A comprehensive overview on the role of phytocompounds in human immunodeficiency virus treatment.

Acquired immune deficiency syndrome (AIDS) is a worldwide epidemic caused by human immunodeficiency virus (HIV) infection. Newer medicines for eliminating the viral reservoir and eradicating the virus are urgently needed. Attempts to locate relatively safe and non-toxic medications from natural resources are ongoing now. Natural-product-based antiviral candidates have been exploited to a limited extent. However, antiviral research is inadequate to counteract for the resistant patterns. Plant-derived bioactive compounds hold promise as powerful pharmacophore scaffolds, which have shown anti-HIV potential. This review focuses on a consideration of the virus, various possible HIV-controlling methods and the recent progress in alternative natural compounds with anti-HIV activity, with a particular emphasis on recent results from natural sources of anti-HIV agents. Please cite this article as: Mandhata CP, Sahoo CR, Padhy RN. A comprehensive overview on the role of phytocompounds in human immunodeficiency virus treatment. J Integr Med. 2023; 21(4):332-353.

Antiviral Potential of the Genus Panax: An updated review on their effects and underlying mechanism of action.

Viral infections are known as one of the major factors causing death. Ginseng is a medicinal plant that demonstrated a wide range of antiviral potential, and saponins are the major bioactive ingredients in the genus Panax with vast therapeutic potential. Studies focusing on the antiviral activity of the genus Panax plant-derived agents (extracts and saponins) and their mechanisms were identified and summarized, including contributions mainly from January 2016 until January 2022. P. ginseng, P. notoginseng, and P. quinquefolius were included in the review as valuable medicinal herbs against infections with 14 types of viruses. Reports from 9 extracts and 12 bioactive saponins were included, with 6 types of protopanaxadiol (PPD) ginsenosides and 6 types of protopanaxatriol (PPT) ginsenosides. The mechanisms mainly involved the inhibition of viral attachment and replication, the modulation of immune response by regulating signaling pathways, including the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway, cystathionine γ-lyase (CSE)/hydrogen sulfide (H2S) pathway, phosphoinositide-dependent kinase-1 (PDK1)/ protein kinase B (Akt) signaling pathway, c-Jun N-terminal kinase (JNK)/activator protein-1 (AP-1) pathway, and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway. This review includes detailed information about the mentioned antiviral effects of the genus Panax extracts and saponins in vitro and in vivo, and in human clinical trials, which provides a scientific basis for ginseng as an adjunctive therapeutic drug or nutraceutical.

Use of Apixaban in Atrial Fibrillation With Ritonavir-Boosted Antiretroviral Therapy: A Case Report.

Purpose: Direct oral anticoagulants (DOACs) pose a challenge when given with potent CYP3A4 and P-gp inhibitors, such as the commonly prescribed pharmacokinetic booster ritonavir. As per the manufacturer, apixaban offers a dose reduction when administered concurrently with ritonavir; thus, we explore the clinical indication and safety of apixaban when given with ritonavir-boosted highly active antiretroviral therapy (HAART) in an HIV patient. Summary: We describe a 73-year-old male with extensive cardiac history, including a past medical history of resolved left ventricular thrombus, newly diagnosed non-valvular atrial fibrillation treated with warfarin, and HIV infection treated with ritonavir-boosted HAART. The patient presented to the emergency department with bleeding from multiple sites, necessitating the use of vitamin K. Consequently, his hospital course was complicated by episodes of minor bleeding and labile INR. Due to the complicated nature of his condition and the potential for drug-drug interactions (DDIs), he was transitioned from warfarin to apixaban. Since there is little readily available data to support the use of rivaroxaban and dabigatran with ritonavir, our patient was safely started on dose-reduced apixaban for stroke prophylaxis in atrial fibrillation due to the predictable nature of apixaban pharmacokinetics and proven superiority regarding adverse effects, as compared to other DOACs. Conclusion: Dose-reduced apixaban is a safe and viable choice in patients with atrial fibrillation warranting stroke prophylaxis while concurrently receiving ritonavir-boosted HAART.

