Protein Requirements for AIDS Patients
Protica Staff Writer - Wednesday, June 29, 2005
AIDS is a chronic, intractable condition caused by the Human Immunodeficiency Virus (HIV). The virus targets the immune system and ultimately overwhelms it. Given the limitations of current therapy, it is imperative that a holistic approach be implemented, which involves medication, dietary management and stress management.

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AIDS is a chronic, intractable condition caused by the Human Immunodeficiency Virus (HIV). The virus targets the immune system and ultimately overwhelms it. Given the limitations of current therapy, it is imperative that a holistic approach be implemented, which involves medication, dietary management and stress management.

Dietary Management for AIDS concentrates on increasing appetite, improving digestion and absorption of nutrients, and preventing catabolism (i.e. breakdown) of proteins in the body. Consequently malnutrition and weight loss can be minimized, which in turn enhances the immune system. Proteins play a vital role for optimal health especially in AIDS as it replenishes cells, tissues and muscles, apart from its biological and immunological functions. Enough medical literature exists to suggest that a high protein diet of casein and whey are recommended. Specific amino acids such as glutamine, methionine, arginine, N-acetyl cysteine (NAC) and hydroxymethyl butyrate (HMB) are essential.

Involuntary body weight loss is a frequent manifestation of HIV infection and ultimately affects the majority of patients. Wasting may not be an inevitable consequence of HIV infection, but may be a consequence of multiple nutritional insults. A variety of etiologies contribute to this wasting, including, hypermetabolism, alterations in metabolism, lessened oral intake, malabsorption, immune mechanisms and endocrine dysfunction. Wasting of the lean body mass is associated with a decreased survival rate. It further impairs immune function. According to studies, a trend was found towards a decrease in body weight and disease progression. Both HIV positive men and women have significantly lower body weight, fat and body cell mass than that of HIV negative controls.

The number of nutrition–related clinical signs and symptoms in each individual correlated with the magnitude of weight loss. A low energy intake, lack of protein in diet and catabolism of proteins from muscle tissues are largely responsible for this avoidable morbidity in immunocompromised patients (Suneeta franklin et al., 1999). Hence it is recommended that a person living with HIV or AIDS consumes between 0.8 g - 1 g of easily digestible and high quality protein per pound of body weight (equivalent to 1.8 -2.2 g body weight (Bristol, 1995). Treating AIDS-related wasting syndrome with a whey protein concentrate (WPC) may combat the negative effect of oxidative stress, improve T-cell function and T-cell survival, as well as aid in the control of HIV replication.

Whey proteins are made up of a-lactalbumin and ß-lactoglobulin (defending against infection) serum albumin, the immune globulin, enzymes and protease -- peptones ß-lactoglobulin accounts for about 50% of total whey proteins. It also contains small amounts of lactoferrin (iron, containing protein having protecting effect) and serum transferrin. Whey protein consists of a group of proteins known to produce a substance (glutathione) that may improve the immune system and also slow the weight loss often experienced by people with AIDS. It is also a diet supplement providing a protein rich energy boost while containing little lactose.
 
A Partially hydrolyzed whey protein is useful if digestion is difficult. Milk proteins are also easier to digest due to the presence of casein (Metcalfe, 1992). Casein constitute 80% of total nitrogen in milk and is a colloidal protein calcium phosphate complex. It is a good source of essential amino acids (Glutamic acid, proline, aspartic, leucine, lysine and valine) (Srilakshmi, 1996).

Another consideration for proteins is their content of the sulphur-containing amino acids cystine and methionine. People with AIDS have low levels of methionine (Muller, 1996). It causes deterioration that occurs in the nervous system (Revillard, 1992). It is responsible for some aspects of disease process in AIDS (Keating, 1991). Methionine deficiency can also be responsible for symptom such as dementia (Tan, 1998). There are reasons to suspect the HIV myelopathy might be due to a deficiency of the amino acid Methionine (Di Rocco A et al., 1998).

