April 29, 2013
By 2015, more than 50% of the United States HIV population will be over 50. There are approximately 120,750 people now living with HIV/AIDS in NYC; 43% are over age 50, 75% are over age 40. Over 30% are co-infected with hepatitis.
What does the future hold for people with HIV and HIV/HCV as they get older?
These statistics and this question furnished the starting point for the New York Buyers’ Club March 28 event HIV and Aging: Living Long and Living Well, presented by Stephen Karpiak, PhD, of the AIDS Community Research Initiative of America (ACRIA).
Dr. Karpiak’s background uniquely positions him to paint the full picture behind the bare statistics, and to provide expert guidance through the complex healthcare challenges faced by the growing population of older people with HIV. After two decades as a researcher at Columbia University’s Medical School, Dr. Karpiak moved to Arizona, where he directed AIDS service organizations through the 1990s, including AIDS Project Arizona (which offered a supplements buyers’ club similar to NYBC’s). In 2002, back in NYC, he joined ACRIA as Assistant Director of Research, and was the lead investigator for the agency’s landmark 2006 study, Research on Older Adults with HIV. This report, the first in-depth look at the subject, surveyed 1,000 older HIV-positive New Yorkers on a host of issues, including health status, stigma, depression, social networks, spirituality, sexual behavior, and substance abuse.
Why are there more and more older people with HIV? The first and principal answer is very good news: HIV meds (HAART), introduced more than 20 years ago, have increased survival dramatically. Secondly, a smaller but still significant reason: older people are becoming infected with HIV, including through sexual transmission. (Older people do have sex, though sometimes healthcare providers don’t seem to acknowledge this reality.)
As Dr. Karpiak noted, HAART prevents the collapse of the immune system, and so it serves its main purpose, to preserve and extend life. And yet, as he reminded the audience, HIV infection initiates damaging inflammatory responses in the body that continue even when viral load is greatly suppressed. These inflammatory responses, together with side effects of the HIV meds, give rise to many health challenges as the years pass. In people with HIV on HAART, research over longer time periods has found higher than expected rates of cardiovascular disease, liver disease, kidney disease, bone loss (osteoporosis), some cancers, and neurological conditions like neuropathy.
That brings us to “multi-morbidity management”—a term we weren’t enthused about at first, since it sounded more like medical-speak than the plain talk our NYBC event had promised. But Dr. Karpiak gave us a simple definition: dealing with three or more chronic conditions at the same time (and HIV counts as one). He then made the case that this is a critical concept to grasp if older people with HIV are going to get optimal care. Multi-morbidity management, he explained, is a well-accepted healthcare concept in geriatric medicine, which recognizes that older people may have several conditions and will benefit from a holistic approach in order to best manage their health. Treating one condition at a time, without reference to other co-existing conditions, often doesn’t work, and sometimes leads to disastrously conflicting treatments.
And here’s where Dr. Karpiak warned about “polypharmacy”–another medical term worth knowing. “Polypharmacy” can be defined as using more than five drugs at a time. Frequently, it comes about when healthcare provider(s) add more and more pills to treat a number of conditions. But this approach can backfire, because, as a rule of thumb, for every medication added to a regimen, there’s a 10% increase in adverse reactions. That’s why adding more and more drugs to treat evolving conditions may be a poor approach to actually staying well.
In closing, Dr. Karpiak focused especially on a finding from ACRIA’s 2006 study: the most prevalent condition for older people with HIV, aside from HIV itself, was depression. Over two-thirds of those surveyed had moderate to severe depression. Yet while depression can have serious conse-quences–such as threatening adherence to HIV meds–it has remained greatly under-treated. It may seem an obvious truth, but as Dr. Karpiak underlined, psychosocial needs and how they’re met will play a big role in the health of people with HIV as they age. What social and community supports are available becomes a big medical question, and how healthcare providers and service organizations respond to it can make for longer, healthier lives for people with HIV.
And now we come back to NYBC’s contribution to the discussion on HIV and Aging. While NYBC doesn’t keep track of such information in a formal way, we do recognize that quite a few of our members have been using supplements since the days of our predecessor organization DAAIR–going back 20 years now. That’s a lot of accumulated knowledge about managing symptoms and side effects among people with HIV! To accompany the March 28 presentation, our Treatment Director George Carter drew up a pocket guide to complementary and alternative approaches: HIV and Aging – Managing and Navigating. Partly derived from his long experience, and partly drawn from a 2012 Canadian report, the guide ranges over those kinds of “co-morbidities” that Dr. Karpiak spoke of, including cardiovascular, liver, kidney, bone, and mental health conditions. Interventions or management strategies include supplements, but also diet and exercise recommendations, as well as psychosocial supports (counseling, support groups, meditation, and activism).