A comprehensive overview on the role of phytocompounds in human immunodeficiency virus treatment / 中西医结合学报

Acquired immune deficiency syndrome (AIDS) is a worldwide epidemic caused by human immunodeficiency virus (HIV) infection. Newer medicines for eliminating the viral reservoir and eradicating the virus are urgently needed. Attempts to locate relatively safe and non-toxic medications from natural resources are ongoing now. Natural-product-based antiviral candidates have been exploited to a limited extent. However, antiviral research is inadequate to counteract for the resistant patterns. Plant-derived bioactive compounds hold promise as powerful pharmacophore scaffolds, which have shown anti-HIV potential. This review focuses on a consideration of the virus, various possible HIV-controlling methods and the recent progress in alternative natural compounds with anti-HIV activity, with a particular emphasis on recent results from natural sources of anti-HIV agents. Please cite this article as: Mandhata CP, Sahoo CR, Padhy RN. A comprehensive overview on the role of phytocompounds in human immunodeficiency virus treatment. J Integr Med. 2023; 21(4):332-353.

Treatment with natalizumab during pregnancy in multiple sclerosis: The experience of implementing a clinical practice protocol (NAP-30).

BACKGROUND: Pregnancy planning in women with highly active multiple sclerosis (HAMS) who need a high-efficacy disease-modifying therapy (heDMT) currently requires a careful risk-benefit evaluation. This includes minimizing fetal drug toxicity and preventing MS reactivation. We describe our experience with natalizumab in women with HAMS and unplanned pregnancy by implementing a clinical practice protocol (NAP-30) designed to maintain the effectiveness of natalizumab during pregnancy, reduce fetal exposure and prevent complications. METHODS: This was an observational retrospective study including women with HAMS on active treatment with natalizumab who became unexpectedly pregnant in the period 2018-2021 and continued this treatment during pregnancy according to the NAP-30 protocol. MS clinical and radiological variables were analyzed before and during pregnancy and in the postpartum period, along with maternal and fetal toxicity during pregnancy and safety findings in newborns. We also describe the NAP-30 protocol, which includes the use of a bridging dose to adjust and maintain natalizumab infusions every 6 weeks during pregnancy up to week 30 and scheduled delivery at week 40. RESULTS: Six women (one in her first gestation) with a median age of 31.5 years at the onset of pregnancy (min-max: 24-37 years) were included. All were negative for anti-John Cunningham virus (JCV) antibodies and were on treatment with intravenous natalizumab 300 mg every 4 weeks. At the time of conception, three patients had received 12, 17 and 53 infusions of natalizumab, respectively, while for the remaining three patients natalizumab was their first DMT (two patients had received 6 infusions and one patient had received 3 infusions of natalizumab). All six patients received 6 doses of natalizumab during pregnancy according to the NAP-30 protocol. After delivery, all six patients restarted natalizumab every 4 weeks (median: 3 days; range: 2-4 days). No patients had relapses during pregnancy or at 6 months postpartum, nor did they develop any general health or laboratory abnormalities. The MRI scan performed at 4-6 months postpartum showed no new T2 lesions or gadolinium-enhancing lesions. No miscarriages or threatened miscarriages were reported. One of the patients underwent elective preterm delivery at week 35 after mild-to-moderate anemia was detected by fetal Doppler scan. The newborn had low birth weight (2080 g) and mild anemia, which resolved within two months with oral iron supplementation. The other infants were born with normal birth weight and showed no blood count abnormalities. After a median follow-up of 10 months, all six babies showed normal development with no complications detected. CONCLUSIONS: Based on our experience, the implementation of the NAP-30 protocol in women with HAMS and unplanned pregnancy undergoing treatment with natalizumab allows the continuation of natalizumab during pregnancy, with a very favorable clinical and radiological effectiveness and maternal-fetal safety profile during pregnancy and postpartum. Both in pregnancy with HAMS and in general, and particularly for successful implementation of the NAP-30 protocol, obstetric support and monitoring is essential for adequate pregnancy management.

Histomorphological study of the effects of aqueous extract of Curcuma longa on highly active antiretroviral therapy-induced testicular toxicity.

