1. Nonvitamin, Nonmineral Dietary Supplementation in HIV-Positive People Nutrition in Clinical Practice 22:679-687, December 2007 American Society for Parenteral and Enteral Nutrition

2. Nonvitamin/Nonmineral (NVNM) Dietary supplement Herbs Botanicals Concentrates Metabolites Constituents Extracts Most common echinacea, gingko biloba

3. HIV-infected population ~15% used herbal medicine Questions to ask… How the components of these pills will interact with conventional medicine and alter patient care? How the financial burden of these supplements will affect the patient.

4. Therapy for HIV/AIDS Health maintenance Control of viral replication Highly active antiretroviral therapy (HAART) Questions to ask… Do supplements interfere with HAART metabolism? What supplements the HIV-infected population is taking? What is the interaction with HIV medications and disease process?

5. Objective Describe current NVNM supplement use of HIV-infection people Financial burden of buying these supplements Review current literature on potential interaction between NVNM supplements

6. Methods Nutrition for Healthy Living study Subjects: Boston area/ Rhode Island 1995 to 2002 Documentation of HIV infection Age >18 years

7. Data Collection Data Medical Nutrition Dietary intake Body composition Quality of life Met with a registered dietitian Educated on keeping a 3-day food record

8. Study Design Cross-sectional Population: HIV-infected patients in the NFHL study Duration: 9/1/2001 to 9/1/2002

9. Results 72 subjects out of 368 reported consumption of NVNM supplements 24% men, 8% women Caucasian Education: at least a high school diploma A mean of 6 NVNM supplements per subject

10. NVNM supplements Most common Glutamine (51%) N-acetyl-cysteine (36%) Fish oil (33%) Alpha-lipoic acid (32%) Acetyl-L-carnitine (28%) Coensyme Q10 (28%)

11. Vitamin/Mineral Most common Multivitamin / Multimineral (83%) Vitamin E (51%) Vitamin C (47%) Vitamin B complex (43%) Calcium (29%) Selenium (28%)

12. Discussion Supplement users Take an average of 4 VM + 6 NVNM White Well-educated High incomes Secure housing Not IV drug users Receive appropriate HIV/AIDS therapy Diet High fiber and protein More calories from polyunsaturated and monounsaturated fatty acids

13. Glutamine Functions Increased body weight Increased body cell mass Increased interacellular water Provide a highly cost-effective therapy for HIV patients

14. N-acetyl-cysteine (NAC) Glutathione precursor Sulfur containing amino acid Functions Restore cysteine and glutathione levels Inhibit the replication of HIV virus

15. Fish Oil Polyunsaturated fatty acid Eicosapentaenoic acid (EPA) Docosahexaenoic acid (DHA) Functions Lower triglyceride levels Decrease mortality Lower blood pressure

16. Alpha-lipoic acid (ALA) Vitamin-like antioxidant Nonessential nutrient Functions Treatment of diabetic polyneuropathy Inhibit the replication of HIV

17. Acetyl-L-carnitine Transports long-chain fatty acids across the inner mitochondrial membrane in the form of acetyl carnitine Functions Promote energy metablosim Promote regeneration of nerves May prevent cell death of CD4 cells

18. Coenzyme Q10 Vitamin-like fat-soluble substance Functions Produce energy needed for cell growth and maintenance Antioxidant

19. Conclusions NVNM supplement use is common in HIV patients Estimated cost : $25-40 / week May involve some risk Further research is necessary