We be JAMA! Report: Multivitamin + selenium slows progression of early-stage HIV

We’re tempted to file this story under the heading of “news that we already knew,” but it’s still good to get a stamp of approval in the form of publication in Journal of the American Medical Association (JAMA), one of the top medical journals in the U.S., if not the world.

At NYBC and at our predecessor DAAIR we have long recognized the development of vitamin and mineral deficiencies in HIV, and have long recommended multivitamin/mineral supplements to counter those health-threatening deficiencies. We have also followed for years the work of Marianna Baum, lead author of the JAMA study, who has focused attention on the mineral selenium, which may have an important role in preventing replication of HIV. So, while this story doesn’t come as a complete surprise, it’s great to have further support for some long-held practices.

The combination of a daily multivitamin
plus the mineral selenium
proved to be an effective regimen,
cutting by about half
the risk of reaching the point
where ARV therapy would be recommended

Baum’s study was conducted in Botswana, where nearly one in four adults is infected with HIV. The trial followed about 900 newly infected adults who were not yet taking any HIV medications. These participants were divided into groups that randomly received different combinations of vitamins, the mineral selenium, or a placebo. Over the study’s two-year period, the combination of a daily multivitamin plus the mineral selenium proved to be the effective regimen, cuting by about half the risk of reaching the point where ARV therapy would be recommended in Botswana (CD4 count of 200-250).

Baum’s findings are especially relevant for early-stage HIV infection, where the multivitamin + selenium combination proved its value in cutting risk of progression, and actually decreased the likelihood that participants would reach the point where antiretroviral meds would be recommended. Other research, such as Dr. Jon Kaiser’s study of a multivitamin + antioxidants, has been directed at those who are using antiretroviral meds, and may have developed some symptoms or side effects such as peripheral neuropathy. Kaiser’s finding that the multivitamin + antioxidants combination could increase CD4 counts led to the development of K-PAX, and also motivated NYBC to offer its MAC Pack, a close equivalent of K-PAX, assembled from hand-picked products from NYBC’s catalog.

Taken together, the Baum and Kaiser studies suggest to us the value of long-term supplementation strategies that can slow progression of HIV, oppose the known, damaging deficiencies that are likely to develop with HIV, and help stabilize and even improve health for people with HIV, whether they are taking antiretroviral meds or not.

 

If you’d like to get started with NYBC’s MAC-Pack, or if you’d like to find a multivitamin + selenium combination,
please visit our website. You can also call our toll-free number at (800) 650-4983
for further information and advice about supplement strategies for HIV.

This article from the Spring 2014 edition of SUPPLEMENT: Newsletter of the New York Buyers’ Club, available for download at http://www.NewYorkBuyersClub.org

 

References:

Baum, M. et al. Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic, Antiretroviral-Naive, HIV-Infected Adults in Botswana: : A Randomized Clinical Trial. JAMA. 2013;310(20):2154-2163. doi:10.1001/jama.2013.280923. 

Kaiser, J. Micronutrient Supplementation Increases CD4 Count in HIV-infected Individuals on Highly Active Antiretroviral Therapy: A Prospective, Double-Blinded, Placebo-Controlled Trial. Kaiser JK, et al. JAIDS 2006;42[5]: 523-528.

 

Top Ten Reasons to Support the New York Buyers’ Club

As we reach the finish of the New York Buyers’ Club fundraiser, we thought it was time to circulate the “Top Ten Reasons” to support NYBC–in case there are those of you out there who aren’t familiar with the unique contributions this nonprofit co-op and information exchange makes to the lives of people with HIV and/or Hepatitis C.

Learn more and make your donation at

http://www.indiegogo.com/projects/empower-people-with-hiv-hep-c-to-thrive

TOP TEN REASONS TO SUPPORT THE NEW YORK BUYERS’ CLUB

1. ThiolNAC. NYBC is the only source for this formula combining two widely recommended and well-researched antioxidants, alpha lipoic acid and NAC (N-acetylcysteine). ThiolNAC is especially useful for people with HIV and those with liver disease. NYBC’s combination formula reduces both cost and pill count.