This study evaluates the effects of highly active antiretroviral therapy (HAART) and Curcuma longa on testicular histology, stereological parameters, body weight and relative organ weights, seminal fluid, testosterone, follicle-stimulating hormone, the antioxidant marker malondialdehyde (MDA), reduced glutathione (GSH) and superoxide dismutase (SOD) in adult male Wistar rat. Thirty-six adult male Wistar rats were grouped into A: distilled water (control); B: 100 mg/kg C. longa; C: 200 mg/kg C. longa; D: HAART only; E: HAART + 100 mg/kg C. longa; and F: HAART + 200 mg/kg C. longa. The rats were sacrificed after 8 weeks. Results showed a significant increase in abnormal morphology in group D when compared with group A. In group D, progressive sperm motility was significantly decreased compared with group F. The GSH level was significantly increased in group D compared with control group A, group E and group F. Histomorphological studies showed that HAART caused loss of germ cells and widening tubule lumen which were improved and partially restored by C. longa. This study suggests that C. longa improves testicular morphology and ameliorates HAART-induced toxicity. Further studies confirming putative mechanisms are required.

Política pública transcultural y factores no adherentes al TARGA del VIH-sida etnia Perú-Amazónica Kusu Pagata / Cross-cultural public policy and factors not adherent to HIV-aids HAART-Peru-Amazon ethnic group Kusu Pagata

Introducción: Uno de los problemas que afecta los pueblos indígenas latinoamericanos es la falta de datos epidemiológicos respecto a la prevalencia del VIH-sida, debido a que los sistemas de información y vigilancia no registran la variable etnicidad. Objetivo: Proponer una política pública transcultural para prevenir factores asociados a la no adherencia a la terapia antirretroviral de gran actividad del VIH-Sida de la etnia Amazónica Kusu Pagata. Métodos: Estudio descriptivo, transversal, con 18 pobladores diagnosticados de VIH-sida en la comunidad Kusu Pagata, Perú. 2018-2019. Se aplicó cuestionario validado por expertos y confiabilidad alfa de Cronbach (0,71). La variable investigada fue factores asociados a la no adherencia a terapia antirretroviral, la propuesta fue una política pública basada en la Teoría de Madeleine Leininger. Se utilizaron estadísticas descriptivas (promedio, desviación estándar) e inferencial (prueba de comparación de promedios para varianzas homogéneas Shapiro-Wilk y prueba F para comparación de varianzas de 1 cola). Resultados: La edad promedio del paciente no adherente al tratamiento fue 21 años, significativamente mayor que la de los adherentes (18,2) años. El 80 por ciento de los que acudieron al curandero fueron no adherentes al tratamiento, el 50 por ciento fueron adherentes y acudieron al establecimiento sanitario. El 64 por ciento consumió tratamientos con productos elaborados con plantas, los que se consideraron no adherentes al tratamiento farmacológico, el 71 por ciento tomó otros tratamientos alternos. Conclusión: Se propuso una política pública transcultural según Teoría de Madeleine Leininger para prevenir factores asociados a la no adherencia a la terapia antirretroviral del VIH-sida de la etnia Amazónica Kusu Pagata(AU)

Introduction: One of the problems affecting Latin American indigenous peoples is the lack of epidemiological data regarding the prevalence of HIV-Aids, due to the fact that the information and surveillance systems do not register the ethnicity variable. Objective: To propose a cross-cultural public policy to prevent factors associated with non-adherence to highly active antiretroviral therapy for HIV-Aids of the Amazon Kusu Pagata ethnic group. Methods: Descriptive, cross-sectional study with 18 residents diagnosed with HIV-Aids in the Kusu Pagata community, Peru. 2018-2019. An expertly validated questionnaire and Cronbach's alpha reliability (0.71) were applied. The variable investigated was factors associated with non-adherence to antiretroviral therapy; the proposal was a public policy based on the Theory of Madeleine Leininger. Descriptive (mean, standard deviation) and inferential statistics (means comparison test for homogeneous Shapiro - Wilk variances and F-test for comparison of 1-tail variances) were used. Results: The average age of the patient not adherent to the treatment was 21 years, significantly higher than that of the adherents (18.2) years. 80.00 percent of those who went to the healer were non-adherent to the treatment, 50.00 percent were adherent and went to the health facility. 64.00 percent consumed treatments with products made with plants, those who were considered non-adherent to the pharmacological treatment, 71.00 percent took other alternative treatments. Conclusion: A cross-cultural public policy was proposed according to Madeleine Leininger's Theory to prevent factors associated with non-adherence to antiretroviral therapy for HIV-AIDS of the Amazon Kusu Pagata ethnic group(AU)

Momordica charantia mitigates hepatic injury following adjuvant treatment with antiretroviral drugs in diabetic animal models.