NYBC has also updated several info sheets from its website and blog, offering these as a way to address some of the most common healthcare issues facing people with HIV as they get older: cardiovascular topics; :digestive health; NYBC’s MAC-Pack (a close equivalent to K-PAX®); key antioxidants NAC and ALA and their potential to counter inflammatory responses; and supplement alternatives to anti-anxiety prescription drugs. These info sheets, together with the HIV and Aging – Managing and Navigating pocket guide, are available on the NYBC website and blog.
We hope that our HIV and Aging: Living Long and Living Well event has been useful to all. Special thanks to our audience on March 28, many of whom brought excellent questions to the session. Now let’s continue the conversation…
To your health,
New York Buyers’ Club
April 4, 2008
Nutrients for Liver Toxicity: Practical Guide from the Canadian AIDS Treatment Information Exchange (CATIE)
CATIE provides an information sheet on liver toxicity as part of its “Practical Guide to Managing HIV Drug Side-Effects.” This info sheet suggests ways of coping with liver impairment, which is frequent in people with HIV, and may result from a variety of factors, including medication side-effects, hepatitis co-infection, repeated use of antibiotics, alcohol or drug use, or a nutrient-poor, chemically-rich diet.
Here’s an excerpt on some supplementation strategies to counteract liver impairment:
In addition to removing, as much as possible, anything that might be stressing the liver, it is very important to add the therapeutic agents that can help the liver to detoxify, repair and protect itself. There are a number of potentially useful agents, listed below:
Nutrients to Maintain Glutathione
Glutathione (GSH) is the most important intracellular antioxidant and is crucially important for protecting the liver against toxicity when it goes about its task of breaking down drugs and other toxins. Taking the following nutrients may help to maintain or increase levels of glutathione:
–vitamin C (2–6 grams per day, in divided doses)
–N-acetyl-cysteine, or NAC (500 mg, 3 times per day; always take with food because taking it on an empty stomach can cause gastrointestinal tract irritation)
–L-glutamine (5 grams per day, increased up to 30–40 grams in those who also have diarrhea or wasting). Note that anyone with seriously compromised liver or kidney function should not take glutamine without a doctor’s approval since it is an amino acid that must be processed by those organs.
–alpha-lipoic acid, or thioctic acid (300-500 mg, twice daily; take on an empty stomach with fluids). Alpha-lipoic acid is a naturally occurring fatty acid that acts as a cellular coenzyme. It is very important to the liver cell metabolic pathways and can be rapidly depleted when the liver is under stress. It appears to help boost repair when there has been either virally induced or drug-induced liver damage. Note that alpha-lipoic acid disappears from the bloodstream very rapidly, so products made in an extended-release form will last longer and work better.
For anyone with liver dysfunction or disease, the above nutrients may be very important as part of a total treatment approach.
For people with fatty livers, another important nutrient is the amino acid carnitine. Researchers say that it may help prevent mitochondrial toxicity, thus helping the body to handle fat better. Early studies of its use for non-HAART-related elevated triglycerides in PHAs did, indeed, show successful lowering of the blood fat levels. Research in animals has shown its successful use in reversal of fatty livers. The usual dosage is two capsules (500 mg each) twice daily. The alternative is Carnitor, the basic form of carnitine, available by prescription only. It is usually prescribed in doses of 3,000 mg daily (three 330-mg capsules, 3 times daily). Too-high doses can cause diarrhea, so watch for this. Doses of plain carnitine need to be higher because the acetyl-L-carnitine releases four times as much free carnitine into the bloodstream, using equivalent doses.
Note that in addition to the individual supplements mentioned above, NYBC also stocks its combination of N-acetyl-cysteine and alpha-lipoic acid, ThiolNAC.
March 4, 2008
Silymarin/Milk Thistle: University of Washington laboratory study confirms this traditional botanical’s anti-inflammatory, anti-hepatitis C activity, and suggests its usefulness as an adjunct approach in managing chronic hepatitis C
In the May 2007 issue of Gastroenterology, investigators from the University of Washington/Seattle reported on a study of a standardized extract of milk thistle (silymarin), the botanical with a long tradition of use to treat liver disease. They concluded: “The data indicate that silymarin exerts anti-inflammatory and antiviral effects, and suggest that complementary and alternative medicine-based approaches may assist in the management of patients with chronic hepatitis C.”
