Antioxidants and progression of human immunodeficiency virus (HIV) disease

Abstract

HIV infection is thought to lead to increased oxidative stress which may in turn lead to faster progression of HIV disease. Therefore, antioxidants may have a role in the treatment of HIV disease. We review the data on the relations of selected antioxidants to HIV disease progression. Results from observational epidemiologic studies suggest that vitamin A deficiency may accelerate HIV disease progression. In observational studies conducted among vitamin A replete populations, associations between intake or status of vitamin A (both preformed vitamin A and ß-carotene) and HIV disease progression have been less consistent. Available data from intervention studies are not entirely consistent with a beneficial effect of supplementation with preformed vitamin A or ß-carotene. The relations of vitamins C and E to HIV disease progression have been examined in a small number of epidemiologic studies; results from such studies are compatible with a protective effect of high intakes or levels of these vitamins. In two prospective studies, low selenium levels were found to be associated with an increased risk of progression of HIV disease. Available epidemiologic data are consistent with a protective effect of multivitamin (or multivitamin-mineral) supplements, preparations which typically include several of the above antioxidants. Finally, limited epidemiologic data support a protective role of N-acetylcysteine (NAC) in HIV disease. Many studies conducted to date have been observational prospective studies; the interpretation of such studies is problematic, however, given the possibility of confounding by infection duration and other factors. Thus, well designed randomized trials are essential to properly investigate the role of antioxidants, particularly vitamin E, vitamin C, selenium, and NAC, in HIV disease. Such trials are urgently needed since dietary administration of antioxidants to HIV infected persons would be an inexpensive intervention appropriate for the developing world.