HIV and AIDS Support

Also indexed as: Acquired Immunodeficiency Syndrome, AIDS Support

Acquired immunodeficiency syndrome (AIDS) is a condition in which the immune system becomes severely weakened and loses its ability to fight infections. Although some scientists, including a Nobel Prize-winning chemist, have questioned whether or not the human immunodeficiency virus (HIV) has actually been proven to cause AIDS,1 2 3 most researchers do believe that HIV causes AIDS.

AIDS is an extremely complex disorder, and no cure is currently available. Certain drugs appear to be capable of slowing the progression of the disease. In addition, various nutritional factors may be helpful. However, because of the complicated nature of this disorder, medical supervision is strongly recommended with regard to dietary changes and nutritional supplements. People who have been infected with HIV are hereafter referred to as “HIV-positive.”

Checklist for HIV and AIDS Support

Rating Nutritional Supplements Herbs
2Stars Arginine (in combination with HMB and glutamine) for preservation of lean body mass
DHEA (for fatigue and depression)
Glutamine (in combination with HMB and arginine) for preservation of lean body mass
Hydroxymethylbutyrate (HMB) (in combination with glutamine and arginine) for preservation of lean body mass
Multiple vitamin-mineral
N-acetyl cysteine
Saccharomyces boulardii
Selenium
Zinc		 Boxwood
Licorice
Sangre de Drago (for HIV-associated diarrhea)
1Star Beta-carotene
Coenzyme Q10
Folic acid
Glutamine
Iron
Methionine
Thymus extracts
Vitamin A
Vitamin B1
Vitamin B12
Vitamin B3
Vitamin B6
Vitamin C (oral and topical)
Vitamin E		 Andrographis
Asian ginseng
Bupleurum (in combination with peony root, pinellia root, cassia bark, ginger root, jujube fruit, Asian ginseng root, Asian scullcap root, and licorice root.)
Cat’s claw
Echinacea
Eleuthero
Garlic
Maitake
Mistletoe
Reishi
Shiitake
St. John’s wort
Tea tree oil
Turmeric
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of HIV and AIDS? HIV causes a broad spectrum of clinical problems, which often mimic other diseases. Within a few weeks of infection, some people may experience flu-like signs and symptoms, including fever, malaise, rash, joint pain, and generalized swelling of the lymph nodes. These acute manifestations usually disappear, and many people remain asymptomatic for long periods. AIDS, the clinical syndrome associated with HIV infection, produces symptoms throughout the body related to opportunistic infections, tumors, and other immune-deficiency complications.

How is it treated? Three main classes of antiviral drugs are used to treat HIV infection: nucleoside analog reverse transcriptase inhibitors (e.g., zidovudine [ZDV, AZT, Retrovir®], didanosine [ddI, Videx®], zalcitibine [ddC, Hivid®], stavudine [d4T, Zerit®], lamivudine [3TC, Epivir®]); non-nucleoside reverse transcriptase inhibitors (e.g., nevirapine [Viramune®], delavirdine [Rescriptor®]); and protease inhibitors (e.g., saquinavir [Fortovase™, Invirase™], ritonavir [Norvir®], indinavir [Crixivan®], nelfinavir [Viracept®]). Several other investigational drugs are also used. Treatment with two to four of these drugs is standard. Treatment of the complications of AIDS is specific to the infection or complication present, and frequently includes antibiotics, antifungal medications, corticosteroids, and heart drugs.

Dietary changes that may be helpful: People with AIDS often lose significant amounts of weight or suffer from recurrent diarrhea. A diet high in protein and total calories may help a person maintain his or her body weight. In addition, whole foods are preferable to refined and processed foods. Whole foods contain larger amounts of many vitamins and minerals, and people with HIV infection tend to suffer from multiple nutritional deficiencies.

Nonetheless, no evidence currently suggests that dietary changes are curative for people with AIDS, or even that they significantly influence the course of the disease. In fact, a controlled trial comparing the efficacy of three nutritional regimens in the prevention of weight loss in HIV-positive people found no benefit from increasing caloric intake.4 A 500-calorie per day caloric supplement with fatty acids plus a multivitamin and minerals did not promote increases in body weight beyond that offered by a multivitamin-mineral supplement alone.

AIDS-related weight loss and chronic diarrhea are sometimes the result of abnormal intestinal function in the absence of an infectious organism. This condition, called “HIV enteropathy” (pronounced “en-ter-OP-a-thee”), may respond to a gluten-free diet. In a preliminary trial,5 men with HIV enteropathy were given a gluten-free diet for one week. During that week, the number of episodes of diarrhea decreased by nearly 40%. When gluten-containing foods were re-introduced for a week, the diarrhea returned. When they were eliminated a second time, again for one week, the episodes of diarrhea were again reduced. Participants in the study also experienced significant weight gain during the gluten-free periods.