Momordica charantia (M. charantia) is a medicinal plant, used in traditional practice for treating diseases like hypertension and diabetes mellitus. This study investigated the possible hepato-protective effect of M. charantia following treatment with highly active antiretroviral therapy (HAART) in diabetic rats. 48 adult male Sprague Dawley rats were divided into seven groups (A-G) of 7 animals per group and treated according to protocols. Diabetes was induced with streptozotocin (STZ) by intraperitoneal injection (45 mg/kg body weight). The animals were euthanized on the 10th week with liver removed for examination and blood obtained via cardiac puncture and centrifuged to collect the sera. Blood glucose levels (BGL) were consistently and significantly raised (p < 0.05) in all groups not receiving the adjuvant M. charantia. Treatment with M. charantia reverses the increase in BGL to near normal. Markers of liver injury assayed showed significant increase (p < 0.05) in AST, ALP and ALT levels in groups not receiving M. charantia. Adjuvant HAART and M. charantia caused significant declines in the liver enzymes (p < 0.05). Serum GGT was not markedly altered. Treatment with M. charantia significantly restored liver enzymes elevations to near normal comparable to control. Histopathological observations ranged from severe hepatocellular distortions, necrosis and massive fibrosis following treatment of HAART in diabetic groups not receiving M. charantia. Treatment with M. charantia did not show any sign of hepatotoxicity as judged from the histological and biochemical observations.

Optimizing Treatment for Adults with HIV/AIDS in China: Successes over Two Decades and Remaining Challenges.

PURPOSE OF REVIEW: The introduction of the National Free Antiretroviral Therapy Program (NFATP) in 2003 by the China National Center for AIDS/STD Control and Prevention has led to dramatic increases in antiretroviral therapy (ART) coverage among HIV-infected Chinese patients. Despite limitations in the number of available free antiretroviral drugs, the overall mortality associated with HIV/AIDS has dropped from 39.3 per 100 person-years in 2002 to 3.1 in 2014. In this review, we summarize the challenges, responses, and achievements of antiretroviral therapy (ART) in China over the past 20 years. RECENT FINDINGS: Continuous optimization of the Chinese National Guidelines for HIV/AIDS Diagnosis and Treatment has been guided by data from serial domestic multi-center studies aimed at evaluating efficacy and toxicity of available ART regimens among Chinese patients with HIV, with the goal of maximizing adherence, access, and efficacy. In addition, increasing attention has been focused on the importance of continuity in the HIV care cascade to promote linkage to care, and address the multidisciplinary chronic care needs HIV/AIDS patients on lifelong ART. Great progress has been achieved in the past 20 years in terms of access to and optimization of antiretroviral treatment in China. As the number of patients receiving long-term ART continues to grow, the focus of HIV/AIDS treatment has gradually transitioned from urgent care to the management of non-AIDS-related chronic complications and control of chronic inflammation.

Essential trace elements and progression and management of HIV infection.

This review was written to update the review that we published in Nutrition Research in 2007 by examining studies published in the last 11 years which describe the effects of trace mineral deficiencies and micronutrient supplementation on HIV infection and its progression. In addition, we included studies that explore the interactions between Highly Active Anti-Retroviral Therapy (HAART) and micronutrient nutrition, focusing on the essential trace minerals. This review summarizes the results described in relevant articles that were identified by literature searches conducted using the OVID Medline database. Four of the nine essential trace minerals, specifically chromium, iron, selenium, and zinc, can influence HIV progression and/or its treatment. Notably, copper-containing filters may prevent transmission of the HIV virus via breastfeeding. However, there is a lack of good evidence to date that fluoride, iodine, manganese, or molybdenum influence HIV infection. Recent studies reveal that HAART can alter serum trace mineral and vitamin concentrations, but the effects vary based on the medications used. Although they have contributed useful new data, the sample sizes for most of these studies were too small to draw definitive conclusions for introducing changes in the management of HIV infection. Larger studies are needed to better understand and define the roles of trace mineral and vitamin deficiencies and micronutrient supplementation in the management and treatment of HIV-infected patients.

