Sialic acid associated with αvß3 integrin mediates HIV-1 Tat protein interaction and endothelial cell proangiogenic activation.

Sialic acid (NeuAc) is a major anion on endothelial cells (ECs) that regulates different biological processes including angiogenesis. NeuAc is present in the oligosaccharidic portion of integrins, receptors that interact with extracellular matrix components and growth factors regulating cell adhesion, migration, and proliferation. Tat is a cationic polypeptide that, once released by HIV-1(+) cells, accumulates in the extracellular matrix, promoting EC adhesion and proangiogenic activation by engaging α(v)ß(3). By using two complementary approaches (NeuAc removal by neuraminidase or its masking by NeuAc-binding lectin from Maackia amurensis, MAA), we investigated the presence of NeuAc on endothelial α(v)ß(3) and its role in Tat interaction, EC adhesion, and proangiogenic activation. α(v)ß(3) immunoprecipitation with biotinylated MAA or Western blot analysis of neuraminidase-treated ECs demonstrated that NeuAc is associated with both the α(v) and the ß(3) subunits. Surface plasmon resonance analysis demonstrated that the masking of α(v)ß(3)-associated NeuAc by MAA prevents Tat/α(v)ß(3) interaction. MAA and neuraminidase prevent α(v)ß(3)-dependent EC adhesion to Tat, the consequent FAK and ERK1/2 phosphorylation, and EC proliferation, migration, and regeneration in a wound-healing assay. Finally, MAA inhibits Tat-induced neovascularization in the ex vivo human artery ring sprouting assay. The inhibitions are specific because the NeuAc-unrelated lectin from Ulex europaeus is ineffective on Tat. Also, MAA and neuraminidase affect only weakly integrin-dependent EC adhesion and proangiogenic activation by fibronectin. In conclusion, NeuAc is associated with endothelial α(v)ß(3) and mediates Tat-dependent EC adhesion and proangiogenic activation. These data point to the possibility to target integrin glycosylation for the treatment of angiogenesis/AIDS-associated pathologies.

Nutritional care, time period since diagnosis, demographics and body mass index in HIV/AIDS patients.

BACKGROUND: Nutritional status and nutritional care have long been ignored among HIV/AIDS patients. Furthermore, in Mexico there is no information on potential factors favoring weight increase in such population. OBJECTIVE: To assess the association between the time period since diagnosis, demographics and BMI in different categories of patients with HIV/AIDS in Monterrey, Mexico. In addition, to provide information on overweight/obesity prevalence and nutritional care referral. MATERIAL AND METHODS: This was a cross-sectional study of HIV/AIDS positive patients receiving outpatient secondary care (n = 231). Nutritional care referral, time period since diagnosis and demographic data were obtained by interview. A standardized and registered dietitian collected anthropometrics measures. Binary multiple logistic regression was used to evaluate the association between increasing BMI categories and variables of interest. RESULTS: Mean patient age was 40.6 ± 11.2 years, 87% were male, 79.2% were economically active, 65% were single and 60% had less than a college education. The average time since diagnosis was 6.5 ± 5.4 years. Overweight and obesity prevalence were 35.8% and 12.5%, respectively. Only 18% of patients had ever been referred for nutritional care. The time period since diagnosis, the sum of skinfold measurements and the waist-to-hip ratio, were significantly predictive of the BMI category (normal/underweight vs. overweight/obese), when controlling for nutritional care referral and daily carbohydrate intake; age and marital status were not associated with BMI category. CONCLUSIONS: Identification of predisposing factors to overweight/obesity among HIV/AIDS patients constitutes a significant step for providing nutritional care, of the same importance as the load or CD4+ count, especially nowadays, with more common increased survival rates and consequently, longer lives with the disease.

The impact of integrating food supplementation, nutritional education and HAART (Highly Active Antiretroviral Therapy) on the nutritional status of patients living with HIV/AIDS in Mozambique: results from the DREAM Programme.