The amino acid N-acetyl cysteine (NAC) has shown to inhibit the replication of HIV (Roederes et al., 1990). NAC, along with glutamine, is required to maintain adequate levels of glutathione (Noyer et al., 1998). Glutamine is needed for the synthesis of glutathione, an important antioxidant within cells that is frequently depleted in people with HIV and AIDS (Robinson et al., 1992).

The combination of glutamine, arginine and amino acid derivative, hydroxy methyl butyrate (HMD), may prevent loss of lean body mass (i.e. wasting) in people with AIDS (Clark et al., 2000).

Thus development of a protein supplement containing casein, whey and amino acid derivative arginine, glutamine, methionine, N-acetyl cysteine and HMB can provide an apt high protein diet for individuals suffering from HIV or AIDS. Change of the attitude with assessment of nutritional status is necessary to slow down the progression of the disease and improve the quality of the life, in the absence of a cure for HIV/AIDS.

 

About Protica

Founded in 2001, Protica, Inc. is a nutritional research firm with offices in Lafayette Hill and Conshohocken, Pennsylvania. Protica manufactures capsulized foods, including Profect, a compact, hypoallergenic, ready-to-drink protein beverage containing zero carbohydrates and zero fat. Information on Protica is available at http://www.protica.com 

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References

1. Dr Suniti Solomon, AIDs and Nutrition, Second regional workshop on planning diet  for health March 1999, pg.347.

2. Suneeta Franklin and Dr. Gomathy shivaji, Nutritional management of HIV/AIDs Patients Second regional workshop on planning diet for health March 1999, pg.350, 351

3. "Good Nutrition for people with HIV/AIDS" - A video distributed by Bristol-Myers Squibb, 1995.

4. POZ Magazine (02/97) p.102; Burroughs, Carola.

5. Metcalfe DD, “The Nature and mechanisms of food allergies and related disease”, Food Technology

6. Srilakshmi B., Food Science, June 1996. New age International Private Limited Publishers, pg. 120-121.

7. Muller F, Suardal AM, Ankrust P, et al. Elevated plasma concentration of reduced homocysteine in patients with human immuno deficiency virus infection. Am. J. Clin. Nuts. 1996; 242-246.

8. Revillard JP. Lipid peroxidation in Human Immunodeficiency virus infection. Acquired immuno def. synd 1992; 5: 637-638.

9. Keating J.N. Trimble K.C., Hulcahy, P. et al. Evidence of brain methyl transferase inhibition and early brain involvement in HIV positive patients. Lancet, 1991; 337: 935-939.

10. Tan SV, Gssiloff RJ. Hypothesis in the pathogenesis of vacuolar myelopathy, dementia and peripheral neuropathy in AIDS. J. Neural Neurosurg. Psychiat. 1998; 65 : 23-28.

11. Di Rocco A, Tagliati M, Danisi F, Dorfmam D, Moise J, and Simpson DM, A pilot study of L-methionine for the treatment of AIDS-associated myelopathy. Neurology July 1998; Volume 5, pages 266-268

12. Roederes M, Staal FJ, Raju PA, et al. Cytokine stimulated human immuno deficiency virus replication is inhibited by N-acetyl-L-cysteine.  Proc. Natl. Acad. Sci. 1990; 87: 4884-4888.

13. Noyar CM, Simon D, Borezub A, et al. A double-blind placebo controlled pilot study of glutamine therapy for abnormal intestinal permeability in patients with AIDS. Am. J. Gastroenterol. 1998; 83: 972-975.

14. Robinson MK, Hong RW, Wilmore DW. Glutathione deficiency and HIV infection. Lancet 1992; 339: 1603-1604.

15. Clark RH, Peleke G, Din M, et al. Nutritional treatment for acquired immuno deficiency virus - associated wasting using beta-hydroxy beta-methylbutyrate, glutamine and arginine- a randomised double-blind, a placebo-controlled study. Jpen  J.  Parameter  Enterol.  Nuts.  2000; 24: 133-139.

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