2. NYBC stocks a unique lineup of high quality, specially formulated multivitamins, including Added Protection and Ultra Preventive Beta from Douglas Labs, and the Super Immune Multivitamin and Opti-Energy Easy Swallow from SuperNutrition, Member pricing for these multis is very low—in fact, Douglas asked us to hide the Member price from the general public!

3. NYBC’s MAC Pack and Opti-MAC Pack provide a mix of antioxidants and micronutrients very similar to those in K-PAX®, but at half the price. (Included in many formularies, K-PAX®, is based on Dr. Jon Kaiser’s 2006 journal article that reported an increase in CD4 count for people with HIV taking the nutrient combination.)

4. NYBC stocks a wide selection of Traditional Chinese Medicine supplements, from suppliers like Health Concerns, Pacific Biologic, and Zhang. (NOTE: Zhang products are available only if you log into the NYBC website as a Member.)

5. PharmaNAC®. This effervescent, extremely stable form of NAC (N-acetylcysteine) supports respiratory and immune function. In particular, it holds promise for people with cystic fibrosis, according to recent clinical trials conducted at Stanford. NYBC has stocked an effervescent form of NAC since 2004, based on its well-supported usefulness for chronic conditions.

6. NYBC specializes in probiotics like Florastor® and Jarro-Dophilus EPS. Probiotics support gastrointestinal health, a foundation for general health. And, a recent review in the Journal of the American Medical Association found probiotics effective for preventing and treating antibiotic-related diarrhea, a common side effect.

7. NYBC monitors and presents to its Members the latest research on supplements to support cardiovascular health, including fish oil, CoQ10, plant sterols, and Vitamin D.

8. NYBC annual membership is a tremendous bargain at $5 (low-income, unemployed), $10 (middle-income), or $25 (higher income). Do you know of any other organization that offers annual memberships as low as $5, yet gives you such significant savings?

9. The NYBC Blog alphabetically indexes more than 400 informative posts, providing the latest research news about supplements in an easy-to-read online format.

10. Yes, you can talk to a live person at NYBC! Our Treatment Director, George Carter, has two decades of experience with supplement research, especially for people with HIV and/or liver disease. Reach him at our toll-free number 800-650-4983.

MAC-Pack and Opti MAC-PACK: Alternatives to K-PAX at HALF THE PRICE

K-PAX®, the popular multi-supplement pack, was developed following Dr. Jon Kaiser’s 2006 study that found an increase in CD4 count among HIV+ individuals using a mix of a potent multivitamin and antioxidants.* Eventually, Medicaid or ADAP formularies of many states included K-PAX®– a validation by the healthcare system welcomed by those of us who have long maintained that supplements can help to address chronic illness. Unfortunately, many people do not have access to these programs and for them, cost can be an issue. Even worse, some states, such as New York, are cutting budgets and eliminating items like K-PAX® from their formularies.

That’s why NYBC continues to offer the MAC Pack (for Multivitamin Antioxidant Combination), a low-cost alternative to the “Double-Strength” K-PAX® formula, based on products already available through our nonprofit co-op. (Unlike K-PAX®, the parts of the MAC Pack are delivered in their original bottles, so “some assembly is required”–one reason we also stock small ziplock baggies, which are great for travel, too!)

Note that the NYBC MAC Pack is based on the formula that was originally studied and published in the journal AIDS, while the current version of K-PAX®, on the other hand, has considerably less of certain micronutrients, such as vitamins B6 and B12. Nevertheless, the NYBC MAC Pack still costs HALF THE PRICE of the retail “Double Strength” K-PAX® formula. (That’s $62/month for the MAC Pack, versus $139/month for K-PAX® Double Strength.)

Subsequently, NYBC added to its MAC Pack offering by introducing the Opti-MAC Pack. This version of the MAC-Pack relies on SuperNutrition’s OptiPack (iron free), which has higher amounts of B vitamins than Added Protection, and so represents a further economy in number of bottles (no P5P or B12 needed!) and in cost (about $56/month).

