Re: Risk/benefit of HIV therapy 18 July 2003
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Christopher S Tyler,
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Re: Re: Risk/benefit of HIV therapy

Many times commonly held, perceived 'truths' of a society and its institutions of medicine have eventually been seen for the faulty beliefs they were. Both society and the psychological and medical professions, for the better part of this and past centuries, proclaimed homosexuality as deviant and even immoral. Pellagra, SMON, Beri Beri, Scurvy, and more have all had initial causes attributed to them, only later to be abandoned in the face of more accurate science. No doctor today would consider treating a person suffering from scurvy with antibiotics or other agents directed at a microbe in the hopes of ameliorating the condition. The simple administration of vitamin C is, instead, the correct course of action—this we know and take for granted as part of our modern medical wisdom, but that wasn't always so.

Today, antiretrovirals are held up as the saving grace of many people considered to be infected with HIV. Look how much longer people have been living since the introduction of these powerful drugs, goes the common refrain. Look how we can suppress HIV, decrease their viral load, and make them healthier, goes another.

However, other possible explanations and factors are ignored or downplayed. The redefinition of AIDS in 1993 made the majority of 'people with AIDS' live longer, simply by changing to definition to include many non-sick people. People who aren't sick are going to have 'better outcomes and longer lives' than those who are seriously ill.

AZT was once commonly prescribed at 1500mgs per day. The Phase II Trials also claimed dramatic benefits at "doses that were up to three times higher in the late 1980s than are currently used now". However, they proved far too toxic and fatal in many cases, and so the regimen was lowered over time to where it is now, 300 to 500mgs. Although even at these doses, difficult toxicities still exist.

Both doctors and their patients have sought out ways of dealing with the many problems associated with HIV antiretrovirals. The use of antioxidants over the past decade has become an increasingly important aspect of treating "HIV infection" and coping with the side effects of these drugs.

I believe the increasing use and awareness of antioxidants has been one important factor in helping people to live longer, healthier lives.

In a recent email letter from Dr. Jon Kaiser, author of Healing HIV, (http://www.integrativehealthconsulting.com/), this very subject was discussed. The article is entitled, "Antiviral Medication Toxicity--Do We Already Have the Antidote?". The opening phrase states, "Unfortunately, at the present time, at least 50% of the deaths attributed to HIV infection in the United States are due to the toxic side effects from antiviral medications."

Not a terribly good track record for drugs that are 'keeping people alive longer."

The article goes on to say,

"Many of these toxicities have been traced to a class of antiviral medications known as nucleoside reverse transcriptase inhibitors (NRTI's). This class of drugs includes AZT, D4T, 3TC, Abacavir, DDI, and DDC. The toxicities they cause include anemia, peripheral neuropathy, pancreatitis, lipoatrophy, fatigue, lactic acidosis, hepatic steatosis, and the newly described, ascending neuromuscular weakness syndrome."

What is the common mechanism here? Mitochondrial toxicity caused by the extreme oxidative stress induced by these drugs.

Dr. Kaiser continues;

"...NRTI antiviral drugs block a mitochondrial enzyme known as mitochondrial DNA polymerase gamma. They block this enzyme up to ten times more efficiently than they block HIV's major enzyme, reverse transcriptase. This effectively tosses a wrench into the healthful functioning of the mitochondria and destroys its ability to produce energy cleanly and safely.

As this process occurs, the level of toxic free radicals in the mitochondria rises precipitously. Elevated free radical levels eventually poison the mitochondria leading to their death... When enough cells in a nerve or other organ die, a symptomatic disease state occurs which produces acute symptoms such as nerve pain, pancreatitis, or in the case of the liver, lactic acidosis and/or liver failure."

What is Dr. Kaiser's answer to these nagging problems of current 'therapies'?

"In my practice, I have been using a fixed combination of potent antioxidants for the past five years. The results have been extremely positive. Hardly any of my patients experience side effects to this class of drugs."

What are these potent antioxidants?

"...vitamins A, E, C, the minerals zinc and selenium, and other potent antioxidants such as alpha lipoic acid, acetyl-L-carnitine, and N-acetyl-cysteine (NAC)."

