Hostname: page-component-797576ffbb-6mkhv Total loading time: 0 Render date: 2023-12-04T07:59:31.838Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "useRatesEcommerce": true } hasContentIssue false

Nutritional Contributions to the CNS Pathophysiology of HIV-1 Infection and Implications for Treatment

Published online by Cambridge University Press:  07 November 2014

Abstract

Nutritional deficiencies are commonplace in patients with human immunodeficiency virus type 1 (HIV-1) infection, and recent research has indicated that nutritional factors may play an important role in the pathogenesis of HIV-1 disease. Although nutritional deficiencies are unlikely to be the primary causative factor in disease progression, they may contribute to cognitive dysfunction, neurologic abnormalities, mood disturbance, and immune dysregulation associated with HIV-1 infection. Furthermore, deficiencies of specific micronutrients have been associated with increased risk of HIV-1–associated mortality. This article will briefly summarize the role of macronutrient deficiency, the interactions of specific micronutrient deficiencies with neuropsychiatrie functioning, and the role of these factors in HIV-1 disease progression. Since recent research has shown that normalization of many nutritional deficits and supplementation beyond normal levels are associated with improvements in neuropsychiatrie functioning, potential treatment implications will also be discussed.

Type
Feature Articles
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Baum, MK, Shor-Posner, G. Micronutrient status in relationship to mortality in HIV-1 disease. Nutr Rev. 1998;56:S135S139.Google Scholar
2.Chlebowski, RT, Grosvenor, MB, Bernhard, NH, Morales, LS, Bulcavage, LM. Nutritional status, gastrointestinal dysfunction, and survival in patients with AIDS. Am J Gastroenterol. 1989;84:12881293.Google Scholar
3.Macallan, DC, Noble, C, Baldwin, C, Foskett, M, McManus, T, Griffin, GE. Prospective analysis of patterns of weight change in stage IV human immunodeficiency virus infection. Am J Clin Nutr. 1993;58:417424.Google Scholar
4.Centers for Disease Control. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep. 1992;41(No.RR-17):119.Google Scholar
5.Shevitz, AH, Know, TA, Spiegelman, D, Roubenoff, R, Gorbach, SL, Skolnik, PR. Elevated resting energy expenditure among HIV-seropositive persons receiving highly active antiretroviral therapy. AIDS. 1999;13:13511357.Google Scholar
6.Baum, MK, Shor-Posner, G, Bonvehi, P, et al.Influence of HIV infection on vitamin status and requirements. Ann N Y Acad Sci. 1992;699:165174.Google Scholar
7.Baum, M, Cassetti, L, Bonvehi, P, Shor-Posner, G, Lu, Y, Sauberlich, H. Inadequate dietary intake and altered nutrition status in early HIV-1 infection. Nutrition. 1994;10:1620.Google Scholar
8.Niyongabo, T, Bouchaud, O, Henzel, D, et al.Nutritional status of HIV-seropositive subjects in an AIDS clinic in Paris. Eur J Clin Nutr. 1997;51:637640.Google Scholar
9.Suttmann, U, Ockenga, J, Selberg, O, Hoogestraat, L, Deicher, H, Muller, MJ. Incidence and prognostic value of malnutrition and wasting in human immunodeficiency virus-infected outpatients. J Acquir Immune Defic Syndr Hum Retrovirol. 1995;8:239246.Google Scholar
10.Abrams, B, Duncan, D, Hertz-Picciotto, I. A prospective study of dietary intake and acquired immune deficiency syndrome in HIV-seropositive homosexual men. J Acquir Immune Defic Syndr Hum Retrovirol. 1993;6:949958.Google Scholar
