Infection with the human immunodeficiency virus (HIV) results in progressive destruction of the immune system, ultimately resulting in opportunistic infections and AIDS. HIV-infection, affecting 40 million people worldwide, poses a big burden on current healthcare.
The main targets for viral replication are the CD4 T-lymphocytes, which are central to immune defenses. Once infected, CD4 cells become inactive and are destroyed. This has made the CD4 cell decline the gold standard in monitoring disease progression. CD4 cells are most abundant in the gut, which is believed to be a possible reservoir for the virus after infection and difficult to reach by antiretrovirals. Early in disease, the gut integrity is disturbed. Also malnutrition and hyperimmune activation can occur in these early stages and trigger disease progression.
Research in this area in past years has, therefore, focused on the effect of specific nutritional components on improving gut health and immune function. In proof-of concept trials a unique oligosaccharide mixture showed improvement in the disturbed gut microbiota present in HIV patients, who are not yet on antiretrovirals. Also, immune activation was suppressed and NK activity improved. These properties are of great importance in HIV disease, especially early on, to prevent or slow deterioration associated with infection.
To address the role of nutrition in CD4 decline, a new and unique nutritional formulation that targets the decline is being tested in a large randomised placebo controlled multi-centre trial at 31 sites. If this intervention trial ultimately proves successful, it may have major health implications for HIV patients.
This is a summary of the presentation given Professor Donald Kotler at the recent Nutricia Satellite Symposium, ESPEN 2009 held in Vienna on Sunday 30th August 2009.
Donald Kotler MD is Professor of Medicine at the Columbia University College of Physicians and Surgeons and Chief of Gastroenterology at St. Luke’s-Roosevelt Hospital Center in New York City where he also is Director of the GI training program.