For more information on NYBC’s MAC Pack or Opti-MAC Pack, or to place an order, visit us at www.newyorkbuyersclub.org, or call us at 1-800-650-4983. A comparison chart of the exact ingredients is available on our website. All the components of the MAC-Pack or Opti-MAC Pack can be ordered individually as well.

*  Micronutrient Supplementation Increases CD4 Count in HIV-infected Individuals on Highly Active Antiretroviral Therapy: A Prospective, Double-Blinded, Placebo-Controlled Trial. Kaiser JK, et al. JAIDS 2006;42[5]: 523-528.

NYBC’s MAC-Pack on the “Ask The Experts” forum, thebody.com

We were glad to see a recent Q&A on the “Ask the Experts” forum of thebody.com, which is one of the leading online sources of information for people with HIV. The question concerned NYBC’s MAC-Pack, our low-cost, close equivalent to K-PAX, a multivitamin/antioxidant combination which has been shown in research to raise CD4 counts, and which is available thru some — but not all–formularies in some — but not all — states.

For more information, see NYBC’s entry

MAC-Pack
Here’s the exchange:

QUESTION: macpac
Jul 5, 2011
are you familiar with the co. NYBC and their MACPAC-combination multivitamin & antioxidant program sells for 65 dollars and they compare to KPAC for 1/2 the cost..don’t want to throw money away on useless vitamins or vitamins that are sub-par or not tested

ANSWER: Response from Mr. Vergel

Supplement quality is always an important issue. One available resource is http://www.consumerlab.com although they are a for-profit company. It would be preferable if there were a government agency that routinely tested supplements and published the results!
It will always be a bit of a crapshoot, but the good news is the majority of supplements tested by them either pass and those that do fail often do for relatively minor reasons (though some do spectacularly).
According to Jared Becker and George Carter from the New York Buyers Club, the brands used in NYBC’s MAC Pack come from companies as reputable as K-PAX and with longer histories. NYBC has assessed Jarrow, Douglas Labs and Montiff, the providers used to make the Mac Pack. A few years ago, NYBC sent Montiff’s acetylcarnitine for testing and it came back fine. NYBC also uses consumerlab’s reports to verify quality of our big suppliers like Jarrow and Douglas.

Nelson Vergel

Entry posted at: http://www.thebody.com/Forums/AIDS/Nutrition/Q216051.html?ic=700101

Raltegrivir (Isentress) and Antacids/Minerals

A recent discussion on the excellent PozHealth listserve has alerted us to a potential problem with the relatively new HIV medication, raltegravir (brand name, Isentress). This drug inhibits an enzyme used by HIV called integrase.

As with many medications, it needs to be absorbed properly by the body after being taken. Some drugs can interact with this, blunting its benefit in lowering viral load to undetectable. In particular, antacids (that often come in the form of calcium carbonate) appear to reduce the drug’s efficacy when they are taken at the same time.

One contributor to the list noted that he now takes the drugs separately from any antacids as WELL as his K-PAX. This is prudent. We strongly urge you to separate any multi or other minerals that may inhibit the benefit of this medication by taking them about 4 hours apart.

This is also based on some research, as discussed on the HIV Insite website. They note: “:

”It appears that polyvalent cations (such as magnesium, calcium, and iron) 
bind integrase inhibitors and interfere with their activity against 
integrase. A pharmacokinetic study showed that administration of antacids 
containing divalent cations at the same time as elvitegravir (an 
investigational integrase inhibitor) lowered serum elvitegravir 
concentration by more than 40%. This effect was minimal if antacids were 
taken 4 hours apart from the integrase inhibitor.(5) The interaction of 
raltegravir and antacids has not been studied; pending further 
investigation, antacid medications and other agents with polyvalent cations 
should be used cautiously with (and taken separately from) raltegravir.”

(If you would like to join the POZHealth group, send a blank email to PozHealth-subscribe@yahoogroups.com and you will get an email with instructions to follow. It is a terrific group!)

Opti-MAC Pack

The Opti MAC Pack is NYBC’s simplest and least expensive alternative to the K-PAX multivitamin/antioxidant combination, which was the subject of Dr Jon Kaiser’s groundbreaking study showing the value of these supplements for people with HIV.