11.Skurnick, JH, Bogden, JD, Baker, H, et al.Micronutrient profiles in HIV-1 infected heterosexual adults. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;12:7583.Google Scholar
12.Beach, RS, Mantero-Atienza, E, Shor-Posner, G, et al.Specific nutrient abnormalities in asymptomatic HIV-1 infection. AIDS. 1992;6:701708.Google Scholar
13.Eglen, RM, Wong, EHF, Dumuis, A, Bockaert, J. Central 5-HT4 receptors. Trends Pharmacol Sci. 1995;16:391398.Google Scholar
14.Hodges, RE, Bean, WB, Ohlson, MA, Bleiler, RE. Factors affecting human antibody response. IV. Pyridoxine deficiency. Am J Clin Nutr. 1962;11:180186.Google Scholar
15.Wilkie, F, Shor-Posner, G, Mantero-Atienza, E, et al.Association of vitamin B6 status and reaction time in early HIV-1 infection. Neurological and Neuropsychological Complications of HIV Infection. 1991;2:67.Google Scholar
16.Baldewicz, T, Goodkin, K, Feaster, DJ, et al.Plasma pyridoxine deficiency is related to increased psychological distress in recently bereaved homosexual men. Psychosom Med. 1998;60:297308.Google Scholar
17.Shor-Posner, G, Feaster, D, Blaney, NT, et al.Impact of vitamin B6 status on psychological distress in a longitudinal study of HIV-1 infection. Int J Psychiatry Med. 1994;24:209222.Google Scholar
18.Wurtman, RJ. Food for thought. The Sciences. 1978;18:69.Google Scholar
19.Park, SB, Coull, JT, McShane, RH, et al.Tryptophan depletion in normal volunteers produces selective impairments in learning and memory. Neuropharmacology. 1994;33:575588.Google Scholar
20.Faustman, WO, Faull, KF, Whiteford, HA, Borchert, C, Csernansky, JG. CSF 5-HIAA, serum Cortisol, and age differentially predict vegetative and cognitive symptoms in depression. Biol Psychiatry. 1990;27:311318.Google Scholar
21.Singer, EJ, Wilkins, J, Syndulko, K, et al.Cerebrospinal fluid (CSF) biogenic amines increase and Cortisol levels decrease after zidovudine (AZT) therapy in subjects with AIDS dementia complex (ADC). Neurological and Neuropsychological Complications of HIV Infection. Program and abstracts. 1990;145.Google Scholar
22.Brouwers, P, Heyes, MP, Moss, HA, et al.Quinolinic acid in the cerebrospinal fluid of children with symptomatic human immunodeficiency virus type 1 disease: relationships to clinical status and therapeutic response. J Infect Dis. 1993;168:13801386.Google Scholar
23.Sei, S, Saito, K, Stewart, SK, et al.Increased HIV-1 DNA content and quinolinic acid concentration in brain tissues obtained from AIDS patients with HIV encephalopathy. J Infect Dis. 1995;172:638647.Google Scholar
24.Heyes, MP, Brew, BJ, Martin, A, et al.Quinolinic acid in the cerebrospinal fluid and serum in HIV-1 infection: relationship to clinical and neurological status. Ann Neurol. 1991;29:202209.Google Scholar
25.Deijen, JB, van der Beek, EJ, Orlebeke, JF, van der Berg, H. Vitamin B6 supplementation in elderly men: effects on mood, memory, performance and mental effort. Psychopharmacology. 1992;109:489496.Google Scholar
26.Tang, AM, Graham, NM, Saah, AJ. Effects of micronutrient intake on survival in human immunodeficiency virus type 1 infection. Am J Epidemiol. 1996;143:12441256.Google Scholar
27.Schaumburg, H, Kaplan, J, Windebank, A, et al.Sensory neuropathy from pyridoxine abuse: a new megavitamin syndrome. N Engl J Med. 1983;309:445448.Google Scholar