OK–no big surprising news here. But it’s always nice to see more evidence and more detail about how and why a traditional botanical works effectively!
Citation: SJ Polyak, C Morishima, MC Shuhart, and others. Inhibition of T-cell inflammatory cytokines, hepatocyte NF-kappa B signaling, and HCV infection by standardized silymarin. Gastroenterology 132(5): 1925-1936. May 2007.
February 21, 2008
Here’s an excerpt from the New York Buyers’ Club guide to using nutritional supplements in the management of liver disease. This entry deals with SAMe, which you’ll also find discussed on this Blog for its use as an anti-depressant. (SAMe is currently the subject of a multi-year National Institutes of Health study of depression at Massachusetts General and Butler Hospitals.)
See also the NYBC entry on SAMe, which explains why it may be a good idea to use this supplement together with vitamins B6, B12, folic acid and, possibly, betaine (TMG).
S-adenosyl-L-methionine (SAMe). SAMe is an amino acid which helps in the manufacture of the “master antioxidant” glutathione in the liver. It appears to help cell membranes function normally, and assists the liver with detoxification (removal of toxins such as ethanol and pesticides from the system). SAMe can help to normalize bile secretion by the liver, a process commonly affected in chronic liver diseases. Interestingly, in several European studies of people living with hepatitis B or C, it has also been shown to help reduce jaundice, fatigue, and chronic skin irritation and itching, while also lowering liver enzymes and bilirubin levels. Dosages of SAMe in these studies were either 800 mg given intravenously or 800 to 1,600 mg given orally. No significant side effects were reported in any of the studies with SAMe in chronic liver disease.
As SAMe’s mechanism of action in the liver has become better understood by researchers, it’s been used to treat people with alcohol-induced damage to the liver. Basically, SAMe raises levels of the key antioxidant glutathione, which acts in the body to eliminate toxins such as ethanol and other poisons. In this way, SAMe can address cirrhosis and hepatitis stemming from alcohol abuse.
Other recent investigations have suggested that SAMe may play a role in preventing liver cancer, since it seems to have the ability to induce the death of cancerous liver cells. See, for example: Pascale RM, Simile MM, De Miglio MR, Feo F. Chemoprevention of hepatocarcinogenesis: S-adenosyl-L-methionine. Alcohol. 2002 Jul;27(3):193-8.
January 31, 2008
Milk thistle, or silymarin, has long been used as a botanical treatment for liver disease. In 2007, researchers at the University of California, Irvine, published a study showing that a biologically active component of milk thistle has significant effect against liver cancer cells (see brief summary below).
Compound of milk thistle (silymarin) has a significant anti-cancer effect
Dr. Ke-Qin Hu and his research team at the University of California, Irvine recently published a study showing the significant anti-cancer effects of silibinin, a major biologically active compound of milk thistle (aka silymarin). Milk thistle has a long tradition of use as a remedy for liver diseases, is generally safe and well-tolerated, and is also known to protect the liver from drug or alcohol-related injury. (Silibinin is purified from milk thistle, with a defined chemical structure and molecular weight.)
Dr. Hu is an experienced research scientist and physician in the field of hepatology. He has published over 70 scientific journal articles, many focused on viral hepatitis B and C, cirrhosis, and liver cancer.
Dr. Hu and his research team found that silibilin can significantly reduce the growth of several human hepatoma cell lines. These findings suggest that silibinin can be used to prevent the development of liver cancer, one of the most common cancers worldwide.
Lah JJ, Cui W, Hu KQ. Effects and mechanisms of silibinin on human hepatoma cell lines.
World J Gastroenterol 2007; 13(40): 5299-5305
September 21, 2007
NYBC is taking a look at a Health Concerns liver tonic called HEPATOPLEX. Our interest was sparked because a long-time NYBC member attended a seminar led by Misha Cohen, a Lic. Ac. who’s been instrumental in developing some of the Chinese herb combinations for Health Concerns.
To read Misha Cohen’s Interferon Treatment Protocol (as well as general remarks on managing hepatitis treatment using Eastern, Western, or a combination of Eastern and Western approaches), go to
For more information on Hepatoplex, see also the NYBC website:
Hepatoplex One (earlier stage liver disease, little fibrosis)–
and Hepatoplex Two (chronic hepatitis with cirrhosis and fibrosis)–
As always, NYBC’s membership co-op wants to hear about the experience people have with the items we stock. So if you use either of the Hepatoplex products, let us know about outcomes, or about any comments/questions/concerns you may have.
NYBC’s email: email@example.com