Instead of the Added Protection multivitamin, it uses SuperNutrition’s Opti-Pack, which includes about 1000 mcg of B12 and 250 mg of B6 as pyridoxine, thus providing a good replacement for the extra pills offered in NYBC’s regular MAC (Multivitamin Antioxidant Combination) Pack. As we’ve said before, though the regular MAC Pack and the Opti-MAC Pack are not precise, 100% matches of the K-PAX, they do, we feel, provide a close equivalent, and at a much lower cost (less than half the price!) Note that some may wish to add more Vitamin C to the regimen, but note also that NYBC’s Opti-MAC Pack and regular MAC Pack both have the advantage of providing more acetylcarnitine than K-PAX–not a bad idea, in our estimation, especially if you’re experiencing neuropathy. And the NYBC combination products are available iron-free, which is a good idea for those dealing with liver disease or impairment as well as HIV.

Read more about the general ideas behind the MAC Pack and Opti-MAC Pack at

http://nybcsecure.org/index.php?cPath=55

K-PAX Canadian Trial

K-PAX, the comprehensive multivitamin/antioxidant formula for immune support, is now the subject of a randomized clinical trial in Canada. The sponsors of the Canadian trial are the Canadian HIV Trials Network and the Ontario HIV Treatment Network (OHTN). This is a high-quality scientific study, that is, it’s a double-blind, placebo-controlled randomized clinical trial–the same kind of investigation required by the FDA before approval of drugs.

The Canadian K-PAX trial is enrolling antiviral-naive HIV-infected patients, and seeks to test whether K-PAX can provide useful support for the CD4 counts of HIV(+) individuals who have not yet begun taking anti-retroviral medications. (Patients starting the study will have CD4 counts between 350 – 800.) Half the group will be randomly chosen to receive K-PAX, while the other half will receive a low-dosage type multivitamin like those sold over the counter in drugstores.

We welcome this follow-up study on the K-PAX formula. The first study, which led to wide release of the K-PAX formula, was published in 2006 and did show a significant increase in CD4 counts among those taking it, whereas other participants had no increase or even some decline. We should also mention that our predecessor organization, DAAIR, was suggesting multivitamin/antioxidant protocols for people with HIV/AIDS back in the 1990s, even before anti-retroviral therapy became generally available.

In 2006, meanwhile, NYBC developed a close equivalent of the K-PAX formula using components from its product list. This allowed the purchasing co-op to offer its MAC-Pack (Multivitamin-Antioxidant-Combination Pack) for approximately half the price of the K-PAX, a useful alternative especially for those living in localities where K-PAX was not covered by ADAP or other insurance. See www.newyorkbuyersclub.org for more details.

NEW! Managing and Preventing HIV Med Side-Effects

To mark its fifth anniversary, the New York Buyers’ Club has prepared a special edition of SUPPLEMENT. In it you will find a concise Guide to managing and preventing HIV medication side effects with supplements and other complementary and alternative therapies.

This is an invaluable introduction to how nutritional supplements can be used to counter those side effects that can make life miserable–or even disrupt treatment adherence–in people taking antiretroviral medications for HIV.

Read about approaches to dealing with diarrhea, nausea, heart health issues, diabetes, insomnia, fatigue, liver stress, lipodystrophy, anxiety and depression.

This FREE Guide is available online at:

http://newyorkbuyersclub.org/

On the NYBC website you can also SUBSCRIBE to the nonprofit co-op’s quarterly FREE newsletter, THE SUPPLEMENT, which continues to offer a unique perspective on current evidence-based use of supplements for chronic conditions including cardiovascular disease, diabetes/insulin resistance, hepatitis and other liver conditions, anxiety/depression, osteoarthritis, cognitive and neurorological issues, and gastrointestinal dysfunction.