28.Bernstein, AL. Vitamin B6 in clinical neurology. Ann N Y Acad Sci. 1990;585:250260.Google Scholar
29.Bendich, A, Cohen, M. Vitamin B6 safety issues. Ann N Y Acad Sci. 1990;585:321330.Google Scholar
30.Dommisse, J. Subtle vitamin B12 deficiency and psychiatry: a largely unnoticed but devastating relationship? Med Hypotheses. 1991;34:131140.Google Scholar
31.Ellis, FR, Nasser, S. A pilot study of vitamin B12 in the treatment of tiredness. Br J Nutr. 1973;30:277283.Google Scholar
32.Herbert, V, Das, KC. Folic acid and vitamin B12 In: Shils, ME, Olson, JA, Shike, M, eds. Modern Nutrition in Health and Disease. Philadelphia, Pa: Lea & Febiger; 1994.Google Scholar
33.Lindenbaum, J, Healton, EB, Savage, DG, et al.Neuropsychiatric disorders caused by cobal-amin deficiency in the absence of pernicious anemia or macrocytosis. N Engl J Med. 1988;318:17201728.Google Scholar
34.Rule, SAJ, Hooker, M, Costello, C, Luck, W, Hoffbrand, AV. Serum vitamin B12 and transcobalamin levels in early HIV disease. Am J Hematol. 1994;47:167171.Google Scholar
35.Beach, RS, Morgan, R, Wilkie, F, et al.Plasma vitamin B12 level as a potential cofactor in studies of human immunodeficiency virus type 1-related cognitive changes. Arch Neurol. 1992;49:501506.Google Scholar
36.Herbert, V, Fong, W, Guile, V, Stropler, T. Low holotranscobalamin II is the earliest serum marker for subnormal vitamin Bl2 absorption in patients with AIDS. Am J Hematol. 1990;34:132139.Google Scholar
37.Healton, EB, Savage, DG, Brust, JC, Garrett, TJ, Lindenbaum, J. Neurologic aspects of cobal-amin deficiency. Medicine. 1991;70:229245.Google Scholar
38.Saracaceanu, E, Tramoni, AV, Henry, JM. An association between subcortical dementia and pernicious anemia—a psychiatric mask. Compr Psychiatry. 1997;38:349351.Google Scholar
39.Baldewicz, TT, Goodkin, K, Blaney, NT, et al.Cobalamin level is related to self-reported and clinically rated mood and to syndromal depression in bereaved HIV-1+ and HIV-1-homosexual men. J Psychosom Res. 2000;48:177185.Google Scholar
40.Shor-Posner, G, Morgan, R, Wilkie, F, Eisdorfer, C, Baum, MK. Plasma cobalamin levels affect information processing speed in a longitudinal study of HIV-1 disease. Arch Neurol. 1995;52:195198.Google Scholar
41.Bell, IR, Edman, JS, Miller, J, et al.Relationship of normal serum vitamin B12 and folate levels to cognitive test performance in subtypes of geriatric major depression. J Geriatr Psychiatry Neurol. 1990;3:98105.Google Scholar
42.Bell, IR, Edman, JS, Morrow, FD, et al.B complex vitamin patterns in geriatric and young adult inpatients with major depression. J Am Geriatr Soc. 1991;39:252257.Google Scholar
43.Perkins, DO, Stern, RA, Golden, RN, Murphy, C, Naftolowitz, D, Evans, DL. Mood disorders in HIV infection: prevalence and risk factors in a nonepicenter of the AIDS epidemic. Am J Psychiatry. 1994;151:233236.Google Scholar
44.Robertson, KR, Stern, RA, Hall, CD, et al.Vitamin B12 deficiency and nervous system disease in HIV infection. Arch Neurol. 1993;50:807811.Google Scholar
45.Newbold, HL. Vitamin B12: placebo or neglected therapeutic tool? Med Hypotheses. 1989;28:155164.Google Scholar
46.Carethers, M. Diagnosing vitamin B12 deficiency: a common geriatric disorder. Geriatrics. 1988;43:89–94, 105–107, 111112.Google Scholar
47.Hector, M, Burton, JR. What are the psychiatric manifestations of vitamin B12 deficiency? J Am Geriatr Soc. 1988;36:11051112.Google Scholar