DREAM (Drug Resources Enhancement against AIDS and Malnutrition) is a multiregional health program active in Mozambique since 2002 and provides free of charge an integrating package of care consisting of peer to peer nutritional and health education, food supplementation, voluntary counseling and testing, immunological, virological, clinical assessment and HAART (Highly Active AntiRetroviral Treatment). The main goals of this paper are to describe the state of health and nutrition and the adequacy of the diet of a sample of HIV/AIDS patients in Mozambique on HAART and not. A single-arm retrospective cohort study was conducted. 106 HIV/AIDS adult patients (84 in HAART), all receiving food supplementation and peer-to-peer nutritional education, were randomly recruited in Mozambique in two public health centres where DREAM is running. The programme is characterized by: provision of HAART, clinical and laboratory monitoring, peer to peer health and nutritional education and food supplementation. We measured BMI, haemoglobin, viral load, CD4 count at baseline (T0) and after at least 1 year (T1). Dietary intake was estimated using 24h food recall and dietary diversity was assessed by using the Dietary Diversity Score (DDS) at T1. Overall, the patients'diet appeared to be quite balanced in nutrients. In the cohort not in HAART the mean BMI values showed an increases but not significant (initial value: 21.9 ± 2.9; final value: 22.5 ± 3.3 ) and the mean haemoglobin values (g/dl) showed a significant increases (initial value: 10.5+ 2.1; final value: 11.5 ± 1.7 p< 0.024) . In the cohort in HAART, both the mean of BMI value (initial value: 20.7 ± 3.9; final value: 21.9 ± 3.3 p< 0.001) and of haemoglobin (initial value: 9.9 ± 2.2; final value: 10.8 ± 1.7 p< 0.001) showed a higher significant increase. The increase in BMI was statistically associated with the DDS in HAART patients. In conclusion nutritional status improvement was observed in both cohorts. The improvement in BMI was significant and substantially higher in HAART patients because of the impact of HAART on nutritional status of AIDS patients. Subjects on HAART and with a DDS > 5, showed a substantial BMI gain. This association showed an additional expression of the synergic effect of integrating food supplementation, nutritional education and HAART on the nutritional status of African AIDS patients and also highlights the complementary role of an adequate and diversified diet in persons living with HIV/AIDS in resources limited settings.

Effect of a liquid nutritional supplement on viral load and haematological parameters in HIV-positive/AIDS patients.

The effect of a nutritional supplement on the immune status and haematological parameters of HIV-positive/AIDS patients is tested using standard procedures. This clinical trial of 35 patients consists of a baseline visit and three months of supplementation from April to September 2003. Results showed that viral load decreased significantly (P<0.002) with time following supplementation. Mean cell volume (MCV) and mean cell haemoglobin concentration (MCHC) increased significantly (P<0.002 and P<0.0002, respectively), reflecting the positive effect of the supplement on these haematological parameters. Supplementation had no effect on CD4+ T-cell count, which decreased significantly with disease progression. Owing to certain limitations of the study (small sample size, short duration and the late stage of HIV infection), further studies are needed to confirm the effect attributed to the supplement.

Effect of Chocolate and Yerba Mate Phenolic Compounds on Inflammatory and Oxidative Biomarkers in HIV/AIDS Individuals.

Flavonoids in cocoa and yerba mate have a beneficial role on inflammation and oxidative disorders. Their effect on HIV individuals has not been studied yet, despite the high cardiovascular risk of this population. This study investigated the role of cocoa and yerba mate consumption on oxidative and inflammatory biomarkers in HIV+ individuals. A cross-over, placebo-controlled, double-blind, randomized clinical trial was conducted in 92 individuals on antiretroviral therapy for at least six months and at viral suppression. Participants were randomized to receive either 65 g of chocolate or chocolate-placebo or 3 g of yerba mate or mate-placebo for 15 days each, alternating by a washout period of 15 days. At baseline, and at the end of each intervention regimen, data regarding anthropometry, inflammatory, oxidative and immunological parameters were collected. High-sensitivity C-reactive protein, fibrinogen, lipid profile, white blood cell profile and thiobarbituric acid reactive substances were assessed. There was a difference between mean concentrations of HDL-c (ANOVA; p ≤ 0.05) among the different regimens: dark chocolate, chocolate-placebo, yerba mate and mate-placebo. When a paired Student t-test was used for comparisons between mean HDL-c at baseline and after each regimen, the mean concentration of HDL-c was higher after supplementation with dark chocolate (p = 0.008).

