Vitamins’ Value in HIV Care

San Francisco doctor, Jon Kaiser, blazes trail in evaluating interventions to aid anti-viral therapies

With the advent of anti-viral medications (ARV), the “Lazarus effect” of HIV-positive people coming back from the brink of death has become humdrum, at least to the outside world. So with all this success, why would anyone care about things like vitamins?

But in the world of living with HIV, things aren’t always as simple as they seem.

Dr. Jon Kaiser came to New York on May 26 for an event he led at the Masonic Building, sponsored by Body Positive and Gay Men of African Descent. Kaiser has been at the forefront of treating HIV infections for nearly two decades in San Francisco. He is renowned for his book, “Healing HIV” and for an aggressive approach to managing the disease with a complete approach of nutrition, medication, exercise and holistic care.

Unfortunately, recent stories in the press have thrown the use of vitamins back into the jaws of absurd polemics. Fostered by an HIV denialist named Mathias Rath, the notion has been bandied about that a good multi is all you need for AIDS. This caused Peter Piot, the director of the United Nations Joint Programme on HIV/AIDS (UNAIDS), to issue a statement that vitamins are not a cure or a treatment for AIDS.

Kaiser holds a more nuanced view, noting, “If micronutrient therapy is presented appropriately, based on the evidence to date, it is quite likely that it will be viewed very soon as a standard of care in HIV disease management. It is unfortunate that the debate was presented in such a polarized way.”

A bold statement, but is there any evidence to support this notion?

It has long been documented that people with HIV see reduced blood levels of a range of vitamins, minerals and amino acids. This is partly because HIV infects the digestive system where it causes significant damage.

Recent and well-controlled studies that shed light on this issue have been conducted in Tanzania and Thailand. In Tanzania, researchers found that just using a multivitamin slowed the rate of HIV disease progression by 30 percent. This is significant. In a separate multivitamin study among Thai people with more compromised immune systems—low T cells, a marker of immune function—there was no impact on these blood markers. However, people using a multi had less sickness and were 50 percent less likely to die.

Kaiser evaluated a nutrient combination that was reported on at the prestigious retrovirus conference held in Boston in February. This included a potent multivitamin, acetyl-L-carnitine, alpha lipoic acid and N-acetylcysteine (NAC). The study was designed to see if this would offset neuropathy, a painful and disabling drug side effect. In the patients taking the vitamins, there was an average 42 percent reduction in extremity pain during the 12-week study, but this value did not achieve statistical significance when compared to the placebo, or control, group.

But what researchers did observe was that people taking the combination—as opposed to people who received a placebo or “sugar” pills—had a 25 percent rise in T cells, a finding that was statistically significant meaning that the result wasn’t just chance. This is a new way to look at supplements that goes beyond just replenishing the body’s needs.

Kaiser, noting that these results could reshape conventional thinking, noted, “The only thing that we’re taught is that taking micronutrients help prevent deficiency diseases, and that’s about 50 years outdated.”

The study’s results are under review by a major peer-reviewed HIV journal.

The vitamin protocol is not inexpensive. Depending on whether one chooses a single- or double-strength form, the cost can run to more than $100 per month. Kaiser hopes that with increasing recognition and more data, state Medicaid and AIDS Drug Assistance Programs (ADAPs) will see that this can be a cost-effective approach and will increase coverage of these interventions.

Like all treatments, what counts at the end of the day is what effect it will have on an individual. And Kaiser notes that people on ARV using his “K-PAX” formula should see an increase in T cells after a few months.

Kaiser adopts a four-pronged approach to managing HIV disease as a result of these observations and the benefits he has observed in his clinical practice: addressing diet; employing aggressive micronutrient therapy; hormonal evaluation and treatment; and annual evaluation for intestinal parasites with vigorous treatment, as needed.

Kaiser argues that a diet high in protein, with plenty of vegetables while limiting fat, sugar and processed carbs is the best way to go. Of course, this is a generalization and each individual needs to address their particular needs—for example, people with serious kidney or liver trouble mustn’t overdo the protein intake.

Hormonal treatment consists of testing, at least in adults, levels of testosterone, DHEA and thyroid function. If levels are low and there are symptoms such as fatigue, reduced sexual drive or depression, he will treat appropriately.

And intestinal health is a critical component of slowing HIV disease. Aggressive diagnosis and treatment of parasites is key.

Kaiser has also been exploring the possibilities that exist with closely monitored ARV treatment interruptions. He feels that people with higher CD4 counts—over 500—for at least a year may well benefit.

But rather than just waiting until the T cell count dips back to 350 or below, maintaining the whole program is hoped will maintain a robust immune status for longer periods.

Anti-viral medications have clearly proven themselves in helping keep people alive and well. But they can also result in serious side effects and resistance can develop. Kaiser reflected on a point underscored at the recent Boston conference, that “there’s an increase of 17-percent in heart attack risk for every year that you’re on HAART” Kaiser believes that fully managing HIV disease with his comprehensive approach can help to minimize these problems.

Of course, more data is needed. Looking to the future, Kaiser notes that a large, multi-centered study of his vitamin formula is in the works. A New York institution will be among the sites in the study.

It’s not nature versus nurture—it’s the balance of the two. And it’s not vitamins versus ARV—it’s figuring out what works best to help people to survive and thrive despite HIV.

You can learn more about Kaiser’s protocols at integrativehealthconsulting.com, jonkaiser.com and kpax.us. George M. Carter is director of the Foundation for Integrative AIDS Research (FIAR), a non-profit dedicated to clinical evaluation of complementary and alternative approaches to managing HIV and chronic hepatitis (fiar.us). He is also an administrator of the new New York Buyers’ Club (newyorkbuyersclub.org).

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