48.Levitt, AJ, Joffe, RT. Vitamin B12 in psychotic depression. Br J Psychiatry. 1988;153:266267.Google Scholar
49.Geagea, K, Ananth, J. Response of a psychiatric patient to vitamin B12 therapy. Dis Nerv Sys. 1975;36:343344.Google Scholar
50.Verbanck, PM, Oliver, L. Changing psychiatric symptoms in a patient with vitamin B12 deficiency. J Clin Psychiatry. 1991;52:182183.Google Scholar
51.Evans, DL, Edelsohn, GA, Golden, RN. Organic psychosis without anemia or spinal cord symptoms in patients with vitamin B12 deficiency. Am J Psychiatry. 1983;140:218221.Google Scholar
52.Phillips, SL, Kahaner, KP. An unusual presentation of vitamin B12 deficiency. Am J Psychiatry. 1988;145:529.Google Scholar
53.Zucker, DK, Livingston, RL, Nakra, R, Clayton, PJ. B12 deficiency and psychiatric disorders: case report and literature review. Biol Psychiatry. 1981;16:197205.Google Scholar
54.Tan, SV, Guiloff, RJ. Hypothesis on the pathogenesis of vacuolar myelopathy, dementia, and peripheral neuropathy in AIDS. J Neurol Neurosurg Psychiatry. 1998;65:2328.Google Scholar
55.DiRocco, A, Tagliati, M, Danisis, F, Dorfman, D, Noise, J, Simpson, DM. A pilot study of L-methionine for the treatment of AIDS-associated myelopathy. Neurology. 1988;51:266268.Google Scholar
56.Bottiglieri, T. Ademetionine (S-adenosylmethionine) neuropharmacology: implications for drug therapies in psychiatric and neurologic disorders. Opin Invest Drugs. 1997;6:417426.Google Scholar
57.Dorfman, D, DiRicco, A, Simpson, D, Tagliati, M, Tanners, L, Moise, J. Oral methionine may improve neuropsychological function in patients with AIDS myelopathy: results of an open-label trial. AIDS. 1997;11:10661067.Google Scholar
58.Surtees, R, Hyland, K, Smith, I. Central-nervous-system methyl-group metabolism in children with neurological complications of HIV infection. Lancet. 1990;335:619621.Google Scholar
59.Kieburtz, KD, Giang, DW, Schiffer, RB, Vakil, N. Abnormal vitamin B12 metabolism in human immunodeficiency virus infection. Arch Neurol. 1991;48:312314.Google Scholar
60.Burkes, RL, Cohen, H, Krailo, M, Sinow, RM, Carmel, R. Low serum cobalamin levels occur frequently in the acquired immune deficiency syndrome and related disorders. Eur J Haematol. 1987;38:141147.Google Scholar
61.Baum, MK, Shor-Posner, G, Lu, Y, et al.Micronutrients and HIV-1 disease progression. AIDS. 1995;9:10511056.Google Scholar
62.Wickramasinghe, SN. Morphology, biology, and biochemistry of cobalamin- and folate-deficient bone marrow cells. Baillieres Clin Haematol. 1995;8:441459.Google Scholar
63.Tang, AM, Graham, NM, Chandra, RK, Saah, AJ. Low serum B12 concentrations are associated with faster human immunodeficiency virus type 1 (HIV-1) disease progression. J Nutr. 1997;127:345351.Google Scholar
64.Nijst, TQ, Wevers, RA, Schoonderwaldt, HC, Hommes, OR, de Haan, AFJ. Vitamin B12 and folate concentrations in serum and cerebrospinal fluid of neurological patients with special reference to multiple sclerosis and dementia. J Neurol Neurosurg Psychiatry. 1990;53:951954.Google Scholar
65.Altay, C, Cetin, M. Oral treatment in selective vitamin B12 malabsorption. J Pediatr Hematol Oncol. 1997;19:245246.Google Scholar
66.Young, SN. The use of dietary components in the study of factors controlling affect in humans: a review. J Psychiatry Neurosci. 1993;18:235244.Google Scholar
67.Beach, RS, Mantero-Atienza, E, Eisdorfer, C, Fordyce-Baum, MK. Altered folate metabolism in early HIV infection. JAMA. 1988;259:519.Google Scholar