It should be noted that in the West, AIDS patients and those at risk for AIDS have not only been treated with nucleoside analogues since 1987, but also before that time with a host of other drugs, some of which produce substantial oxidative stress. From the early 1970s onward, Bactrim/Septrim were used to treat a wide range of microbial infections, mostly in promiscuous homosexuals, for especially stubborn urinary tract infections, intestinal infections and atypical pneumonias. Bactrim/Septrim inhibit folic acid production and use, and thus have a negative impact on ATP production. These are on top of other oxidative stress factors that are common to the various risk groups, such as the nearly ubiquitous use of nitrite inhalants in gay men.

Since the very beginning of the AIDS era, the Perth Group has argued that oxidative stress is the common denominator among those who began getting sick in the late 70's and early 80's, and those who continue to get sick today. In 1988, they published, "Reappraisal of AIDS - Is the Oxidation Induced by the Risk Factors the Primary Cause?"(1), followed by, "Oxidative Stress, HIV and AIDS" in 1992 (among many other articles). (2)

What Dr. Kaiser finds in his practice with regard to the successful use of antioxidants "for the past five years" was predicted by the Perth Group and their oxidative stress theory almost 2 decades ago. The utility of these reducing agents to offset the problems caused by antiretrovirals has become much more widely known and used by people like Dr. Kaiser and also AIDS organizations.

AIDSMEDS.com, a popular web resource for those using antiretrovirals, has many posts with individuals discussing these compounds. One very recent post elicited this response from another member:

"As for other supplements to counter fatigue: Here is a list of some supplements to help you with fatigue and some links to help you get a better understanding of them.

CoQ10 (coenzyme Q10)

NAC (N-acetyl-cysteine)

Super B Complex Supplement

Siberian Ginseng:
You should only take ginseng for no more then 60 days then take a 3 week break from it before taking it again.

L-Glutamine

Selenium

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In fact, dissidents who were once 'treated' with these drugs, are now using these very same compounds to restore their health, that is, to restore their bodies from the negative impact the drugs had on them.

This last year I attended a presentation given in the Seattle, Washington area, called "Things You Can't Do Without If You Are POZ" (presented by STEP, LifeLong AIDS Alliance, and POZ Seattle, in conjunction with Program for Wellness Restoration (PoWeR)). Antioxidants, along with many other prescription drugs, were presented throughout as an integral part to the health and well being of 'POZ' individuals. During a section of the presentation entitled, "Side Effects of HIV Disease" (which is a euphemism for drug toxicities), most of the common problems people experience from "HIV disease" were discussed. Diarrhea, nausea and vomiting, appetite loss, fatigue, skin rash, and more were listed. In almost every category, antioxidants were discussed and recommended.

During a discussion of diarrhea, L-Glutamine (needed for the important production of glutathione), calcium and magnesium were recommended.

During the discussion of lactic acidosis, the only agents recommended were Carnitine, Co-Enzyme Q10, and vitamins B1, B2.

Other agents discussed and recommended during the presentation were N-Acetyl Carnitine, N-Acetyl Cysteine, Alpha Lipoic Acid, and Omega 3 fatty acids.

During the discussion of fatigue, supplementation with DHEA, multivitamins, and switching from AZT were listed as ways of coping with this "HIV related" side effect. It was also stated that many other factors can contribute to fatigue, including infections, inadequate nutrition, and nutrient deficiencies, "especially B12".

An understanding of nutritional deficiencies as related to AIDS is important especially in areas of the world such as Africa, which is said to be a continent rife with HIV infection and AIDS.

Researchers from the Harvard School of Public Health state:

  • “The higher rates of HIV progression and vertical transmission in developing countries coincide with similarly higher rates of malnutrition and vitamin deficiencies, indicating that HIV infection, may be modified by nutritional status.”
  • “Numerous observational studies report inverse association between vitamin status, measured bio-chemically or as levels of dietary intake, and the risk of disease progression or vertical transmission.”
  • “Adequate vitamin status may also reduce vertical transmission through the intra-partum and breastfeeding routes by reducing HIV viral load in lower genital secretions and breast milk,” and;
  • “Vitamin supplements may be one of the few potential treatments that are inexpensive enough to be made available to HIV-infected persons in developing countries” (3).

In other research from Malawi, it was found that 'transmission' was closely correlated with levels of vitamin A in the mother. Those with the lowest levels 'transmitted HIV' to their babies at a rate of 32.4 percent, while those with the highest levels had a 'transmission rate' of only 7.2 percent -- a figure lower than the lowest figures attributed to AZT. (4) The Oxidative Stress Theory of AIDS predicts this outcome.

