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Date Posted: 13:24:17 01/26/02 Sat
Author: No name
Subject: DRUGS;ETC.

WHY ARE VITAMINS AND MINERALS IMPORTANT?
Vitamins and minerals are sometimes called micronutrients. Our bodies need them, in small amounts, to support the chemical reactions our cells need to live. Different nutrients affect digestion, the nervous system, thinking, and other body processes.

Micronutrients can be found in many foods. Healthy people might be able to get enough vitamins and minerals from their food. People with HIV or another illness need more micronutrients to help repair and heal cells. Also, many medications can create shortages of different nutrients.



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WHAT ARE ANTIOXIDANTS?
Some molecules in the body are in a form called oxidized. These molecules are also called free radicals. They react very easily with other molecules, and can damage cells. High levels of free radicals seem to cause a lot of the damage associated with aging.

Free radicals are produced as part of normal body chemistry. Antioxidants are molecules that can stop free radicals from reacting with other molecules. This limits the damage they do. Several nutrients are antioxidants.

Antioxidants are important for people with HIV, because HIV infection leads to higher levels of free radicals. Also, free radicals can increase the activity of HIV. Higher levels of antioxidants can slow down the virus and help repair some of the damage it does.



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HOW MUCH DO I NEED?
You might think that all you have to do to get enough vitamins and minerals is to take a "one-a-day" multivitamin pill. Unfortunately, it's not that easy. The amounts of micronutrients in many of these pills are based on the Recommended Dietary Allowances (RDAs) set by the US government. The problem with the RDAs is that they are not the amounts of micronutrients that are needed by people with HIV. Instead, they are the minimum amounts needed to prevent shortages in healthy people. HIV disease and many AIDS medications can use up some nutrients. One study of people with HIV showed that they needed between 6 and 25 times the RDA of some nutrients! Still, a high potency multivitamin is a good way to get basic micronutrients.


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WHICH NUTRIENTS ARE IMPORTANT?
There has not been a lot of research on specific nutrients and HIV disease. Also, many nutrients interact with each other. Most nutritionists believe in designing an overall program of supplements.

People with HIV may benefit from taking supplements of the following vitamins and minerals:

B Vitamins: Vitamin B-1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin B12 (Cobalamin), and Folate (Folic Acid).
Antioxidants, including beta-carotene (the body breaks down beta-carotene to make Vitamin A), selenium, Vitamin E (Tocopherol), and Vitamin C.
Magnesium and Zinc


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WHAT ABOUT OTHER SUPPLEMENTS?

In addition to vitamins and minerals, some nutritionists suggest that people with HIV take supplements of other nutrients:

Acidophilus, a bacterium that grows naturally in the intestines, helps with digestion.
Alpha-lipoic acid is a powerful antioxidant that may help with neuropathy and mental problems.
Coenzyme Q10 may help with immune function.
Essential fatty acids found in evening primrose oil or flaxseed oil can help with dry skin and scalp.
N-Acetyl-Cysteine, an antioxidant, can help maintain body levels of glutathione. Glutathione is one of the body's main antioxidants.


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CAN NUTRIENTS BE HARMFUL?
Most vitamins and nutrients appear to be safe as supplements, even at levels higher than the Recommended Dietary Allowances (RDAs). However, some can cause problems at higher doses, including Vitamin A, Vitamin D, copper, iron, niacin, selenium, and zinc.

A basic program of vitamin and mineral supplementation should be safe. This would include the following, all taken according to directions on the bottle:

A multiple vitamin/mineral (without extra iron),
An antioxidant supplement with several different ingredients, and
A trace element supplement. There are seven essential trace elements: chromium, copper, cobalt, iodine, iron, selenium, and zinc. Some multivitamins also include trace elements.
Any other program of supplements should be based on discussion with a doctor or nutritionist. Remember that higher price may not mean better quality.


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FOR MORE INFORMATION
You can get more information on nutrition and HIV from the following books:

Nutrition and HIV: A New Model for Treatment by Mary Romeyn, MD, $18.95, published by Jossey-Bass, Inc, telephone 415-433-1740.

Positively Well: Living with HIV as a Chronic, Manageable, Survivable Disease by Lark Lands, Ph.D., $24.95, available soon by calling 1-800-542-8102.