68.Coodley, GO, Coodley, MK, Nelson, HD, Loveless, MO. Micronutrient concentrations in the HIV wasting syndrome. AIDS. 1993;7:595600.Google Scholar
69.Abou-Saleh, MT, Coppen, A. Serum and red blood cell folate in depression. Acta Psychiatr Scand. 1989;80:7882.Google Scholar
70.Wesson, VA, Levitt, AJ, Joffe, RT. Change in folate status with antidepressant treatment. Psychiatry Res. 1994;53:313322.Google Scholar
71.Bell, IR, Edman, JS, Marby, DW, et al.Vitamin B12 and folate status in acute geropsychiatric inpatients: affective and cognitive characteristics of a vitamin nondeficient population. Biol Psychiatry. 1990;27:125137.Google Scholar
72.Fava, M, Borus, JS, Alpert, JE, Nierenberg, AA, Rosenbaum, JF, Bottiglieri, T. Folate, vitamin B12, and homocysteine in major depressive disorder. Am J Psychiatry. 1997;154:426428.Google Scholar
73.Riedel, WJ, Jorissen, BL. Nutrients, age and cognitive function. Curr Opin Clin Nutr Metab Care. 1998;1:579585.Google Scholar
74.Riggs, KM, Spiro, A III, Tucker, K, Rush, D. Relations of vitamin B12, vitamin B6, folate, and homocysteine to cognitive performance in the Normative Aging Study. Am J Clin Nutr. 1996;63:306314.Google Scholar
75.Ebly, EM, Schaefer, JP, Campbell, NR, Hogan, DB. Folate status, vascular disease and cognition in elderly Canadians. Age Ageing. 1998;27:485491.Google Scholar
76.LaRue, A, Koehler, KM, Wayne, SJ, Chiulli, SJ, Haaland, KY, Garry, PJ. Nutritional status and cognitive functioning in a normally aging sample: a 6-y reassessment. Am J Clin Nutr. 1997;65:2029.Google Scholar
77.Romero-Alvira, D, Roche, E. The keys of oxidative stress in acquired immune deficiency syndrome apoptosis. Med Hypotheses. 1998;51:169173.Google Scholar
78.Favier, A, Sappey, C, Leclerc, P, Faure, P, Micoud, M. Antioxidant status and lipid peroxidation in patients infected with HIV. Chem Biol Interact. 1994;91:165180.Google Scholar
79.Baruchel, S, Wainberg, MA. The role of oxidative stress in disease progression in individuals infected by the human immunodeficiency virus. J Leukoc Biol. 1992;52:111114.Google Scholar
80.Semba, RD, Graham, NMH, Caiaffa, WT, Margolick, JB, Clement, L, Vlahov, D. Increased mortality associated with vitamin A deficiency during human immunodeficiency virus type 1 infection. Arch Intern Med. 1993;153:21492154.Google Scholar
81.Allard, JP, Aghdassi, E, Chau, J, et al.Effects of vitamin E and C supplementation on oxidative stress and viral load in HIV-infected subjects. AIDS. 1998;12:16531659.Google Scholar
82.Perrig, WJ, Perrig, P, Stahelin, HB. The relation between antioxidants and memory performance in the old and very old. J Am Geriatr Soc. 1997;45:718724.Google Scholar
83.Constans, J, Seigneur, M, Blann, AD, et al.Effect of the antioxidants selenium and beta-carotene on HIV-related endothelium dysfunction. Thromb Haemost. 1998;80:10151017.Google Scholar
84.Kelly, P, Musonda, R, Kafwembe, E, Kaetano, L, Keane, E, Farthing, M. Micronutrient supplementation in the AIDS diarrhea-wasting syndrome in Zambia: a randomized controlled trial. AIDS. 1999;13:495500.Google Scholar
85.Pacht, ER, Diaz, P, Clanton, T, Hart, J, Gadek, JE. Serum vitamin E decreases in HIV-seropositive subjects over time. J Lab Clin Med. 1997;130:293296.Google Scholar
86.Jordao, AA Jr, Silveira, S, Figueiredo, JF, Vannucchi, H. Urinary excretion and plasma vitamin E levels in patients with AIDS. Nutrition. 1998;14:423426.Google Scholar