Other researchers have found “...similarities between AIDS and Protein Caloric Malnutrition suggest(ing) that nutrition may contribute to the immunodeficient state. The immunodeficiency in children with PCM can be reversed by nutritional rehabilitation, which suggests that restoration of nutritional state may be a useful adjunct to therapy for AIDS patients” (5).

If one considers the great clamor to export these 'life-extending' antiviral drugs to places like Africa, one must also ask if, in addition, an equal amount of antioxidants are also going to be sent. If not, how are these people going to cope with "HIV disease related' side effects that can be offset by other means available to relatively affluent Westerners?

A final point regarding the Protease Inhibitors needs to be made. Again, in relation to the steady decline in the death rate over the past decade, the PI's have been cited as THE reason. That is, their putative ability to suppress 'HIV infection', thus allow the body's immune defenses to restore, thus creating better health for the person taking them. However, in 1999/2000, 2 groups of European researchers found that the PI's had a very active antibiotic-like effect against two of the most common "HIV-related" diseases, PCP and Thrush.

"In Vitro Activity of HIV Pls Against Pneumocystis carinii" (Atzori, 181:1629-1634) appeared in the May 2000 issue of Journal of Infectious Diseases, while "In Vitro and In Vivo Anticandidal Activity of HIV Protease Inhibitors" (Cassone, 180: 448-53) ran in the August 1999 issue.

The PCP investigators found that each of the four Pls they examined (indinavir, ritonavir, nelfinavir, and saquinavir) directly suppress PCP as effectively as standard PCP medications. The Candida investigators concluded both of the Pls they examined (indinavir and ritonavir) exerted in vivo anti-Candida effects that were "particularly remarkable as they compared with the curative effects of fluconazole, a well-known anticandidal agent."

Thus for individuals who were very ill with these common AIDS defining illnesses, the protease inhibitors appeared to inhibit these microbes sufficiently for them to recover. However, the problem is, once a person experiences improved health, he is expected to stay on these drugs indefinitely (lest the putative microbe mutate). Eventually, the drugs toxicities will begin to take hold. It's only now that, after the intial wave of euphoria has dissipated that the real problems with these drugs have appeared.

To restate Dr. Kaiser, "Unfortunately, at the present time, at least 50% of the deaths attributed to HIV infection in the United States are due to the toxic side effects from antiviral medications."

To end this post, I thought it would be appropriate to share a brief experience from one man (who gave his permission) whose health was nearly destroyed by these drugs.
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I am currently a 45 years old male. I was diagnosed "HIV Positive" in Sept. 1997. At that time I entered the hospital with double pneumonia with histoplasmosis in the lungs. I was malnourished due to the fact that I was in the middle of remodeling my kitchen and was not eating properly. I also had a MAJOR sinus infection going on.

They ran an HIV test without telling me, then started me immediately on AZT, 3TC and Crixivan (Indinivir).

They told me they could keep me alive for 10 more years if I followed their orders and took the "meds" religiously. Every time I went to the doctor for a physical (every 3 months) they could not find anything physically wrong with me. While taking the "meds" I had almost constant diarrhea, stomach aches, loss of appetite, weight loss, lack of energy, depression and anxiety attacks.

In January of 2003 I decided to stop taking the "meds" I regained my appetite, gained weight, gained muscle mass, no more depression or anxiety attacks. Basically I took my life back and feel better then I ever did on the "meds".
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Chris Tyler

 

1) Reappraisal of AIDS - Is the Oxidation Induced by the Risk Factors the Primary Cause? ELENI PAPADOPULOS-ELEOPULOS, Royal Perth Hospital, Medical Physics Dept., Perth Western Australia. Medical Hypotheses (1988) 25: 151-162

2) Oxidative Stress, HIV and AIDS, Res. Immunol. 1992, 143, 145-148, E. Papadopulos-Eleopulos, V.F. Turner and J.M. Papadimitriou

3) Fawzi WW, Hunter DJ. Vitamins in HIV disease progression and vertical transmission. Epidemiology 1998; 9: 457-466.

4) R. D. Semba, N. M. H. Graham, W. T Caiaffa, L. Clement, and D. Vlahov, "Increased Mortality Associated With Vitamin A Deficiency During Human Immunodeficiency Virus Type-1 Infection," Arch Intern Med 153 (1993): 2149-2154.

5) Gray RH. Similarities between AIDS and PCM (Protein Caloric Malnutrition). Amer J Publ Health 1983; 73: 1332.

Competing interests:   None declared