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Revised January 27, 2001



HOW SERIOUS IS HIV FOR WOMEN?
More women are being infected with HIV. Only 7% of AIDS cases reported in 1985 were women. That percentage grew to 14% in 1992 and 23% in 1999. About 40% of women are infected through sex with an HIV-infected man (often an injection drug user), and about 27% through drug use (see Fact Sheet 153 on Drug Use and HIV). Almost 80% of infected women in the US are Black or Hispanic.

Many women do not have good information on how they can be infected with HIV, and scientists know very little about HIV infection in women.


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WHAT DO WOMEN NEED TO KNOW?

More women are being infected through heterosexual sex. Many women think AIDS is a disease of gay men. But women get HIV from sharing needles and from heterosexual sex. Heterosexual sex is a growing source of HIV infection in women in the US.
During sex, HIV is transmitted from men to women much more easily than from women to men. A woman's risk of infection is higher with anal intercourse, or if she has a vaginal disease.
Women should know the HIV risk factors for their sex partners. The risk of infection is higher if your sex partner is or was an injection drug user, has other sex partners, has had sex with infected people, or has sex with men. Talk about these risk factors and take steps to protect yourself.
If you are not absolutely certain about your sex partner's HIV status, take precautions. Using a condom (see Fact Sheet 152) correctly can prevent most cases of HIV infection.
Many women feel they can not ask their boyfriends or husbands to use condoms. But condoms are the safest way to avoid HIV infection. There is a female condom that provides some protection, but not as much as a male condom. Other forms of birth control, such as birth control pills, diaphragms, or implants do NOT provide protection against HIV.
Get tested for HIV if you think a sex partner might be at risk. Many women don't find out they have HIV until they become ill or get tested during pregnancy. If women don't get tested for HIV, they seem to get sick and die faster than men. But if they get tested and treated, they live as long as men.
Viral loads may be lower in women. Several studies have shown that women may have lower viral loads during the first few years of HIV infection. At this point, treatment guidelines are the same for women and men.
Vaginal problems can be early signs of HIV infection. Ulcers in the vagina, or yeast infections that come back within 2 months and don't clear up easily, can be signs of HIV. Hormone changes, birth control pills, or antibiotics can also cause them. See your doctor to make sure you know the cause.
Mothers can pass HIV infection to their babies. When a woman with HIV gets pregnant, she can pass HIV to her unborn child. Also, a mother's breast milk can infect her new baby. See Fact Sheet 611 for more information on HIV and pregnancy.


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WHAT DO RESEARCHERS NEED TO KNOW?


More women need to be studied. In 1997 the FDA said that women could no longer be kept out of clinical trials just because they might become pregnant. The proportion of women in AIDS research studies is increasing but is rarely over 20% of total patients studied.
Some HIV-related diseases are different in women.
Women get vaginal infections, genital ulcers, pelvic inflammatory disease, and genital warts more often - and more severely - than uninfected women. Cervical cancer was added to the list of HIV-related infections in 1993. HIV-infected women should get pap and pelvic exams at least once a year. See Fact Sheet 507 for more information.
Only 1 woman gets Kaposi's Sarcoma, a skin cancer (See Fact Sheet 508), for every 8 men who get it.
Women get thrush (a fungal infection, Fact Sheet 516) in their throats, and herpes (a virus that causes cold sores and genital herpes) about 30% more often than men.
Women are much more likely than men to get a severe rash when using nevirapine (See Fact Sheet 431.)
Women with fat redistribution (see Fact Sheet 551 on Lipodystrophy) are more likely than men to accumulate fat in the abdomen or breast areas and are less likely to lose fat in the arms or legs.
More research is needed on how HIV medications affect women. Most HIV medications have not been studied to see if they affect women differently or if they affect menstrual cycles. Many of them reduce the effectiveness of birth control pills.


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THE BOTTOM LINE
More women are becoming infected with HIV. With early testing and treatment, women can live with HIV as long as men. Women need to know more about how they can be infected, and should get tested for HIV if they think there is any chance they have been exposed. This is especially true for pregnant women. If they test positive for HIV, they can take steps to reduce the risk of infecting their babies.