87.Joseph, JA, Shukitt-Hale, B, Denisova, NA, et al.Long-term dietary strawberry, spinach, or vitamin E supplementation retards the onset of age-related neuronal signal-transduction and cognitive behavioral deficits. J Neurosci. 1998;18:80478055.Google Scholar
88.Keaney, JF Jr, Simon, DI, Freedman, JE. Vitamin E and vascular homeostatis: implications for atherosclerosis. FASEB J. 1999;13:965975.Google Scholar
89.Carrasquedo, F, Glanc, M, Fraga, CG. Tissue damage in acute myocardial infarction: selective protection by vitamin E. Free Radic Biol Med. 1999;26:15871590.Google Scholar
90.Motoyama, T, Kawano, H, Kugiyama, K, et al.Vitamin E administration improves impairment of endothelium-dependent vasodilation in patients with coronary spastic angina. J Am Coll Cardiol. 1998;32:16721679.Google Scholar
91.Motram, P, Shige, H, Nestel, P. Vitamin E improves arterial compliance in middle-aged men and women. Atherosclerosis. 1999;145:399404.Google Scholar
92.Chariot, P, Perchet, H, Monnet, I. Dilated cardiomyopathy in HIV-infected patients. N Engl J Med. 1999;340:732.Google Scholar
93.Tang, AM, Graham, NM, Semba, RD, Saah, AJ. Association between serum vitamin A and E levels and HIV-1 disease progression. AIDS. 1997;11:613620.Google Scholar
94.Gogu, SR, Beckman, BS, Rangan, SR, Agrawal, KC. Increased therapeutic efficacy of zidovudine in combination with vitamin E. Biochem Biophys Res Commun. 1989;165:401407.Google Scholar
95.Adler, LA, Peselow, E, Rotrosen, J, et al.Vitamin E treatment of tardive dyskinesia. Am J Psychiatry. 1993;150:14051407.Google Scholar
96.Egan, MF, Hyde, TM, Albers, GW, et al.Treatment of tardive dyskinesia with vitamin E. Am J Psychiatry 1992;149:773777.Google Scholar
97.Constans, J, Conri, C, Sergeant, C. Selenium and HIV infection. Nutrition. 1999;15:719720.Google Scholar
98.Chariot, P, Dubreuil-Lemaire, M-L, Zhou, JY, et al.Muscle involvement in human immunodeficiency virus-infected patients is associated with marked selenium deficiency. Muscle Nerve. 1997;20:386389.Google Scholar
99.Kiremidjian-Schumacher, L, Stotzky, G. Selenium and immune responses. Environ Res. 1987;42:277303.Google Scholar
100.Look, MP, Rockstroh, JK, Rao, GS, Kreuzer, KA, Spengler, U, Sauerbruch, T. Serum selenium vs lymphocyte subsets and markers of disease progression and inflammatory response in human immunodeficiency virus-1 infection. Biol Trace Elem Res. 1997;56:3141.Google Scholar
101.Baum, MK, Shor-Posner, G, Lai, S, et al.High risk of HIV-related mortality is associated with selenium deficiency. J Acquir Immune Defic Syndr Hum Retrovirol. 1997;15:370374.Google Scholar
102.Campa, A, Shor-Posner, G, Indacochea, F, et al.Mortality risk in selenium-deficient HIV-positivie children. J Acquir Immune Defic Syndr Hum Retrovirol. 1999;20:508513.Google Scholar
103.Koch, J, Neal, EA, Schlott, MJ, et al.Zinc levels and infections in hospitalized patients with AIDS. Nutrition. 1996;12:515518.Google Scholar
104.Maes, M, D'Haese, PC, Scharpe, S, D'Hondt, P, Cosyns, P, De Broe, ME. Hypozincemia in depression. J Affect Disord. 1994;31:135140.Google Scholar
105.Maes, M, Vandoolaeghe, E, Neels, H, et al.Lower serum zinc in major depression is a sensitive marker of treatment resistance and of the immune/inflammatory response in that illness. Biol Psychiatry. 1997;42:349358.Google Scholar