Lifestyle changes that may be helpful: Loss of strength and lean body mass are frequent complications in people with AIDS. Drug therapy with anabolic steroids is sometimes used to counteract these losses. Preliminary trials suggest that progressive resistance training (i.e., weight training) may be used as an alternative or adjunct to steroids in this disease. In a preliminary trial, people with HIV who did progressive resistance training three times per week for eight weeks had significant increases in their lean body mass.6 Exercise of any type three to four times per week or more has been associated with slower progression to AIDS at one year and with a slower progression to death from AIDS at one year in men.7

Nutritional supplements that may be helpful: Because people with HIV infection or AIDS often have multiple nutritional deficiencies, a broad-spectrum nutritional supplement may be beneficial. In one trial, HIV-positive men who took a multivitamin-mineral supplement had slower onset of AIDS, compared with men who did not take a supplement.8 Use of a multivitamin by pregnant and breast-feeding Tanzanian women with HIV did not affect the risk of transmission of HIV from mother to child, either in utero, during birth, or from breast-feeding.9

Selenium deficiency is an independent factor associated with high mortality among HIV-positive people.10 HIV-positive people who took selenium supplements experienced fewer infections, better intestinal function, improved appetite, and improved heart function (which had been impaired by the disease) than those who did not take the supplements.11 The usual amount of selenium taken was 400 mcg per day.

Selenium deficiency has been found more often in people with HIV-related cardiomyopathy (heart abnormalities) than in those with HIV and normal heart function.12 People with HIV-related cardiomyopathy may benefit from selenium supplementation. In a small preliminary trial, people with AIDS and cardiomyopathy, 80% of whom were found to be deficient in selenium, were given 800 mcg of selenium per day for 15 days, followed by 400 mcg per day for eight days. Improvements in heart function were noted after selenium supplementation.13 People wishing to supplement with more than 200 mcg of selenium per day should be monitored by a doctor.

The amino acid, N-acetyl cysteine (NAC), has been shown to inhibit the replication of HIV in test tube studies.14 In a double-blind trial, supplementing with 800 mg per day of NAC slowed the rate of decline in immune function in people with HIV infection. NAC also promotes the synthesis of glutathione, a naturally-occurring antioxidant that is believed to be protective in people with HIV infection and AIDS.15

The combination of glutamine, arginine, and the amino acid derivative, hydroxymethylbutyrate (HMB), may prevent loss of lean body mass in people with AIDS-associated wasting. In a double-blind trial, AIDS patients who had lost 5% of their body weight in the previous three months received either placebo or a nutrient mixture containing 1.5 grams of HMB, 7 grams of L-glutamine, and 7 grams of L-arginine twice daily for eight weeks.16 Those supplemented with placebo gained an average of 0.37 pounds, mostly fat, but lost lean body mass. Those taking the nutrient mixture gained an average of 3 pounds, 85% of which was lean body weight.

In a double-blind trial, the non-disease-causing yeast Saccharomyces boulardii (1 gram three times per day) helped stop diarrhea in HIV-positive people.17 However, people with severely compromised immune function have been reported to develop yeast infections in the bloodstream after consuming some yeast organisms that are benign for healthy people.18 19 For that reason, people with HIV infection who wish to take Saccharomyces boulardii, brewer’s yeast (Saccharomyces cerevisiae), or other live organisms should first consult a doctor.

A deficient level of dehydroepiandrosterone sulfate (DHEAS) in the blood is associated with poor outcomes in people with HIV.20 Large amounts of supplemental dehydroepiandrosterone (DHEA) may alleviate fatigue and depression in HIV-positive men and women. In a preliminary trial, men and women with HIV infection took 200–500 mg of DHEA per day for eight weeks.21 All participants initially had both low mood and low energy. After eight weeks of DHEA supplementation, 72% of the participants reported their mood to be “much improved” or “very much improved,” and 81% reported having significant improvements in energy level. DHEA supplementation had no effect on CD4 cell (helper T-cell) counts or testosterone levels.

