg concentration.10
Zinc
Impaired cellular and humoral immunity and phagocytic function have been attributed to zinc deficiency.
This study examined the association between low serum zinc concentration and opportunistic infections in
hospitalized patients with the acquired immune deficiency syndrome (AIDS). We examined the records
from all 505 inpatient consultations performed by our Nutrition Service from May 1992 through June
1994. Patients with zinc deficiency (LSZ) had a significantly higher incidence of bacterial infection than did
patients with normal zinc. Patients with borderline zinc levels had an intermediate incidence of bacterial
infection. Severe zinc deficiency was noted in 29% and borderline levels in an additional 21% of
hospitalized AIDS patients. Hypozincemia was associated with an increased incidence of concomitant
systemic bacterial infections.11
Elevated Copper is frequently found in HIV
A total of 142 HIV-infected individuals and 84 control subjects were studied. Serum copper levels in
HIV- infected subjects were significantly higher than those found in control individuals.12
Using a nested case control design, 54 asymptomatic HIV-1 seropositives who later progressed to AIDS
were compared with 54 HIV-1 seropositives who did not progress and 54 seronegatives (mean follow-up
time 2.5 years). Serum copper levels were higher (p = 0.002) in HIV-1- seropositive progressors than the
seropositive nonprogressors and the seronegatives. Conversely, serum zinc levels were lower (p = 0.016) in
the seropositive progressors than the seropositive nonprogressors and the seronegatives. Furthermore, in
a logistic regression, higher serum copper and lower serum zinc predicted progression to AIDS
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independently of baseline CD4+ lymphocyte level, age, and calorie-adjusted dietary intakes of both
nutrients.13
Carnitine
There is an increasing body of evidence that subgroups of patients infected with human immunodeficiency
virus type 1 possess carnitine deficiency. Tissue depletion precipitated by drug toxicities, particularly
zidovudine (AZT), is a major etiology and concern. Carnitine deficiency may impact on energy and lipid
metabolism, causing mitochondrial and immune dysfunction. There are convincing laboratory data
showing the in vitro ameliorative effects of L-carnitine supplementation of zidovudine-induced
myopathies and lymphocyte function. 14
Acetyl-L-Carnitine
We measured the serum levels of acetyl- and total carnitine in 12 subjects with axonal peripheral
neuropathy developed on treatment with different regimens of neurotoxic nucleoside analogues (ddl, ddC,
d4T). Subjects who did not develop peripheral neuropathy while staying on treatment with ddl (n = 10) or
zidovudine (n = 11) served as the control groups. HIV-negative subjects with axonal on demyelinating
autoimmune neuropathies (n = 10) and healthy individuals (n = 13) were additional control groups.
Subjects experiencing axonal peripheral neuropathy on treatment with ddl, ddC and d4T had significantly
reduced levels of acetyl-carnitine in comparison to the control groups. No difference was observed in the
levels of total carnitine between study subjects and the control groups. Our results demonstrate that
subjects who developed peripheral neuropathy while staying on treatment with ddl, ddC and d4T had
acetyl-carnitine deficiency. The critical role of acetyl-carnitine for the metabolism and function of the
peripheral nerves supports the view that the acetyl-carnitine deficiency found in these subjects may
contribute to the neurotoxicity of ddl, ddC and d4T, even though the interference with mitochondrial
DNA synthesis is regarded as the main cause of their toxicity.15
CoQ10
AIDS patients (2 groups) had a blood deficiency (p less than 0.001) of coenzyme Q10 vs. 2 control groups.