106.Baldewicz, T, Goodkin, K, Feaster, DJ, Blaney, NT, Shor-Posner, G, Baum, M. Zinc deficiency is related to depressed mood in recently bereaved HIV-1+ and HIV-1− homosexual men. Psychosom Med. 1998;60:101.Google Scholar
107.Ripa, S, Ripa, R. Zinc and immune function. Minerva Med. 1995;86:315318.Google Scholar
108.Mossad, SB, Macknin, ML, Medendorp, SV, Mason, P. Zinc gluconate lozenges for treating the common cold, a randomized, double-blind, placebo-controlled study. Ann Intern Med. 1996;125:8188.Google Scholar
109.Graham, NM, Sorenson, D, Odaka, N, et al.Relationship of serum copper and zinc levels to HIV-1 seropositivity and progression to AIDS. J Acquir Immune Defic Syndr Hum Retrovirol. 1991;4:976980.Google Scholar
110.Fabris, N, Mocchegiani, E, Galli, M, Irato, L, Lazzarin, A, Moroni, M. AIDS, zinc deficiency, and thymic hormone failure. JAMA. 1988;259:839840.Google Scholar
111.Mocchegiani, E, Muzzioli, M, Gaetti, R, Veccia, S, Viticchi, C, Scalise, G. Contribution of zinc to reduce CD4+ risk factor for “severe” infection relapse in aging: parellelism with HIV. Int J Immunopharmacol. 1999;21:271281.Google Scholar
112.Fabris, N. Neuroendocrine-immune aging: an integrative view on the role of zinc. Ann N Y Acad Sci. 1994;719:353368.Google Scholar
113.Begin, ME, Manku, MS, Horrobin, DF. Plasma fatty acid levels in patients with acquired immune deficiency syndrome and in controls. Prostaglandins Leukot Essent Fatty Acids. 1989;37:135137.Google Scholar
114.Kinchington, D, Randall, S, Winther, M, Horrobin, D. Lithium gamma-linolenate–induced cytotoxicity against cells chronically infected with HIV-1. FEBS Lett. 1993;330:219221.Google Scholar
115.Yehuda, S, Rabinovitz, S, Mostofsky, DI. Essential fatty acids are mediators of brain biochemistry and cognitive functions. J Neurosci Res. 1999;56:565570.Google Scholar
116.Kaplan, RJ, Greenwood, CE. Dietary saturated fatty acids and brain function. Neurochem Res. 1998;23:615626.Google Scholar
117.Stoll, AL, Severus, WE, Freeman, MP, et al.Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry. 1999;56:407412.Google Scholar
118.Crook, MA, Mir, N. Abnormal lipids and the acquired immunodeficiency syndrome: is there a problem and what should we do about it? Int J STD AIDS. 1999;10:353356.Google Scholar
119.Shor-Posner, G, Basit, A, Lu, Y, et al.Hypocholesterolemia is associated with immune dysfunction in early human immunodeficiency virus-1 infection. Am J Med. 1993;94:515519.Google Scholar
120.Grunfeld, C, Pang, M, Doerrler, W, Shigenaga, JK, Jensen, P, Feingold, KR. Lipids, lipoproteins, triglyceride clearance, and cytokines in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. J Clin Endocrinol Metab. 1992;74:10451052.Google Scholar
121.Zangerle, R, Sarcletti, M, Gallati, H, Reibnegger, G, Wachter, H, Fuchs, D. Decreased plasma concentrations of HDL cholesterol in HIV-infected individuals are associated with immune activation. J Acquir Immune Defic Syndr Hum Retrovirol. 1994;7:11491156.Google Scholar
122.Shor-Posner, G, Baldewicz, T, Feaster, D, et al.Psychological distress in HIV-1 disease in relationship to hypocholesterolemia. Int J Psychiatry Med. 1997;27:159171.Google Scholar
123.Heron, DS, Shinitsky, M, Hershkowitz, M, Samuel, D. Lipid fluidity markedly modulates the binding of serotonin to mouse brain membranes. Proc Natl Acad Sci U S A. 1980;77:76437647.Google Scholar