Vitamin A deficiency appears to be very common in people with HIV infection. Low blood levels of vitamin A are associated with greater disease severity22 and increased transmission of the virus from a pregnant mother to her infant.23 However, in preliminary 24 and double-blind25 26 trials, supplementation with vitamin A failed to reduce the overall mother-to-child transmission of HIV. HIV-positive women who took 5,000 IU per day of vitamin A (as retinyl palmitate) and 50,000 IU per day of beta-carotene during the third trimester (13 weeks) of pregnancy, plus an additional single amount of 200,000 IU of vitamin A at delivery, had the same rate of transmission of HIV to their infants as those who did not take the supplement. However, lower rates of illness have been observed in the children of HIV-positive mothers when the children were supplemented with 50,000–200,000 IU of vitamin A every two to three months.27

Little research has explored whether vitamin A supplements are helpful at halting disease progression. HIV-positive children given two consecutive oral supplements of vitamin A (200,000 IU in a gelcap) in the two days following influenza vaccinations had a modest but significant decrease in viral load.28 In one trial, giving people an extremely high (300,000 IU) amount of vitamin A one time only did not improve short-term measures of immunity in women with HIV.29

Beta-carotene levels have been found to be low in HIV-positive people, even in those without symptoms.30 However, trials on the effect of beta-carotene supplements have produced conflicting results. In one double-blind trial, supplementing with 300,000 IU per day of beta-carotene significantly increased the number of CD4+ cells in people with HIV infection.31 In another trial, the same amount of beta-carotene had no effect on CD4+ cell counts or various other measures of immune function in HIV-infected people.32

In HIV-positive people with B-vitamin deficiency, the use of B-complex vitamin supplements appears to delay progression to and death from AIDS.33 Thiamine (vitamin B1) deficiency has been identified in nearly one-quarter of people with AIDS.34 It has been suggested that a thiamine deficiency may contribute to some of the neurological abnormalities that are associated with AIDS. Vitamin B6 deficiency was found in more than one-third of HIV-positive men; vitamin B6 deficiency was associated with decreased immune function in this group.35 In a population study of HIV-positive people, intake of vitamin B6 at more than twice the recommended dietary allowance (RDA is 2 mg per day for men and 1.6 mg per day for women) was associated with improved survival.36 Low blood levels of folic acid and vitamin B12 are also common in HIV-positive people.37

Preliminary observations suggest a possible role for vitamin B3 in HIV prevention and treatment.38 A form of vitamin B3 (niacinamide) has been shown to inhibit HIV in test tube studies.39 However, no published data have shown vitamin B3 to inhibit HIV in animals or in people. One study did show that HIV-positive people who consume more than 64 mg of vitamin B3 per day have a decreased risk of progression to AIDS or AIDS-related death.40 41 Clinical trials in humans are required to validate these preliminary observations.

Vitamin C has been shown to inhibit HIV replication in test tubes.42 Intake of vitamin C by HIV-positive persons may be associated with a reduced risk of progression to AIDS.43 Some doctors recommend large amounts of vitamin C for people with AIDS. Reported benefits in preliminary research include greater resistance against infection and an improvement in overall well-being.44 The amount of vitamin C used in that study ranged from 40 to 185 grams per day. Supplementation with such large amounts of vitamin C must be monitored by a doctor. This same researcher also reports some success in using a topical vitamin C paste to treat herpes simplex outbreaks and Kaposi’s sarcoma in people with AIDS.

In test-tube studies, vitamin E improved the effectiveness of the anti-HIV drug zidovudine (AZT) while reducing its toxicity.45 Similarly, animal research suggests that zinc and NAC supplementation may protect against AZT toxicity.46 It is not known whether oral supplementation with these nutrients would have similar effects in people taking AZT.

Blood levels of coenzyme Q10 (CoQ10) were also found to be low in people with HIV infection or AIDS. In a small preliminary trial, people with HIV infection took 200 mg per day of CoQ10. Eighty-three percent of these people experienced no further infections for up to seven months, and the counts of infection-fighting white blood cells improved in three cases.47

Blood levels of both zinc48 and selenium 49 are frequently low in people with HIV infection. Zinc supplements (45 mg per day) have been shown to reduce the number of infections in people with AIDS.50

Iron deficiency is often present in HIV-positive children.51 While iron is necessary for normal immune function, iron deficiency also appears to protect against certain bacterial infections.52 Iron supplementation could therefore increase the severity of bacterial infections in people with AIDS. For that reason, people with HIV infection or AIDS should consult a doctor before supplementing with iron.