AIDS patients had a greater deficiency (p less than 0.01) than ARC patients. ARC patients had a deficiency
(p less than 0.05) vs. control. HIV-infected patients had a deficiency (p less than 0.05) vs. control. The
deficiency of CoQ10 increased with the increased severity of the disease, i.e., from HIV positive (no
symptoms) to ARC (constitutional symptoms, no opportunistic infection or tumor) to AIDS (HIV
infection, opportunistic infection and/or tumor). This deficiency, a decade of data on CoQ10 on the
immune system, on IgG levels, on hematological activity constituted the rationale for treatment with
CoQ10 of 7 patients with AIDS or ARC. One was lost to follow-up; one expired after stopping CoQ10; 5
survived, were symptomatically improved with no opportunistic infection after 4-7 months. In spite of
poor compliance of 5/7 patients, the treatment was very encouraging and at times even striking.16
Glutamine Reduces Intestinal Permeability
Up to 20% of patients with AIDS have abnormal intestinal permeability. Glutamine seems to play an
important role in preventing the increase in intestinal permeability and loss of intestinal mucosal mass
associated with total parenteral nutrition, and may be superior to glucose for oral rehydration in the setting
of intestinal infection. This study was designed to see if supplemental glutamine could alter the abnormal
intestinal permeability of AIDS. Randomly chosen patients with AIDS from the Jacobi Medical Center
human immunodeficiency virus (HIV) clinic underwent intestinal permeability testing using lactulose and
mannitol. Those with abnormal intestinal permeability were enrolled. Duodenal biopsies were performed
with a Crosby capsule and the patients were randomized in a double-blind fashion to receive placebo or
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glutamine (4 g/day or 8 g/day) for 28 days, after which intestinal permeability tests and duodenal biopsies
were repeated. Intestinal morphology was graded by ratio of villus height to crypt depth, and by degree of
inflammation. All patients complied with the therapy and there were no dropouts or reported side effects.
The results showed less worsening of intestinal permeability with the 4 g/day dose, compared with
placebo. At the 8 g/day dose, there was stabilization of intestinal permeability and improved absorption
of mannitol. Intestinal morphology and inflammation did not change in any group. These results, although
not significant, suggest a trend towards improved intestinal permeability and enhanced intestinal
absorption with glutamine. Glutamine doses of at least 20 g/day may be necessary to improve intestinal
permeability.17
Omega 3 Fats May Help Prevent Weight Loss
Cytokines may be involved in weight loss and disturbances of metabolism associated with human
immunodeficiency virus (HIV) infection. Dietary n- 3 fatty acids reduce the production of interleukin-1
(IL-1) and tumor necrosis factor (TNF) by peripheral blood mononuclear cells (PBMC) in normal humans
and prevent IL-1 and TNF anorexia in animals. Accordingly, we studied the nutritional and metabolic
effects of a 10- week trial of dietary fish oil (MaxEPA 18 g/day) in men with weight loss due to acquired
immune deficiency syndrome (AIDS). Twenty men were enrolled, and 16 completed the 10-week
supplementation period. Prior weight loss was 13.7 +/- 1.8 kg(17.4 +/- 1.6% body weight, means +/-
SE). The metabolic measurement of de novo hepatic lipogenesis fell and weight was gained (2.1 +/- 1.3
kg) in subjects who did not develop new AIDS-related complications, but further increases in DNL and
further weight loss were observed in subjects who developed a new AIDS complication (p0.05 for
interaction between new complication and change in DNL). No changes in body weight, food intake,
serum triglycerides, serum cytokines, or DNL were observed in the unsupplemented group. We conclude
that fish oil is a weak anticytokine agent that is unable to overcome the metabolic and nutritional
consequences of acute AIDS-related complications but may exert a clinical anticytokine effect in stable
AIDS patients.18
Cell Culture Study Shows Benefit of Extract of Self-Heal (Prunella Vulgaris)
Crude extracts of four Chinese herbs, Arctium lappa, Astragalus membranaceus, Andrographis paniculata,
and Prunella vulgaris (Self-Heal), were assessed in several tissue culture lines for anti-HIV activity and for
cytotoxicity. One extract, obtained from P. vulgaris, was able to significantly inhibit HIV-1 replication with
relatively low cytotoxicity. Pretreatment of uninfected cells with the extract prior to viral exposure did not
prevent HIV-1 infection. By contrast, preincubation of HIV-1 with the purified extract dramatically
decreased infectiousness. These results suggest that the purified extract antagonizes HIV-1 infection of
susceptible cells by preventing viral attachment to the CD4 receptor.19
1. Baum MK, Shor-Posner G, Lai S, et al. High risk of HIV-related mortality is associated with selenium
deficiency. J Acquir Immune Defic Syndr Hum Retrovirol 1997;15(5):370-4.