124.Dong, KL, Bausserman, LL, Flynn, MM, et al.Changes in body habitus and serum lipid abnormalities in HIV-positive women on highly active antiretroviral therapy (HAART). J Acquir Immune Defic Syndr Hum Retrovirol. 1999;21:107113.Google Scholar
125.Periard, D, Telenti, A, Sudre, P, et al.Atherogenic dyslipidemia in HIV-infected individuals treated with protease inhibitors: the Swiss HIV Cohort study. Circulation. 1999;100:700705.Google Scholar
126.Echevarria, KL, Hardin, TC, Smith, JA. Hyperlipidemia associated with protease inhibitor therapy. Ann Pharmacother. 1999;33:859863.Google Scholar
127.Martinez, E, Conget, I, Lozano, L, Casamitjana, R, Gatell, JM. Reversion of metabolic abnormalities after switching from HIV-1 protease inhibitors to nevirapine. AIDS. 1999;13:805810.Google Scholar
128.Baum, MK, Shor-Posner, G, Zhang, G, et al.HIV-1 infection in women is associated with severe nutritional deficiencies. J Acquir Immune Defic Syndr Hum Retrovirol. 1997;16:272278.Google Scholar
129.Semba, RD, Farzadegan, H, Vlahov, D. Vitamin A levels and human immunodeficiency virus load in injection drug users. Clin Diagn Lab Immunol. 1997;4:9395.Google Scholar
130.Winick, M. Malnutrition and Brain Development. New York, NY: Oxford University Press; 1976.Google Scholar
131.Cordero, ME, Trejo, M, Garcia, E, Barros, T, Colombo, M. Dendritic development in the neocortex of adult rats subjected to postnatal malnutrition. Early Hum Dev. 1985;12:309321.Google Scholar
132.Galler, G, Ramsey, F. Influence of early malnutrition on subsequent behavioral development: child's behavior at home. J Am Acad Child Psychiatry. 1985;24:5864.Google Scholar
133.Stoch, MB, Smythe, PM. 15-year developmental study on effects of severe undernutrition during infancy on subsequent physical growth and intellectual functioning. Arch Dis Child. 1976;51:327336.Google Scholar
134.Cunningham-Rundles, S, Kim, SH, Dnistrian, A, et al.Micronutrient and cytokine interaction in congential pediatric HIV infection. J Nutr. 1996;126:S2674S2679.Google Scholar
135.Periquet, BA, Jammes, NM, Lambert, WE, et al.Micronutrient levels in HIV-1-infected children. AIDS. 1995;9:887893.Google Scholar
136.Brouwers, P, DeCarli, C, Heyes, MP, et al.Neurobehavioral manifestations of symptomatic HIV-1 disease in children: can nutritional factors play a role? J Nutr. 1996;126:S2651S2662.Google Scholar
137.Agostani, C, Zuccotti, GV, Riva, E, et al.Low levels of linoleic acid in plasma total lipids of HIV-1 seropositive children. J Am Coll Nutr. 1998;17:2529.Google Scholar
138.Brouwers, P, DeCarli, C, Tudor-Williams, G, Civitello, L, Moss, H, Pizzo, P. Interrelations among patterns of change in neurocognitive, CT brain imaging, and CD4 measures associated with antiretroviral therapy in children with symptomatic HIV infection. Adv Neuroimmunol. 1994;4:223231.Google Scholar
139.Dolan, RJ, Mitchell, J, Wakeling, A. Structural brain changes in patients with anorexia nervosa. Psycholl Med. 1988;18:349353.Google Scholar
140.Grantham-McGregor, SM, Powell, CA, Walker, SP, Himes, JH. Nutritional supplementation, psychosocial stimulation, and mental development of stunted children: the Jamaican Study. Lancet. 1991;338:15.Google Scholar
141.Brouwers, P, Moss, H, Wolters, P, et al.Effect of continuous-infusion zidovudine therapy on neuro-psychologic functioning in children with symptomatic human immuno-deficiency virus infection. J Pediatr. 1990;117:980985.Google Scholar