The Impact of 6-month Micronutrient Supplementation on Viral, Immunological, and Mental Health Profile of a Cohort of Highly Active Antiretroviral Therapy-Naive HIV-Positive Patients in Northern Nigeria.

BACKGROUND: HIV is a chronic disease with inflammatory reactions involving numerous elements of the immune system, resulting in an increased risk for other physical and psychiatric morbidities. Micronutrients, some of which possess anti-inflammatory properties, may help prevent the development of psychological disorders such as anxiety and depression in people living with HIV disease. OBJECTIVES: This study examined the profile of viral load, CD4 cell count, C-reactive protein, anxiety, and depression among highly active antiretroviral therapy (HAART)-naive HIV-positive patients receiving micronutrient supplementation over a 6-month period. MATERIALS AND METHODS: A total of ninety HAART-naïve HIV-infected patients completed the Hospital Anxiety Depression Scale. Their blood samples were taken for serum viral load, CD4 cell count, and C-reactive protein at baseline. They all received a micronutrient supplement for 6 months, and 68 participants who remained in treatment at 6 months were reassessed with the same parameters. RESULTS: After 6 months of micronutrient supplementation, the participants were found to have statistically significantly lower mean scores on the anxiety (t-test = 2.970, P = 0.003) and depression (t-test = 3.843, P = 0.001) subscales. They also had statistically significantly lower median CD4 cell count (P = 0.00) and C-reactive protein serum measures (P = 0.04). The median viral load decreased although the difference was not statistically significant. CONCLUSION: Micronutrient supplementation may reduce inflammatory reactions, anxiety, and depression in HAART-naive HIV-infected persons.

Oral candidal carriage correlates with CD4+ cell count but not with HIV and highly active antiretroviral therapy status.

AIM: The occurrence of oropharyngeal candidiasis (OPC) may be influenced by oral candidal carriage (OCC). Although OPC is strongly associated with low CD4+ cell count (400-700 cells/mm3 ) and a lack of highly active antiretroviral therapy (HAART), the effect of these two parameters on OCC is debatable. We investigated the oral candidal carriage, species diversity, antifungal susceptibility and the association of OCC with CD4+ cell count and HAART. METHODS: Oral candidal isolates from 120 HIV+ patients (60 receiving and 60 not receiving HAART) and 60 healthy controls were quantified, and their species determined using standard culture and biochemical methods, followed by antifungal susceptibility testing using the agar dilution method. RESULTS: The OCC was significantly higher in HIV+ patients; Candida albicans was the most frequently isolated species in both groups, followed by Candida tropicalis. Candidal density carriage correlated significantly with CD4+ cell count, but not with HIV and HAART status. Among the isolates from HIV+ patients, 35.4% showed reduced susceptibility to fluconazole. CONCLUSION: HIV status results in significantly elevated rates of OCC C albicans remains the predominant pathogen, although other species are emerging rapidly. Resistance to fluconazole is on the rise, and more efficient treatment strategies need to be implemented.

Prevalence of liver injury among patients with acquired immunodeficiency syndrome treated with highly active antiretroviral therapy in China.

