AIDS post-HIV : beat of a different drummer - AltHeal

andomly received oral N-acetylcysteine (median
4.4 g/d; range 3.2-8 g/d) or placebo. After 8 wks.,
pts. could elect to take open label NAC for an
additional period (median=6 mo.). NAC re s t o re d
decreased whole blood glutathione levels. Pts. with
very low CD4 cell counts who took NAC survived
roughly twice as long as those who did not.
[ H e r z e n b e rg LA et al. Glutathione deficiency is
associated with impaired survival in HIV disease.
Proc Natl Acad Sci 94:1967-72, 1997].
High Sugar Consumption Effects on Immune
Function
7 healthy adults ingested 75 gm glucose. In vitro
lymphocyte transformation in response to PHA at
30 and 60 min. was significantly depressed to
79.4% and 83.3% of fasting levels, respectively. At
2 hrs., lymphocyte transformation had returned to
fasting levels. Addition of physiologic doses of
insulin decreased in vitro lymphocyte transformation
by 40%. Results suggest that glucose ingestion
may affect in vitro measures of cellular
immunity by increasing serum insulin, which
competes with mitogens for binding sites on
lymphocytes. In addition, glucose may impair cellmediated
immunity in vivo [Bernstein J et al.
Depression of lymphocyte transformation following
oral glucose ingestion. Am J Clin Nutr 30:613,
1977].
Intestinal Permeability (‘Leaky Gut’)
This study evaluated intestinal permeability by
using a lactulose- mannitol diff e rential intestinal
permeability test in healthy controls, HIV- p o s i t i v e
patients without symptoms, and AIDS patients with
and without diarrhea. The AIDS patients with
diarrhea had significant alterations in intestinal
permeability with increased lactulose recovery and
decreased mannitol recovery, and their mean lactulose:mannitol
ratio was significantly greater than
the ratio in all other groups. The authors conclude
that patients with AIDS and diarrhea have altere d
intestinal permeability. The reduced absorption of
mannitol suggests there is a decreased functional
absorptive surface in the intestines of AIDS
patients as their disease pro g resses. The term
intestinal permeability refers to how the lining of
the intestines allows molecules to pass through by
nonmediated effusion. The mannitol re c o v e r y
showed an incremental decrease in the 3 HIVpositive
groups, suggesting that as HIV progresses
t h e re is a loss of functional absorptive surface.
Glutamine is an essential amino acid for the gut
lining and has been shown to improve intestinal
permeability and reverse villous atrophy in human
and animal models. [Intestinal Permeability in
Patients Infected With Human Immunodeficiency
Virus. Te p p e r, Robert E., M.D., et al, American
J o u rnal of Gastro e n t e ro l o g y, 1994;89(6):878-882.
Address: Douglas Simon, M.D., Director, Division of
G a s t ro e n t e ro l o g y, Jacobi Hospital, Room 303B,
Bronx Municipal Hospital Center, Pelham Parkway
and Eastchester Rd., Bronx, NY 10461, U.S.A.]
Iron Deficiency and Cell-Mediated Immunity
When iron is deficient, cell-mediated immunity is
impaired, especially when the deficiency is associated
with a vitamin E deficiency [Chandra RK.
Trace element regulation of immunity and infection.
J Am Coll Nutr 4(1):5-16, 1985].
Iron Deficiency and Lymphocyte Levels
In 21 pts. with iron deficiency anemia, the mean
number of total lymphocytes, CD3 and CD4
subsets, and B lymphocytes were decreased, as
was killer cell activity. After iron treatment, some of
these parameters re t u rned to normal [Santos PC,
Falcado RP. Decreased lymphocyte subsets and K-
cell activity in iron-deficiency anemia. Acta
Haematol 84:118-21, 1990].
I ron Metabolism Abnormalities and Oxidative
Stress
AIDS pro g ression in the advanced stage of the
infection is accompanied by increasing body iro n
stores. Iron burden is especially heavy in the bone
m a r ro w, brain white matter, muscle and liver.
Excess iron may enhance oxidative stress by
impairing an already compromised immune
system. The reduction and prevention of iro n
loading might slow the pro g ression of the infectious
complications of AIDS and possibly AIDS
itself. Limiting iron intake from any route and the
use of iron chelating drugs may decrease the iron
b u rden and possibly suppress the growth of
m i c ro o rganisms. [Altered Iron Metabolism in HIV
Infection: Mechanisms, Possible Consequences,
and Proposals For Management. Boelaert, Johan,
R., et al, Infectious Agents and Disease, 1996;5:36-
46. Address: Dr. J.R. Boelaert, Algemeen,
Ziekenhuis Sint Jan., Unit For Renal and Infectious
Disease, Ruddershove 10, 8000 Brugge, Belgium].
Lead and Immune Function
Results of animal studies suggest that chronic lowlevel
exposure to lead can greatly depress immune
system function [Bendick A, Belisle EH, Strausser
HR. Immune response of rats chronically fed
subclinical doses of lead. Clin Exp Immunol
43:189-94, 1981; Blakey BR, Archer DL. The effect
of lead acetate on the immune response in mice.
Toxicol Appl Pharmacol 61:18-26, 1981; Faith RE,
Luster MI, Kimmel CA. Effect of chronic developmental
lead exposure on cell-mediated immune
functions. Clin Exp Immunol 35:413-20, 1979;
Luster MI, Faith RE, Kimmel CA. Depression of
humoral immunity in rats following chronic developmental
lead exposure. J Environ Pathol To x i c o l
1:397-402, 1978; Neilman BA, Taddeini L, McJilton
CE, Handwerger BS. Decreased T-cell function in
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CONTINUUM vol 6, no 1/2