Micronutrients for people with HIV: a low-cost equivalent to K-Pax

K-PAX®, the popular multi-supplement pack, was developed following Dr. Jon Kaiser’s micronutrient study that found an increase in CD4 count among HIV+ individuals using a mix of a potent multivitamin and antioxidants.* At this point, the Medicaid or ADAP formularies of many states include K-PAX®–a validation by the healthcare system welcomed by those of us who have long maintained that supplements can help to address chronic illness. Unfortunately, many people do not have access to these programs and for them, cost can be an issue. (The retail price of the “Double-Strength” K-PAX® formula is about $130/month, quite a sum for those on a budget who face extra healthcare costs.)

That’s why NYBC designed MAC Pack (for Multivitamin Antioxidant Combination), an alternative to the “Double-Strength” K-PAX® formula, based on products already available through our nonprofit co-op. Unlike K-PAX®, the parts of the MAC Pack are delivered in their original bottles, so “some assembly is required” (one reason we also stock small ziplock baggies–great for travel, too!) While NYBC’s MAC Pack is not a precise, 100% match of the K-PAX® formula, it provides a similarly comprehensive vitamin, mineral and antioxidant regimen—and at a much lower cost (about $62/month).

A few small differences between NYBC’s MAC Pack and K-PAX® should be noted:

1) Acetyl L-Carnitine: The MAC Pack actually contains more acetylcarnitine than the double-strength K-PAX®—not a bad idea, especially if you believe, as we do, that acetylcarnitine may be one of the key elements in the multivitamin-antioxidant combination. (Two a day is sufficient if you want to match the K-PAX® formula, but three or more can help if you’re dealing with neuropathy.)

2) Vitamins: The multivitamins contained in the MAC Pack have somewhat different formulas than those in K-PAX®. Taking an extra Vitamin C tab along with the regular multi would make up for one difference. And some might wish to take a bit more calcium and vitamin D3, since bone health remains a concern for people with HIV, and there is also growing recognition of the need for higher doses of D3.

3) Iron: K-PAX® only comes with iron, but for those with liver trouble, this might NOT be a good idea. With the multivitamin Added Protection, you can choose whether to take iron or not (it is available both with iron and without). Also: Ultra Preventive Beta, another Douglas Labs multi, offers a variety of food-based nutrients in addition to a standard multivitamin formula, for $3 more per month.

Note: In 2009, NYBC added to its MAC Pack offerings by introducing the Opti-MAC Pack. This version of the MAC-Pack relies on SuperNutrition’s OptiPack (iron free), which has higher amounts of B vitamins than Added Protection or Ultra Preventive Beta, and so represents a further economy in number of bottles and in cost (about $56/month). Even with these savings, it’s still a close equivalent of the K-PAX®!

For more information on NYBC’s MAC Pack or Opti-MAC Pack, or to place an order, please visit www.newyorkbuyersclub.org, or call 1-800-650-4983. (You can also order the components of the MAC-Pack or Opti-MAC Pack individually.)

REFERENCE:
* Micronutrient Supplementation Increases CD4 Count in HIV-infected Individuals on Highly Active Antiretroviral Therapy: A Prospective, Double-Blinded, Placebo-Controlled Trial. Kaiser JK, Campa AM, Ondercin JP, et al. JAIDS 2006;42[5]: 523-528.

Multivitamin Antioxidant Combination (MAC-Pack): a K-Pax alternative available in no-iron formula for those with liver impairment

In 2007, NYBC began offering an alternative to the K-Pax multivitamin-antioxidant supplement, which was added to some ADAP and Medicaid formularies following publication in 2006 of Dr. Jon Kaiser’s study that found CD4 increases in people with HIV taking a micronutrient combination supplement. A first reason for the NYBC alternative, called the MAC-Pack, was price: for those without access to ADAP or Medicaid programs, the double strength K-Pax cost of about $140/month was rather high, and NYBC as a nonprofit co-op was able to present a close equivalent for only $62/month.

But another rationale for introducing the MAC-Pack was its flexibility. In fact, because MAC-Pack uses the AMNI/Douglas multivitamins Added Protection as its core, it can be configured as a formula with or without iron. Having the option of an iron-free MAC-Pack is important especially to people with elevated liver enzymes, liver impairment, or hepatitis co-infection. Taking iron supplements is generally not recommended for this group, since processing the iron puts an extra strain on liver function.