Home-delivered meal programs for homebound people with HIV/AIDS.

In major cities within the past decade, 17 community-based, home-delivered meal programs have emerged to meet the specialized nutrition needs of homebound people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (HIV/AIDS). This review includes specifics about these meal programs: funding, eligibility criteria, establishing and following nutrition and food safety standards, creating a network of volunteers for delivery of meals, providing nutrition counseling, and conducting periodic program evaluation. People living with HIV/AIDS may need the services of home-delivered meal programs throughout the course of HIV disease. Clinical dietitians and public health nutritionists should become familiar with existing programs and refer clients to services as needed.

A community-based, interagency approach by dietitians to provide meals, medical nutrition therapy, and education to clients with HIV/AIDS.

Dietitians have the opportunity to be leaders in providing medical nutrition therapy and home-delivered meals for people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the community setting. Four community agencies developed the Visiting Nurse Service HIV/Home Delivered Meals Program. Fifty clients with the diagnosis of HIV and/or AIDS were served for a 6-month period. The program provided convenient, energy-enhanced nutritious meals. Participants received daily hot and cold, energy- and protein-enhanced home-delivered meals; weekly high-energy, high-protein, shelf-stable Snack Packs; a Medical Nutritional Supplement Sampler Pack; and two home visits from dietitians. Different diet options were available. Dietitians completed 47 initial nutrition assessment and food safety education visits 1 to 2 weeks after meal delivery began, and 35 participants received follow-up nutrition counseling visits 4 to 8 weeks later. Participant data (including weights) were self-reported. Dietitians reported that 13 of 35 participants gained weight (mean = 6 lb), 11 of 35 remained the same weight, and 11 of 35 lost weight (mean = 5 lb). Initially, 14 of 35 participants were considered to be "doing well"; this improved to 19 of 35 participants 1 to 2 months later. Snack Packs were effective means to help participants meet some of their increased nutrient needs. The Medical Nutritional Supplement Sampler Pack was effective in familiarizing each participant with available products. Medical nutrition therapy by registered dietitians helped most participants improve their food consumption.

Nutritional impact of acquired immune deficiency syndrome: a unique counseling opportunity.

The acquired immune deficiency syndrome (AIDS) presents a challenge for dietitians. Changes in the immune system have a potentially detrimental effect on nutritional status as a result of conditions such as anorexia, infection, diarrhea, and drug side effects. Conversely, poor nutrition status may adversely alter the immune systems. Dietary guidelines for the management of these conditions and additional obstacles are discussed. When counseling patients with AIDS, the dietitian needs to be aware of and sensitive to alternative therapies, to evaluate their effectiveness, and to assist in determining their place in the patient's treatment. Psychosocial factors that could influence nutritional status, such as dementia, unemployment, and isolation, must also be taken into consideration. A nutrition program has been established to address the needs of AIDS patients at AIDS Project Los Angeles-Necessities of Life Program (APLA-NOLP), a food distribution center. The goal of the program is to maintain or improve the client's nutritional status by providing education and counseling. The nutrition program has been enthusiastically received, and the outcome of the program on the nutritional status of the participants is currently under study. The dietitian is in a unique position to intervene by providing resource information, food preparation tips, and individualized nutrition plans. It is imperative that the dietitian become familiar with the AIDS disease process and its implications for nutritional status to be considered an expert in the nutrition management of such patients.

