10.29.07
Probiotics, soluble fiber, and L-glutamine (LGN) reduce nelfinavir (NFV)- or lopinavir / ritonavir (LPV / r)-related diarrhea
Here’s an article from 2004.
Note the combination of probiotics, soluble fiber, and glutamine used:
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Carla R. Heiser, MS, RD, LD Center for Functional Nutrition, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA ; Judith A. Ernst, DMSc, RD Indiana University, Indianapolis, Indiana, USA; James Tom Barrett, MD Howard Brown Health Center, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA; Neel French, MD and Malte Schutz, MD Howard Brown Health Center, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA; Michael P. Dube, MD Indiana University, Indianapolis, Indiana, USA
Purpose: Highly active antiretroviral therapy (HAART) can be associated with diarrhea and other gastrointestinal (GI) side effects. Reducing these side effects may improve treatment durability and quality of life (QOL). This study assessed the impact of nutritional co-therapies known to reduce diarrhea in HIV-positive men treated with nelfinavir (NFV)- or lopinavir/ritonavir (LPV/r)-containing regimens. Methods: Thirty-five HIV-positive men treated with NFV (n = twenty-seven) or LPV/r (n = eight) with diarrhea (± two liquid stools/day [d]) participated in a 12-week prospective study. Twenty-eight subjects were randomly assigned supplements (S), seven received standard of care (C). Group S received probiotics (1.2g/d) and soluble fiber (11g/d). If diarrhea persisted at week 4, 30g/d L-Glutamine (GLN) was added. Diarrhea incidence, as well as supplement and antidiarrheal use, was assessed monthly. Results: Weight, CD4 count, and HIV RNA were unchanged in both groups. Diarrhea completely resolved in 10 of 28 (36 percent) S subjects. The mean (± SD) number of stools/d declined [3.40 ± 1.25 to 2.54 ± 1.34 (p < 0.01)]. Diarrhea (loose, watery stools/d) lessened in S from 2.84 ± 1.42 to 0.74 ± 1.03 (p < 0.0001). Fifteen S subjects did not obtain full relief with probiotics and fiber, but stools/d decreased from 4.08 ± 1.35 to 3.06 ± 1.68 (p < 0.05) after starting GLN. In C, stools/d, 4.14 ± 4.86 to 3.44 ± 1.68(p = 0.678) and incidence of diarrhea/d, 3.00 ± 4.82 to 1.36 ± 1.29 (p= 0.361) was unchanged. In S, loperamide use decreased from 1.69 ± 2.34 to 0.31 ± 0.69 mg/d (p < 0.01); 18 versus eight subjects used loperamide at 0 and 12 weeks, respectively. Conclusion: Probiotics, soluble fiber, and GLN significantly reduced diarrhea for subjects receiving NFV or LPV/r. Nutritional co-therapies show clinical benefit in HIV-positive men with diarrhea.
Citation: J Int Assoc Physicians AIDS Care (Chic Ill) 3: 121-129
Statins and people with HIV: overview of special concerns
This information from www.aidsmap.com provides a good overview of the special concerns involved in the prescription of cholesterol-lowering statins for people with HIV. (Note: references to the scientific literature in this piece may be retrieved by going back to the aidsmap website.)
You may want to read this information together with our posts on Niacin +statins, an emerging standard of care for cholesterol control (see under Niacin on this Blog).
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Atorvastatin (Lipitor) is a statin that can reduce the levels of low-density lipoprotein (LDL or ‘bad’) cholesterol in the blood. This can reduce the risk of cardiovascular disease, including heart attacks and strokes. Statins work by inhibiting the enzyme 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, which is responsible for the production of cholesterol.
Patients with liver disease or who are pregnant should not take statins. However, they are safe drugs in most patients. The main side-effects are muscle pain, as well as headache, altered liver function, tingling sensations, abdominal pain, flatulence, constipation, diarrhoea, nausea and vomiting.
Statins, including atorvastatin, are effective in the treatment of the alterations of blood fat levels due to treatment with anti-HIV drugs, particularly protease inhibitors. However, atorvastatin is broken down by the cytochrome P450 3A4 enzyme, and interacts with all available protease inhibitors and non-nucleoside reverse transcriptase inhibitors (NNRTIs).
Protease inhibitors cause an increase in atorvastatin levels, increasing the risk of side-effects such as muscle pain and damage to the muscle fibres. Consequently, patients taking protease inhibitors should use another statin such as pravastatin sodium (Lipostat) or fluvastatin (Lescol) in place of atorvastatin, or they should use the lowest possible dose of atorvastatin with caution.
In contrast, NNRTIs reduce the levels of atorvastatin, putting patients at risk of poor anti-cholesterol effects. Patients taking an NNRTI and atorvastatin should have their dose of atorvastatin adjusted as required to keep cholesterol levels low.
Some experts believe that statins may have anti-HIV properties in their own right. However, a recent study found that atorvastatin failed to prevent CD4 cell count declines in patients interrupting anti-HIV treatment.
L-carnitine and HIV
Here’s a brief extract on “L-Carnitine and HIV,” as presented by www.aidsmap.com, the website of NAM*, the UK-based HIV/AIDS information exchange.
L-carnitine suppresses the production of tumour necrosis factor, which is responsible for wasting in HIV-positive people. Patients taking L-carnitine have reported reduced fatigue and greater energy.A six-month study of carnitine supplementation also significantly reduced the frequency of CD4 and CD8 T-cell death and produced higher CD4 cell counts. There is substantial evidence from an Italian research group that L-carnitine inhibits HIV-related cell death by targeting the immune system rather than the virus itself.
* From the www.aidsmap.com website: NAM is an award-winning, community-based organisation, which works from the UK. We deliver reliable and accurate HIV information across the world to HIV-positive people and to the professionals who treat, support and care for them. NAM is a UK registered charity number 1011220.
NAM’s publications are evidence-based and reviewed by two international medical panels and one of HIV-positive people, which ensure accuracy, balance, relevance, and accessibility.