Also note that the MAC-Pack provides somewhat more acetylcarnitine than the K-Pax, which may not be a bad idea, especially if you believe, as we do, that acetylcarnitine is probably a key element in the multivitamin-antioxidant combination. (Two tabs/day is sufficient if you’re just interested in matching the K-Pax formula, but three/day may be better especially for those dealing with neuropathy.)

For more information, see the NYBC entry:

MAC-Pack

Acetylcarnitine for peripheral neuropathy, and as a component of a multivitamin/antioxidant combination

The UK-based information website http://www.aidsmap.com provides this succinct summary of evidence for use of acetylcarnitine (also “L-acetylcarnitine” or “acetyl-l-carnitine”) for HIV-associated antiretroviral toxic peripheral neuropathy:

A deficiency in L-acetyl carnitine may also play a role in neuropathy related to HIV treatment[4]. Taking L-acetyl carnitine supplements may reverse the nerve damage caused by HIV treatment, accompanied by an improvement of pain in most patients[5]. Similar studies have also shown improvements in pain with L-acetyl carnitine treatment, with one showing sustained benefit after more than four years[6][7][8]. Although the mechanism of L-acetyl carnitine’s action is unknown, it may counteract neuropathy by acting as an anti-oxidant, preventing the damage to mitochondria. Preliminary evidence suggests that carnitine may also be effective in treating other symptoms of mitochondrial toxicity, including elevated lactic acid levels[9].

(You can retrieve the references by going to the original web page,
at http://www.aidsmap.com/cms1235526.asp)

For more information, see the NYBC entry:

Acetylcarnitine

Also note that acetylcarnitine is a principal component of NYBC’s MAC-Pack (a low-cost alternative to the K-PAX):

MAC-Pack

The MAC-Pack: a K-PAX alternative from NYBC

The New York Buyers’ Club continues to offer its MAC Pack, or Multivitamin-Antioxidant Combination pack, which is a close equivalent to the double-strength K-PAX but at about half the cost. (K-Pax is usually listed at $139; NYBC’s MAC Pack sells for $62.)

K-PAX, a multi-supplement pack, was developed following a study by Dr. Jon Kaiser that found an increase in CD4 count among HIV+ individuals using this mix of a potent multivitamin and antioxidants.
At this point, the Medicaid or ADAP formularies of many states include the K-PAX formula. Unfortunately, some people may not have access to these programs and for them cost can be an issue. That is why NYBC designed the alternative MAC-Pack, which is based on products and prices currently available through its nonprofit purchasing coop.

The MAC-Pack includes:

Acetylcarnitine: 3/day, one month supply = $15.50 (one bottle; 500mg/90)

ThiolNAC (NAC + alpha lipoic acid): 3/day, one month supply = $14.00 (one bottle; 500mg/200mg/90)

Vitamin B6 (pyridoxal-5-phosphate/P5P): 3/day, one month supply = $10.00 (one bottle; 50mg/100)

Vitamin B12 (methylcobalamin): 2/day, one month supply = $3.75 (one bottle; 1000mg/100)

Added Protection (without iron): OR Added Protection (with iron): 6/day, one month supply = $19.25

All of these components of the MAC-Pack are also available as individual items; click on links for more information.

Notes:
1) The NYBC package actually has MORE acetylcarnitine than the double-strength K-PAX. Not a bad idea, especially if you believe, as we do, that acetylcarnitine is probably one of the key elements in the multivitamin-antioxidant combination. (Two a day is probably sufficient if you are just interested in matching the K-PAX formula, but three or more can help if you are dealing with neuropathy.)

2) The multivitamins available through NYBC have somewhat different formulas than the K-PAX (see product labels available on the NYBC website for details). Taking an extra vitamin C tab along with the regular multi would make up for one significant difference. And some might wish to take a bit more calcium and vitamin D3 than Added Protection offers, as bone loss remains a concern among people with HIV.

3) K-PAX only comes with iron; for those with liver issues, this is probably NOT a good idea. With the multivitamin Added Protection, you can choose whether to take iron or not. (Please specify when ordering.)