2. Allard JP, Aghdassi E, Chau J, et al. Effects of vitamin E and C supplementation on oxidative stress and
viral load in HIV-infected subjects. Aids 1998;12(13):1653-9.
3. Favier A, Sappey C, Leclerc P, Faure P, Micoud M. Antioxidant status and lipid peroxidation in patients
infected with HIV. Chem Biol Interact 1994;91(2-3):165-80.
4. Beck MA, Levander OA. Dietary oxidative stress and the potentiation of viral infection. Annu Rev Nutr
1998;18:93-116.
5. Constans J, Seigneur M, Blann AD, et al. Effect of the antioxidants selenium and beta-carotene on HIV-
related endothelium dysfunction. Thromb Haemost 1998;80(6):1015-7.
6. Merin JP, Matsuyama M, Kira T, Baba M, Okamoto T. Alpha-lipoic acid blocks HIV-1 LTR-dependent
expression of hygromycin resistance in THP-1 stable transformants. FEBS Lett 1996;394(1):9-13.
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7. Opalenik SR, Ding Q, Mallery SR, Thompson JA. Glutathione depletion associated with the HIV-1
TAT protein mediates the extracellular appearance of acidic fibroblast growth factor. Arch Biochem
Biophys 1998;351(1):17-26.
8. Revell P, O'Doherty MJ, Tang A, Savidge GF. Folic acid absorption in patients infected with the human
immunodeficiency virus. J Intern Med 1991;230(3):227-31.
9. Remacha AF, Cadafalch J. Cobalamin deficiency in patients infected with the human immunodeficiency
virus. Semin Hematol 1999;36(1):75-87.
10. Beck KW, Schramel P, Hedl A, Jager H, Kaboth W. [Trace element concentrations in HIV infected
patients]. Onkologie 1989;12 Suppl 3:43-7.
11. Koch J, Neal EA, Schlott MJ, et al. Zinc levels and infections in hospitalized patients with AIDS.
Nutrition 1996;12(7-8):515-8.
12. Moreno T, Artacho R, Navarro M, Perez A, Ruiz-Lopez MD. Serum copper concentration in HIV-
infection patients and relationships with other biochemical indices. Sci Total Environ 1998;217(1-
2):21-6.
13. Graham NM, Sorensen D, Odaka N, et al. Relationship of serum copper and zinc levels to HIV-1
seropositivity and progression to AIDS. J Acquir Immune Defic Syndr 1991;4(10):976-80.
14. Mintz M. Carnitine in human immunodeficiency virus type 1 infection/acquired immune deficiency
syndrome. J Child Neurol 1995;10 Suppl 2:S40-4.
15. Famularo G, Moretti S, Marcellini S, et al. Acetyl-carnitine deficiency in AIDS patients with
neurotoxicity on treatment with antiretroviral nucleoside analogues. Aids 1997;11(2):185-90.
16. Folkers K, Langsjoen P, Nara Y, et al. Biochemical deficiencies of coenzyme Q10 in HIV-infection
and exploratory treatment. Biochem Biophys Res Commun 1988;153(2):888-96.
17. Noyer CM, Simon D, Borczuk A, Brandt LJ, Lee MJ, Nehra V. A double-blind placebo-controlled
pilot study of glutamine therapy for abnormal intestinal permeability in patients with AIDS. Am J
Gastroenterol 1998;93(6):972-5.
18. Hellerstein MK, Wu K, McGrath M, et al. Effects of dietary n-3 fatty acid supplementation in men
with weight loss associated with the acquired immune deficiency syndrome: Relation to indices of
cytokine production. J Acquir Immune Defic Syndr Hum Retrovirol 1996;11(3):258-70.
19. Yao XJ, Wainberg MA, Parniak MA. Mechanism of inhibition of HIV-1 infection in vitro by purified
extract of Prunella vulgaris. Virology 1992;187(1):56-62.
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