OBJECTIVE: To estimate the prevalence of liver injury among patients with acquired immunodeficiency syndrome (AIDS) who received highly active antiretroviral therapy (HAART) in rural Henan Province in China, and to explore whether Traditional Chinese Medicine (TCM) treatment based on HAART would increase this risk. METHODS: This was a retrospective cross-sectional study. We collected medical information on patients with AIDS from two treatment databases in 2014. Criteria established by the AIDS Clinical Trials Group in 1996 were used for grading liver injury, classified based on the limit of normal (ULN) for alanine transaminase and aspartate aminotransferase: grade 1 (1.25-2.5 × ULN); grade 2 (2.6-5 × ULN); grade 3 (5.1-10 × ULN); and grade 4 (> 10 × ULN). Factors associated with liver injury were evaluated using a logistic regression model. RESULTS: A total 6953 patients with AIDS (3324 male and 3629 female patients) were enrolled into this study. The prevalence of liver injury was 22.0% (18.0% grade 1, 3.1% grade 2, 0.9% grade 3). In multivariate analysis, patients aged 34-45 years were more likely to have liver injury than patients in other age groups [adjusted odds ratio (AOR), 1.39; 95% CI, 1.01-1.91)]. Other factors associated with liver injury included male sex (AOR, 1.64; 95% CI, 1.46-1.85), HIV infection via blood (AOR, 1.47; 95% CI, 1.19-1.82), hepatitis B virus antibody positive (AOR, 1.07; 95% CI, 0.85-1.36), and hepatitis C virus (HCV) antibody positive (AOR, 2.76; 95% CI, 2.28-3.34). CONCLUSION: The prevalence of liver injury was relatively high among HAART-experienced patients. Several factors associated with liver injury included male sex, age 35-45 years old, HIV infection through blood, and concurrent HCV infection. TCM had no relationship with liver injury in patients receiving HAART.

The effect of aerobic exercises on lipid profile of patients with human immunodeficiency virus infection undergoing highly active antiretroviral therapy: a protocol for a systematic review.

Patients living with human immunodeficiency virus (HIV) infection who are treated with highly active antiretroviral therapy (HAART) often experience metabolic changes that have an adverse effect on their over-all health status. This review will assess the effect of aerobic exercises on the lipid profile of individuals with HIV infection undergoing HAART. Cochrane Library, MEDLINE, CINAHL (Cumulative index to Nursing and Allied Health Literature), OVID, ProQuest, AMED (Allied and Complementary Medicine Database), PsycINFO, Web of Science Core Collection and Pedro databases will be searched until June 2018. Studies that investigated the effects of aerobic exercises on the lipid profile of HAART treated patients with HIV will be included. Two reviewers will screen all articles for eligibility and independently evaluate the risk of bias, complete quality assessment and extract data for all included articles. Homogenous quantitative outcome data will be analyzed using a random effect model of meta-analysis with results presented as relative risk for dichotomous variable and standardized mean for continuous variable. Heterogeneous qualitative data will be analyzed using narrative synthesis. This systematic review will provide evidence about the effectiveness of aerobic exercises in managing HAART related dyslipidemia in patients with HIV infection and thus provide the impetus for more structured exercise interventions.

Virgin coconut oil extract mitigates testicular-induced toxicity of alcohol use in antiretroviral therapy.

The consumption of alcohol by people living with HIV/AIDS is associated with a graver prognosis. Long-term use of antiretrovirals may have certain health challenges that may be aggravated by concomitant alcohol use. This study investigated virgin coconut oil (VCO) as an adjuvant to the deleterious effects of highly active antiretroviral therapy (HAART) and alcohol on the cyto-architecture and functioning of the testis. Forty adult male Sprague-Dawley rats, weighing 165~176 g, were divided into eight groups and treated according to protocol. Testicular histology, stereological parameters, seminal fluid, testosterone, luteinizing hormone, follicle-stimulating hormone, the antioxidants marker malondialdehyde (MDA), and antioxidant glutathione (GSH) were examined. The use of ethanol alone and ethanol + HAART showed extensive degeneration in the seminiferous epithelium, decreased semen quality, disorganized basement membrane and widened, hypocellular interstitium. GSH was significantly decreased in the ethanol alone treated group with no significant effect on testosterone, LH, and MDA levels. Adjuvant treatment with VCO at low dose (2.5 mL/kg/bw) improved sperm motility with a partial restoration of the histopathological alterations. High doses of VCO (5.0 mL/kg/bw) showed greater improvement with respect to sperm counts, increased FSH hormonal and GSH antioxidant levels, and a well-preserved testicular cyto-architecture.