The best way to prevent infection in heterosexual sex is with the male condom. Other birth control methods do not protect against HIV. Women who shoot drugs should not share needles, or should learn how to clean them.

Women should discuss vaginal problems with their doctor, especially yeast infections that don't go away or ulcers. These could be signs of HIV infection.



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Revised March 28, 2001



HOW DO BABIES GET AIDS?
The virus that causes AIDS, HIV, can be transmitted from an infected mother to her newborn child. Without treatment, about 20% of babies of infected mothers get infected.

Mothers with higher viral loads are more likely to infect their babies. However, no viral load is low enough to be "safe". Infection can occur any time during pregnancy, but usually happens just before or during delivery.

The baby is more likely to be infected if the delivery takes a long time. During delivery, the newborn is exposed to the mother's blood.

Drinking breast milk from an infected woman can also infect babies. Mothers who are HIV-infected should not breast-feed their babies.



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HOW CAN WE PREVENT INFECTION OF NEWBORNS?
Mothers can reduce the risk of infecting their babies if they:

Use antiviral medications,
Keep the delivery time short, and
Don't breast-feed the baby
Use antiviral medications: The risk of transmitting HIV drops from 20% to 8% or less if antiviral medications are used. Transmission rates are lowest if the mother takes AZT during the last six months of her pregnancy, and the newborn takes AZT for six weeks after birth.

Even if the mother does not take antiviral medications until she is in labor, the transmission rate can be cut by almost half. Two methods have been studied:

AZT and 3TC during labor, and for both mother and child for one week after the birth.
One dose of nevirapine during labor, and one dose for the newborn, 2 to 3 days after birth.
Although these shorter treatments do not work as well, they are less expensive and might be helpful in developing countries.
Keep delivery time short: The risk of transmission increases with longer delivery times. If the mother uses AZT and delivers her baby by cesarean section (C-section), she can reduce the risk of transmission to about 2%.

Do not breast-feed the baby: There is about a 14% chance that a baby will get HIV infection from infected breast milk. This risk can be eliminated if HIV-infected women do not breast-feed babies. Baby formulas should be used.

In developing countries, however, there might not be clean water to prepare baby formulas. The World Health Organization believes that the risk of transmitting HIV is less than the health risk of using contaminated water.



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HOW DO WE KNOW IF A NEWBORN IS INFECTED?
Most babies born to infected mothers test positive for HIV. Testing positive means you have HIV antibodies in your blood. See Fact Sheet 102 for more information on HIV tests. Babies get HIV antibodies from their mother even if they aren't infected with the virus.

If babies are infected with HIV, their own immune systems will start to make antibodies. They will continue to test positive. If they are not infected, the mother's antibodies will gradually disappear and the babies will test negative after about 6 to 12 months.

Another test, similar to the HIV viral load test, can be used to find out if the baby is infected with HIV. Instead of antibodies, these tests detect the HIV virus in the blood.



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WHAT ABOUT THE MOTHER'S HEALTH?
Recent studies show that HIV-positive women who get pregnant do not get any sicker than those who are not pregnant. That is, becoming pregnant does not appear to be dangerous to the health of an HIV-infected woman.

However, although AZT by itself can help protect newborns from HIV, it is not the best choice for the mother's health. Combination therapies using at least three drugs are the standard treatment. If a pregnant woman takes AZT by itself, she may get less benefit from combination therapy in the future.

On the other hand, combination therapy might cause birth defects, especially during the first three months. For example, pregnant women should not use the drug efavirenz (Sustiva). Preliminary studies of pregnant women who used protease inhibitors show good results, with virtually no HIV-infected newborns and no unusual birth defects.

A pregnant woman should consider all of the possible side effects of antiviral medications. Some of them could be worse for pregnant women. For example, in January 2001, the FDA warned pregnant women not to use both ddI and d4T in their antiviral treatment due to a high rate of a dangerous side effect called lactic acidosis.

If you have HIV and you are pregnant, or if you want to become pregnant, talk with your doctor about your options for taking care of yourself and reducing the risk of HIV infection or birth defects for your new child.



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THE BOTTOM LINE
An HIV-infected woman who becomes pregnant needs to think about her own health and the health of her new child.

