Vitamins 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 NAC (N-acetyl cysteine) 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 DHEA (dehydroepiandrosterone) 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 a second double-blind study, supplementing with natural mixed
carotenoids equivalent to 120,000 IU of beta-carotene per day significantly prolonged survival
times in adults with advanced AIDS who were also receiving conventional therapy and a
multivitamin.32 In another trial, however, 300,000 IU per day of beta-carotene had
no effect on CD4+ cell counts or various other measures of immune function in HIV-infected
people.33
In HIV-positive people with B-vitamin deficiency, the use of B-complex vitamin supplements appears to delay
progression to and death from AIDS.34 Thiamine (vitamin B1) deficiency has been identified in nearly
one-quarter of people with AIDS.35 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.36 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.37 Low blood levels of folic acid and vitamin B12 are also common in HIV-positive
people.38
Preliminary observations suggest a possible role for vitamin B3 in HIV prevention and
treatment.39 A form of vitamin B3 (niacinamide) has been shown to inhibit HIV in
test tube studies.40 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.41 42 Clinical trials in humans are required to validate these
preliminary observations.
Vitamin C has been shown to inhibit HIV
replication in test tubes.43 Intake of vitamin C by HIV-positive persons may be
associated with a reduced risk of progression to AIDS.44 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.45 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.46
Similarly, animal research suggests that zinc
and NAC supplementation may protect against
AZT toxicity.47 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.48
Blood levels of both zinc49 and
selenium50 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.51
Iron deficiency is often present in
HIV-positive children.52 While iron is necessary for normal immune function, iron deficiency also appears to
protect against certain bacterial
infections.53 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.54 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.55 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.56 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.57 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,58 59 60 especially the
deterioration that occurs in the nervous system and is responsible for symptoms such as
dementia.61 62 A preliminary trial found that methionine (6 grams per
day) may improve memory recall in people with AIDS-related nervous system
degeneration.63
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.64
Whey protein is rich in the amino acid
cysteine, which the body uses to make glutathione, an important antioxidant. A double-blind
trial showed that 45 grams per day of whey protein increased blood glutathione levels in a
group of HIV-infected people.65 Test tube66 and animal67
studies suggest that whey protein may improve some aspects of immune function.
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).68 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.69 Clinical trials have shown that injections of
glycyrrhizin (isolated from licorice) may have a beneficial effect on AIDS.70 There
is preliminary evidence that orally administered licorice also may be safe and effective for
long-term treatment of HIV infection.71 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
preliminary72 and double-blind trials. Additional double-blind research has
demonstrated the extract’s effectiveness for diarrhea associated with HIV infection and
AIDS.73 74 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.75 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.76 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.77 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.78 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.79
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.80 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.81 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.82 Sho-saiko-to has also been shown to
improve the efficacy of the anti-HIV drug
lamivudine in the test tube.83 One preliminary study found that 7 of 13 people
with HIV given sho-saiko-to had improvements in immune function.84 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.85 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.86 87
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.88 However, these results have not been shown to occur when echinacea
is taken orally by humans.89 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.90 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.91 92 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.93 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.94
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.95 96
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.97 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.98
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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Reliable
and relatively consistent scientific data showing a substantial health benefit.