The amino acid, glutamine, is needed for the synthesis of glutathione, an important antioxidant within cells that is frequently depleted in people with HIV and AIDS.53 In well-nourished people, the body usually manufactures enough glutamine to prevent a deficiency. However, people with HIV or AIDS are often malnourished and may be deficient in glutamine.54 In such people, glutamine supplementation may be needed, along with NAC, to maintain adequate levels of glutathione. It is not known how much glutamine is needed for that purpose; however, in other trials, 4–8 grams of glutamine per day was used.55 In a double-blind trial, massive amounts of glutamine (40 grams per day) in combination with several antioxidants (27,000 IU per day of beta-carotene; 800 mg per day of vitamin C; 280 mcg per day of selenium; 500 IU per day of vitamin E) were given for 12 weeks to AIDS patients experiencing problems maintaining normal weight.56 Those who took the glutamine-antioxidant combination experienced significant gains in body weight compared with those taking placebo. Larger trials are needed to determine the possible benefits of this nutrient combination on reducing opportunistic infections and long-term mortality.

People with AIDS have low levels of methionine. Some researchers suggest that these low methionine levels may explain some aspects of the disease process,57 58 59 especially the deterioration that occurs in the nervous system and is responsible for symptoms such as dementia.60 61 A preliminary trial found that methionine (6 grams per day) may improve memory recall in people with AIDS-related nervous system degeneration.62

In a preliminary trial, a thymus extract known as Thymomodulin® improved several immune parameters among people with early HIV infection, including an increase in the number of T-helper cells.63

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Many different herbs have been shown in test tube studies to inhibit the function or replication of HIV. Few of these studies have been followed up with any kind of investigation in HIV-positive humans. Some notable exceptions to this rule are discussed below.

There are three categories of herbs used in people with HIV infection. The first are herbs that are believed to directly kill HIV (antiretroviral herbs). The second are herbs that strengthen the immune system to better withstand HIV’s onslaught (immuno-modulating herbs). The third are herbs that combat opportunistic infections (antimicrobial herbs). The following table summarizes each category and herbs that belong in each. Note that some herbs fall into more than one category.

Category of Herb Supporting Evidence from Human Trials Supporting Evidence from Test Tube Studies
Antiretroviral Andrographis, boxwood, licorice, St. John’s wort Garlic
Immuno-modulators Andrographis (possible antiretroviral), Asian ginseng, bupleurum, echinacea, licorice, mistletoe, Sangre de Drago, turmeric Herbs: ashwagandha, eleuthero, schisandra

Mushrooms: coriolus, maitake, reishi, shiitake
Antimicrobial Garlic, tea tree oil  

One double-blind trial has found that 990 mg per day of an extract of the leaves and stems of boxwood (Buxus sempervirens) could delay the progression of HIV infection (as measured by a decline in CD4 cell counts).64 No adverse effects directly attributable to the extract were reported. Taking twice the amount of boxwood extract did not lead to further benefits and may have actually decreased its usefulness.

Licorice has shown the ability to inhibit reproduction of HIV in test tubes.65 Clinical trials have shown that injections of glycyrrhizin (isolated from licorice) may have a beneficial effect on AIDS.66 There is preliminary evidence that orally administered licorice also may be safe and effective for long-term treatment of HIV infection.67 Amounts of licorice or glycyrrhizin used for treating HIV-positive people warrant monitoring by a physician, because long-term use of these substances can cause high blood pressure, potassium depletion, or other problems. Approximately 2 grams of licorice root should be taken per day in capsules or as tea. Deglycyrrhizinated licorice (DGL) will not inhibit HIV.

An extract from stem bark latex of Sangre de Drago (Croton lechleri), an herb from the Amazon basin of Peru, has demonstrated significant anti-diarrheal activity in preliminary68 and double-blind trials. Additional double-blind research has demonstrated the extract’s effectiveness for diarrhea associated with HIV infection and AIDS.69 70 Very high amounts of this extract (350–700 mg four times daily for seven or more days) were used in the studies. Such levels of supplementation should always be supervised by a doctor. Most of this research on Sangre de Drago is unpublished, and much of it is derived from manufacturers of the formula. Further double-blind trials, published in peer-reviewed medical journals, are needed to confirm the efficacy reported in these studies.

A constituent from St. John’s wort known as hypericin has been extensively studied as a potential way to kill HIV. A preliminary trial found that people infected with HIV who took 1 mg of hypericin per day by mouth had some improvements in CD4+ cell counts, particularly if they had not previously used AZT.71 A small number of people developed signs of mild liver damage in this study. Another much longer preliminary trial used injectable extracts of St. John’s wort twice a week combined with three tablets of a standardized extract of St. John’s wort taken three times per day by mouth. This study found not only improvements in CD4+ counts but only 2 of 16 participants developed opportunistic infections.72 No liver damage or any other side effects were noted in this trial. In a later study, much higher amounts of injectable or oral hypericin (0.25 mg/kg body weight or higher) led to serious side effects, primarily extreme sensitivity to sunlight.73 At this point, it is unlikely that isolated hypericin or supplements of St. John’s wort extract supplying very high levels of hypericin can safely be used by people with HIV infection, particularly given St. John’s wort’s many drug interactions.