[Moxibustion combined with highly active antiretroviral therapy for CD4+ and γ chain cytokines of HIV infected patients].

OBJECTIVE: To compare the effects of moxibustion combined with highly active antiretroviral therapy (HAART) and simple HAART for human immunodeficiency virus (HIV) infected patients. METHODS: A total of 100 patients with HIV receiving HAART were randomized into an observation group and a control group, 50 cases in each one. In the observation group, moxibustion was used at Zusanli (ST 36), Guanyuan (CV 4) and Sanyinjiao (SP 6), etc. combined with HAART of zidovudine, lamivudine, nevirapine and efavirenzone, etc. Simple HAART was used in the control group. The patients were observed for 18 months. The indexes were CD4+, CD4+/CD8+, interleukin 2 (IL-2), interleukin 7 (IL-7), the incidence of side effects and the score of quality of life. RESULTS: After treatment, CD4+, CD4+/CD8+, serum IL-2 and the scores of quality of life (physiological, psychological, social relation fields and comprehensive score) increased and serum IL-7 decreased compared with those before treatment in the two groups (P<0.01, P<0.05), with better results except CD4+ in the observation group (P<0.01, P<0.05). The incidences of gastrointestinal side effects and total side effects in the observation group were lower than those in the control group (14% (7/50) vs 32% (16/50), 58% (29/50) vs 80% (40/50), both P<0.05). CONCLUSION: Moxibustion combined with HAART for HIV infected patients could reduce the incidence of side effects, improve medication compliance, CD4+/CD8+, IL-2, IL-7 and the quality of life.

Moxibustion combined with highly active antiretroviral therapy for CDand γ chain cytokines of HIV infected patients / 中国针灸

<p><b>OBJECTIVE</b>To compare the effects of moxibustion combined with highly active antiretroviral therapy (HAART) and simple HAART for human immunodeficiency virus (HIV) infected patients.</p><p><b>METHODS</b>A total of 100 patients with HIV receiving HAART were randomized into an observation group and a control group, 50 cases in each one. In the observation group, moxibustion was used at Zusanli (ST 36), Guanyuan (CV 4) and Sanyinjiao (SP 6), etc. combined with HAART of zidovudine, lamivudine, nevirapine and efavirenzone, etc. Simple HAART was used in the control group. The patients were observed for 18 months. The indexes were CD, CD/CD, interleukin 2 (IL-2), interleukin 7 (IL-7), the incidence of side effects and the score of quality of life.</p><p><b>RESULTS</b>After treatment, CD, CD/CD, serum IL-2 and the scores of quality of life (physiological, psychological, social relation fields and comprehensive score) increased and serum IL-7 decreased compared with those before treatment in the two groups (<0.01,<0.05), with better results except CDin the observation group (<0.01,<0.05). The incidences of gastrointestinal side effects and total side effects in the observation group were lower than those in the control group (14% (7/50) vs 32% (16/50), 58% (29/50) vs 80% (40/50), both<0.05).</p><p><b>CONCLUSION</b>Moxibustion combined with HAART for HIV infected patients could reduce the incidence of side effects, improve medication compliance, CD/CD, IL-2, IL-7 and the quality of life.</p>

Dietary supplement interactions with antiretrovirals: a systematic review.

Many patients who take antiretroviral drugs also take alternative therapies including dietary supplements. Some drug-supplement combinations may result in clinically meaningful interactions. We aimed to investigate the evidence for dietary supplement interactions with antiretrovirals. A systematic review was conducted using multiple resources including PubMed, Natural Medicine Comprehensive Database, The Review of Natural Products, and Google Scholar. All human studies or case reports evaluating an interaction between a dietary supplement and an antiretroviral were selected for inclusion. Twenty-eight pharmacokinetic studies and case-series/case reports were selected for inclusion. Calcium carbonate, ferrous fumarate, some forms of ginkgo, some forms of garlic, some forms of milk thistle, St. John's wort, vitamin C, zinc sulfate, and multivitamins were all found to significantly decrease the levels of selected antiretrovirals and should be avoided in patients taking these antiretrovirals. Cat's claw and evening primrose oil were found to significantly increase the levels of antiretrovirals and patients should be monitored for adverse effects while taking these dietary supplements with antiretrovirals. This systematic review shows the importance of screening all human immunodeficiency virus patients for dietary supplement use to prevent treatment failure or adverse effects related to an interaction.