The risk of transmitting HIV to a newborn can be cut to just 2% if the mother takes AZT during the last 6 months of her pregnancy, delivers her child by Cesarean section, and the newborn takes AZT for six weeks.

Pregnancy does not seem to make the mother's HIV disease any worse. However, some medications used to fight HIV or to treat opportunistic infections might cause birth defects. This is especially true during the first 3 months of pregnancy. If a mother chooses to stop taking some medications during pregnancy, her HIV disease could get worse.

Any woman with HIV who is thinking about getting pregnant should carefully discuss treatment options with her doctor.



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Revised January 8, 2001



WHAT IS IMMUNE RESTORATION?
Immune restoration refers to repairing the damage done to the immune system by HIV.


In a healthy immune system, there is a full range of T-cells (CD4+ cells) that can fight different diseases. As HIV disease progresses, the number of T-cells drops. The first T-cells that HIV attacks are the ones that specifically fight HIV. Some types of T-cells can disappear, leaving gaps in the immune defenses. Immune restoration looks for ways to fill these gaps.

A healthy immune system can fight off opportunistic infections (OIs). Because these infections develop when T-cell levels are low, many researchers think that we can use T-cell counts as a measure of immune function. They believe that increases in T-cell counts are a sign of immune restoration. There is disagreement on this point (see "Are New T-Cells As Good As Old?" below.)


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HOW CAN THE IMMUNE SYSTEM BE RESTORED?
We can preserve the immune system's ability to fight HIV if we start antiviral medications immediately after infection with HIV. Unfortunately, very few cases of HIV are identified that early. As HIV infection continues, it can damage the immune system. Scientists are exploring several ways to repair this damage.

Improving the function of the thymus: The thymus, a small organ located at the base of the throat, takes white blood cells that come from the bone marrow and turns them into T-cells. It works the hardest when you're just 6 months old, and then starts to shrink. Scientists used to think that the thymus stopped working by the age of 20, but newer research shows that it keeps producing new T-cells much longer, maybe until age 50. Strong antiviral medications can allow the thymus to replace lost types of T-cells.

When scientists thought that the thymus stopped working at a young age, they looked into the possibility of transplanting a young thymus into someone with HIV, or even transplanting an animal's thymus. They also tried to stimulate the thymus using thymic hormones. These methods might still be important for older people with HIV.

Restoring the number of immune cells: As HIV disease progresses, the numbers of both CD4+ (T4) and CD8+ (T8) cells drop. Some researchers are trying to prevent these decreases, or to increase the numbers of cells.

One approach, cell expansion, takes an individual's cells, multiplies them outside the body, and then infuses them back into the body. A second, cell transfer, involves giving a patient immune cells from the patient's twin, HIV-negative relative, or from a different species that is HIV-immune.

A third method uses cytokines. These are chemical messengers that support the immune response. The most work has been done on interleukin-2 (IL-2), which can lead to large increases in CD4+ cells. Fact Sheet 622 has more information on IL-2.

Another approach is gene therapy. This involves changing the bone marrow cells that will travel to the thymus and become T-cells. Gene therapy tries to make the bone marrow cells immune to HIV infection.

Letting the immune system repair itself: CD4+ counts have increased for many people who have taken combination antiviral therapy. Some scientists believe that the immune system might be able to heal and repair itself if it's not fighting off large numbers of HIV viruses. This approach seems more likely now that we know that the thymus keeps working until a person is almost 50 years old.

Most people take medication to prevent opportunistic infections when their T-cell counts go below 200. Several studies have shown that if these people take antiviral medications and their T-cell counts climb back over 200, it is safe in most cases to stop taking medications to prevent these infections. Be sure to talk to your doctor before you stop taking any medication.

Stimulating HIV-specific immune response: Researchers are using a special preparation of modified, killed HIV virus (Remuneź) to stimulate the body's response to HIV. Remune is essentially the same as a vaccine, but it is given to people who are already HIV-infected. An initial study of Remuneź added to antiviral therapy showed that it decreased viral load, increased CD4+ cell counts, and increased immune system response to HIV.



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ARE NEW T-CELLS AS GOOD AS OLD?
Most approaches to immune restoration are based on increasing the numbers of CD4+ cells. This is based on the assumption that when T-cells increase, the immune system is stronger.