Garlic may assist in combating opportunistic infections. In one trial, administration of an aged garlic extract reduced the number of infections and relieved diarrhea in a group of patients with AIDS.74 Garlic’s active constituents have also been shown to kill HIV in the test tube, though these results have not been confirmed in human trials.75

A preliminary trial of isolated andrographolides, found in andrographis, determined that while they decreased viral load and increased CD4 lymphocyte levels in people with HIV infection, they also caused potentially serious liver problems and changes in taste in many of the participants.76 It is unknown whether andrographis directly killed HIV or was having an immune-strengthening effect in this trial.

Other immune-modulating plants that could theoretically be beneficial for people with HIV infection include Asian ginseng, eleuthero, and the medicinal mushrooms shiitake and reishi. One preliminary study found that steamed then dried Asian ginseng (also known as red ginseng) had beneficial effects in people infected with HIV, and increased the effectiveness of the anti-HIV drug, AZT.77 This supports the idea that immuno-modulating herbs could benefit people with HIV infection, though more research is needed.

The Chinese herb bupleurum, as part of the herbal formula sho-saiko-to, has been shown to have beneficial immune effects on white blood cells taken from people infected with HIV.78 Sho-saiko-to has also been shown to improve the efficacy of the anti-HIV drug lamivudine in the test tube.79 One preliminary study found that 7 of 13 people with HIV given sho-saiko-to had improvements in immune function.80 Double-blind trials are needed to determine whether bupleurum or sho-saiko-to might benefit people with HIV infection or AIDS. Other herbs in sho-saiko-to have also been shown to have anti-HIV activity in the test tube, most notably Asian scullcap.81 Therefore studies on sho-saiko-to cannot be taken to mean that bupleurum is the only active herb involved. The other ingredients are peony root, pinellia root, cassia bark, ginger root, jujube fruit, Asian ginseng root, Asian scullcap root, and licorice root.

Maitake mushrooms, which are currently being studied, contain immuno-modulating polysaccharides (including beta-D-glucan) that may be supportive for HIV infection.82 83

A controversy has surrounded the use of echinacea in people infected with HIV. Test tube studies initially showed that echinacea’s polysaccharides could increase levels of a substance that might stimulate HIV to spread.84 However, these results have not been shown to occur when echinacea is taken orally by humans.85 In fact, one double-blind trial found that Echinacea angustifolia root (1 gram three times per day by mouth) greatly increased immune activity against HIV, while placebo had no effect.86 Further studies are needed to determine the safety of using echinacea in HIV-positive people.

The story of European mistletoe is similar to that of echinacea. Though originally believed to be a problem based on test tube studies, preliminary human clinical trials of mistletoe injections into the skin have shown only beneficial effects.87 88 Oral mistletoe is very unlikely to have the same effects as injected mistletoe. Injectable mistletoe should only be used under the supervision of a qualified healthcare professional.

Turmeric may be another useful herb with immune effects in people infected with HIV. One preliminary trial found that curcumin, the main active compound in turmeric, helped improve CD4+ cell counts.89 The amount used in this study was 1 gram three times per day by mouth. These results differed from those found in a second preliminary trial using 4.8 or 2.7 grams of curcumin daily. In that study, there was no apparent effect of curcumin on HIV replication rates.90

Cat’s claw is another immuno-modulating herb. Standardized extracts of cat’s claw have been tested in small, preliminary trials in people infected with HIV, showing some benefits in preventing CD4 cell counts from dropping and in preventing opportunistic infections.91 92 Further study is needed to determine whether cat’s claw is truly beneficial for people with HIV infection or AIDS.

A 5% solution of tea tree oil has been shown to eliminate oral thrush in people with AIDS, according to one preliminary trial.93 The volunteers in the study swished 15 ml of the solution in their mouths four times per day and then spit it out. This may cause mild burning for a short period of time after use.

A trial of a combination naturopathic protocol (consisting of multiple nutrients, licorice, lomatium, a combination Chinese herbal product, lecithin, calf thymus extract, lauric acid monoglycerol ester, and St. John’s wort) showed a possible slowing of the progression of mild HIV infection and a reduction of some symptoms.94 Because there was no placebo group in this trial, the findings must be considered preliminary; controlled trials are needed to determine whether this protocol is effective.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

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