Nutritional support in the patient with HIV infection.

Weight loss and malnutrition are the most common symptoms associated with active infection with human immunodeficiency virus. The origin of the malnutrition is considered multifactorial and broadly includes decreased nutrient intake, nutrient malabsorption, and metabolic alterations. Steady advances have been made in understanding the mechanisms underlying weight loss in these patients. The utility and optimal modes of nutrition support have not yet been fully established.

Task Force on Nutrition Support in AIDS. Guidelines for nutrition support in AIDS.

The nutritional status of people with AIDS is challenged throughout the progression of the illness by the manifestation of symptoms such as malabsorption, diarrhea, candidiasis, and fever. As yet, there is no widely accepted method for nutritional management of AIDS. Therefore, a Task Force on Nutrition Support in AIDS was formed to develop practical recommendations for those involved in the management of this patient population. The "Guidelines for Nutrition Support in AIDS" are aimed at improving nutritional status, alleviating symptoms, and enhancing quality of life at each stage of the disease. The Task Force concluded that optimizing the nutritional status of people with AIDs, through aggressive nutritional therapy, is essential in overall medical management; nutrition intervention and education is indicated as early in the disease progression as HIV diagnosis; thorough nutritional assessment and regular monitoring is advocated; and enteral feedings should be considered the first line of nutrition support therapy.

How HIV-1 causes AIDS: implications for prevention and treatment.

HIV-1 encodes for one of the human glutathione peroxidases. As a consequence, as it is replicated, its genetic needs cause it to deprive HIV-1 seropositive individuals not only of glutathione peroxidase, but also of the four basic components of this selenoenzyme, namely selenium, cysteine, glutamine, and tryptophan. Eventually this depletion process causes severe deficiencies of all these substances. These, in turn, are responsible for the major symptoms of AIDS which include immune system collapse, greater susceptibility to cancer and myocardial infarction, muscle wasting, depression, diarrhea, psychosis and dementia. As the immune system fails, associated pathogenic cofactors become responsible for a variety of their own unique symptoms. Any treatment for HIV/AIDS must, therefore, include normalization of body levels of glutathione, glutathione peroxidase, selenium, cysteine, glutamine, and tryptophan. Although various clinical trials have improved the health of AIDS patients by correcting one or more of these nutritional deficiencies, they have not, until the present, been addressed together. Physicians involved in a selenium and amino-acid field trial in Botswana, however, are reporting that this nutritional protocol reverses AIDS in 99% of patients receiving it, usually within three weeks.

Selenium supplementation of symptomatic human immunodeficiency virus infected patients.

The mean whole blood selenium levels in male San Diego, CA patients with acquired immune deficiency syndrome (AiDS) are 0.123 +/- 0.030 micrograms/mL (n = 24), and 0.126 +/- 0.038 micrograms/mL (n = 26) in patients with AIDS-related complex (ARC), compared to 0.195 +/- 0.020 micrograms/mL (n = 28) in San Diego healthy controls (males). To establish whether intestinal absorption of dietary selenium is impaired in AIDS or ARC, a supplementation trial was conducted in which 19 symptomatic HIV-antibody positive male patients with AIDS or ARC were taking 400 micrograms of selenium/d in form of selenium yeast for up to 70 d. The mean whole blood Se levels increased to 0.28 +/- 0.08 micrograms/mL after 70 d of supplementation, the selenium supplements were well tolerated. A rationale for adjuvant selenium supplementation of symptomatic and asymptomatic HIV carriers is proposed.

[Oral nutritional supplements. Are they useful?]. / Suplementos nutricionales orales. Son útiles?

Oral nutritional supplements are products included in enteral nutrition, preferably used in hospital settings, although their use in the community is gradually increasing and in the United Kingdom has doubled in the last seven years, with prescriptions covering a wide range of the population from children to the elderly, and different pathologies affecting their nutritional status. There is, however, no consensus on the usefulness of oral nutritional supplements among these patients, so we do not have any recommendations for use. In this paper we have reviewed the various studies available in the literature in order to clarify the usefulness of these supplements in different contexts or pathologies.