When people with HIV start taking antiviral medications, their T-cell counts usually go up. At first, the new T-cells are probably copies of existing types of T-cells. If some "types" of T-cells were lost, they won't come back right away. This could leave some gaps in the body's immune defenses.

However, if HIV stays under control for a few years, the thymus might make new T-cells that could fill in these gaps and restore the immune system. Some of these T-cells will specifically fight HIV, and can help control HIV infection.



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Revised March 30, 2001



WHAT IS HYDROXYUREA?
Hydroxyurea (Hydreaź) is a drug used for antiviral therapy. It is manufactured by Bristol-Myers Squibb. Hydroxyurea is sometimes referred to as HU.

Hydroxyurea was approved for use against cancer. It also works against sickle cell anemia. Hydroxyurea has not yet been approved by the FDA for use against HIV.

Hydroxyurea blocks an enzyme produced by human cells. This enzyme makes building blocks used by cells that are multiplying. Cancer cells multiply very quickly, so when hydroxyurea blocks this enzyme, the cancer grows more slowly.

These building blocks are also used by HIV when it multiplies. Some of the drugs used against HIV (the nucleoside analog reverse transcriptase inhibitors) are "fake" versions of these same building blocks. When HIV uses the fake materials, it can't multiply.

When hydroxyurea reduces the amount of "real" building blocks, then HIV is forced to use more of the "fake" versions: the anti-HIV drugs. Even though hydroxyurea does not attack HIV directly, it can make some anti-HIV drugs work better. Hydroxyurea works very well with the drugs ddI and d4T. Researchers are studying how Hydroxyurea works with other anti-HIV drugs.


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WHO SHOULD TAKE HYDROXYUREA?
Hydroxyurea has been studied in combination with the antiviral drugs ddI and d4T. Most doctors start antiviral therapy when a person has some symptoms of HIV disease, when their T-cell count (CD4+ cells) falls below 350, or if their viral load is over 30,000.

There are no absolute rules about when to start antiviral drugs. Some people want to "hit HIV hard and early", starting with the strongest drugs to preserve the immune system. Others think that the strongest drugs should be saved until they are needed, later in the course of HIV disease. You and your doctor should consider your T-cell count, viral load, any symptoms you are having, and your attitude about taking HIV medications.


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WHAT ABOUT DRUG RESISTANCE?
The HIV virus is sloppy when it makes copies of its genetic code (RNA). This means that many new copies of HIV are slightly different from the original (mutations). Some mutations can resist an antiviral drug and continue to multiply. When this happens, the drug will stop working. This is called "developing resistance" to the drug.

Hydroxyurea blocks an enzyme produced by our own cells, not by HIV. This means that HIV can not develop resistance to Hydroxyurea. Taking hydroxyurea can slow down HIV mutations so that it takes much longer for resistance to develop to the other anti-HIV drugs you are taking.


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HOW IS HYDROXYUREA TAKEN?
Hydroxyurea is available in 500 mg tablets. The most common doses studied have been 1 gram taken once a day, or 500 mg taken twice a day.

Scientists are working to find out the best dose of hydroxyurea for people with HIV.


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WHAT ARE THE SIDE EFFECTS?
With the start of any anti-viral treatment there may be temporary side effects such as headaches, hypertension, or a general sense of feeling ill. These side effects are likely to get better or even disappear over time.

Hydroxyurea may cause nausea, vomiting, and diarrhea. It can also lead to weight gain, hair loss, and changes in skin coloring. It may cause birth defects, so pregnant women should not take hydroxyurea. It can also damage the bone marrow. This can result in anemia (a drop in the number of red blood cells) or neutropenia (a drop in the number of white blood cells).

Scientists reported in early 2000 that hydroxyurea appears to increase the risk of peripheral neuropathy.


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HOW DOES HYDROXYUREA REACT WITH OTHER DRUGS?

Hydroxyurea is most effective if taken with reverse transcriptase inhibitors such as ddI or d4T. Hydroxyurea is still being studied in combination with other antiviral drugs.

Hydroxyurea's side effects may be worse if taken with AZT, because both drugs can damage the bone marrow.



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Revised July 27, 2001

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