Terapia nutricional em pacientes portadores do HIV em uso de TARV frente ao desenvolvimento de distúrbios metabólicos induzidos pela medicação / Nutrition therapy in HIV-infected patients against antiretroviral therapy-induced metabolic disorders

Embora a incidência de casos de pacientes portadores do vírus HIV ainda esteja aumentando, através da terapia antirretroviral (TARV) é possível melhorar a qualidade de vida e diminuir os agravos provocados pela patologia. No entanto, com a TARV observam-se efeitos colaterais importantes relativos ao metabolismo: resistência à insulina/intolerância à glicose, hipertensão arterial, lipodistrofia e dislipidemia. O objetivo do presente estudo foi revisar a literatura em busca de um maior entendimento acerca do efeito da terapia nutricional associada ou não às alterações nos hábitos de vida em pacientes portadores do HIV que fazem uso de TARV frente ao desenvolvimento de distúrbios metabólicos induzidos pela medicação. Foram revisados 11 estudos que preenchiam os critérios de inclusão, sendo que sete estudos demonstraram que a terapia nutricional apresenta impacto em alterações metabólicas, portanto uma adequada orientação nutricional deve ser parte integrante do tratamento de pacientes HIV positivos em terapia antirretroviral.

Although the incidence of cases of patients with HIV has increased, it is possible to improve the quality of life and reduce the complications caused by the disease through highly active antiretroviral therapy (HAART). However, HAART presents important side effects related to metabolic alterations: insulin resistance/glucose intolerance, hypertension, dyslipidemia, and lipodystrophy. The aim of the present study was to review the literature, searching for a better understanding of the effect of nutrition therapy associated or not with the alterations in lifestyle in HIV patients who use HAART, given the development of metabolic disorders induced by medication. We reviewed 11 studies that met the inclusion criteria, and seven studies showed that the nutrition therapy has impact on metabolic alterations; therefore a proper nutritional guidance should be an integral part of the treatment of HIV-positive patients on antiretroviral therapy.

A two-week regimen of high-dose integrase inhibitors does not cause nephrotoxicity in mice.

BACKGROUND: The integrase inhibitors, raltegravir and dolutegravir, are nucleoside reverse transcriptase inhibitor-sparing agents which may be used as part of first-line antiretroviral therapy for HIV. These drugs inhibit creatinine secretion through organic cation transporters, thus elevating serum creatinine without affecting glomerular filtration. We sought to determine whether subtle signs of nephrotoxicity could be observed in mice administered a two-week regimen of high-dose integrase inhibitors. METHODS: C57BL/6 mice were fed standard water (CTRL, n = 6), raltegravir-containing water (40 mg/kg/day, n = 6), or dolutegravir-containing water (2.7 mg/kg/day, n = 6) for two weeks and sacrificed. Endpoints were assessed including urine microalbumin, kidney injury molecule-1 renal tissue gene expression, renal histopathology, serum creatinine, and blood urea nitrogen. RESULTS: The results are NOT consistent with a direct nephrotoxic effect of the integrase inhibitors in mice. Serum creatinine was significantly elevated in raltegravir and dolutegravir mice (p < 0.05) compared to control (raltegravir = 0.25 mg/dl, dolutegravir = 0.30 mg/dl versus CTRL = 0.17 mg/dl). Blood urea nitrogen, cystatin C, and urine microalbumin were unchanged. Kidney injury molecule-1 tissue expression in raltegravir and dolutegravir groups was nonsignificantly elevated compared to control (1.2-fold compared to control). Renal histopathology by periodic acid-Schiff staining failed to reveal glomerular or tubular renal injury in any group. CONCLUSION: These studies are consistent with integrase inhibitors competitively inhibiting creatinine secretion. While no evidence of direct nephrotoxicity was observed after two weeks of high-dose drug administration, additional studies may be performed to understand whether these drugs lead to chronic nephropathy.