Nutrition in the management of acquired immunodeficiency syndrome.

OBJECTIVE: To highlight the influence of nutrition on the progress of HIV/AIDS and the role and importance of good nutrition in the management of the disease. STUDY SELECTION: The subject was selected because it is now recognised that nutritional care and support is an essential component of the health care plan and management for people with HIV/AIDS. The subject is especially relevant since few studies have been conducted locally on the effects of nutritional status on the progression of HIV/AIDS. DATA RESOURCES AND DATA SYNTHESIS: A review of current literature selected from local and international scientific journals and books on the subject of nutrition and HIV/AIDS. DATA EXTRACTION AND SYNTHESIS: Data were developed from the reviewed information extracted from the contribution of different authors who are interested in nutritional management of people with HIV/AIDS. It was then analysed and synthesised into the current article. CONCLUSION: On the basis of the reviewed information, it is recommended that individuals with HIV/AIDS be given nutrition counselling and support to enable them achieve an adequate nutrient and energy intake for as long as possible. This would enhance the quality of their lives and minimise disease symptoms.

PIP: The role of nutrition in the management of HIV infection and AIDS is now widely recognized. To highlight the influence of nutrition on the progress of HIV/AIDS and the role and importance of good nutrition in the management of the disease, literature selected from local and international scientific books and journals on the subject of nutrition and HIV/AIDS were reviewed and synthesized in this article. As an intervention, it should begin in the early stages of HIV infection and should include nutrition counseling, and in the later stages of the disease, using more advanced nutrition support methods including enteral and parenteral support. These would enable HIV/AIDS patients to achieve an adequate nutrient intake and energy for as long as possible, thus enhancing the quality of their lives and minimizing the symptoms of the disease.

Nutrition and HIV infection. A continuum of care.

Nutrition is a fundamental intervention in the early and ongoing treatment of human immunodeficiency virus (HIV) disease. Nutrition therapy, in coordination with other medical interventions, can extend and improve the quality and quantity of life in individuals infected with HIV and living with acquired immune deficiency syndrome (AIDS). The author reviews the current literature and practice for nutrition use in the treatment of patients with HIV and AIDS.

[Liquid nutrition and AIDS]. / Nutricion liquida y el VIH.

AIDS: A balanced diet is important for everyone, but for an AIDS patient, it is critical. He or she may experience loss of appetite, diarrhea, depression, or stomach problems, all of which affect nutrition. In response, the pharmaceutical industry has developed several products which provide additional calories and essential nutrients. A person with AIDS must plan a diet that will combat weight loss. Several nutritional supplements are mentioned in the article. Distributors, calories, prices, descriptions, and ingredients are outlined for Ensure Plus, Nutren 2.0, Advera, and Peptamien VHP.^ieng

Nutrition for in-home AIDS patients.

Early medical nutrition intervention with in-home AIDS patients can help prolong and improve the quality and quantity of their lives. Teaching the basics of good nutrition both early on as well as in the later stages of AIDS can save thousands of health care dollars through preventive care at home.

Nutritional care of the HIV client.

Patients with HIV infection are at risk for malnutrition from many causes--the disease itself, attendant infections, or medication side effects. There are strategies for the entire caregiving team to help these patients.

[Taking control of HIV/AIDS]. / Tomado control del VIH/SIDA.

AIDS: HIV-positive persons should manage their care early to increase their chances for a healthy and productive life. A CD4 cell count blood test is an indicator of the damage the virus has caused, with diminished numbers reflecting more advanced stages of AIDS. Viral load testing is being investigated by the Food and Drug Administration (FDA) for its potential value. Practicing safer sex and not sharing syringes helps control virus spread. A balanced diet, nutritional supplements, and limited stress are beneficial.^ieng