[pronut-hiv] Let' s focus on the nutrition issues being discussed

["Sara Andrist" <smandrist@dhr.state.ga.us>]

Dear Mr. Carter
 
I believe the purpose of this list serve is to discuss nutrition issues, not express our own personal opinions of political leaders.  Though there may be many presidents of many different countries that have both positive and negative impacts on the state of our nations... for the purpose of this professional nutrition list serve, lets focus on the nutrition issues being discussed.
 
Sara M. Andrist, MPH, RD, LD
Georgia Department of Human Resources
Division of Public Health
Nutrition Manager
Nutrition Section
2 Peachtree Street, NW  Suite 11-222
Atlanta, GA 30303-3142

>>> George M. Carter wrote:

[At 12:36 PM 1/9/2006, you wrote:
>Also, let's not group all geographical regions together. There are regions
>of Africa where iron overload is a probelm, others where deficiency is a
>problem. Some areas need more vitamin A-containing  produce which could be
>obtained by changing crops or by trading with nearby regions where those
>things can grow well.  But where there are vast regions where only one 
>thing is produced - be it maize or onions or coffee or anything else - 
>such trade becomes more cumbersome.]

I could not agree more--and indeed another serious and relevant deficiency 
appears to be selenium. Selenium deficiency in the context of HIV disease 
is significant and I believe may have clinically important sequelae (if not to the same degree as say Keshan's disease among those infected with 
Coxsackie virus which only becomes clinically relevant and heart-dangerous 
among populations suffering selenium-deficiency).

See abstracts below.

I think what we mostly all agree on is multifold:
1) Access to ENOUGH food and clean water is the biggest problem for far too 
many people throughout the world;
2) Access to a VARIETY of food is more sensible, both for humans and for 
ecology;
3) Transnational corporate hegemonies, propped up and supported by the 
US/EU/Australia/Japan perpetuate and exacerbate the problems faced by 
literally billions of people.

Variety is critical to assure adequate macro- and micronutrient intake. 
And, again, I'd add that access to a multivitamin as a next step should be 
simply considered a standard of care for people with most chronic diseases, 
such as HIV, malaria and even TB (not just pyridoxine replacement for those 
on isoniazid).

Local solutions, training in growing urban gardens, rural shifts in 
agricultural practices, wise use of medicinal plants and so forth could all 
go a long way to sidestepping some of these Western-grown, systemic 
problems. What do others think? We're not going to change the GLOBAL 
problems over night, but acting locally and thinking globally may bring us 
closer.

My one hope for the planet is that the end of the absolute worst President 
and administration in US history is going to draw to an ignominious close 
soon; preferably with numerous individuals spending considerable time in 
prison.
George M. Carter

**
Kassu A, Yabutani T, Mahmud ZH, Mohammad A, Nguyen N, Huong BT, Hailemariam 
G, Diro E, Ayele B, Wondmikun Y, Motonaka J, Ota F. Alterations in serum 
levels of trace elements in tuberculosis and HIV infections. Eur J Clin 
Nutr. 2005 Dec 7; [Epub ahead of print]

[1] 1Department of Preventive Environment and Nutrition, Systems of 
Nutritional Sciences, Graduate School of Health Biosciences Research, The 
University of Tokushima, Tokushima, Japan [2] 2Department of Microbiology 
and Parasitology, Gondar College of Medicine and Health Sciences, 
University of Gondar, Gondar, Ethiopia.

Objective:To evaluate serum concentrations of trace elements in 
tuberculosis (TB) patients with or with out human immunodeficiency virus 
(HIV) coinfection before and after anti-TB chemotherapy.Subjects:A total of 
155 TB patients, 74 of which were coinfected with HIV, and 31 healthy 
controls from Gondar, Ethiopia.Methods:Serum levels of copper, zinc, 
selenium and iron were determined using an inductively coupled plasma mass 
spectrometer from all subjects at baseline and from 44 TB patients (22 with 
HIV coinfection) at the end of an intensive phase of anti-TB 
chemotherapy.Results:Compared with the control group, the concentrations of 
iron, zinc and selenium were significantly lower (P<0.05) while that of 
copper and copper/zinc ratio was significantly higher (P<0.05) in the serum 
of TB patients. TB patients with HIV coinfection had significantly lower 
serum zinc and selenium concentrations and significantly higher copper/zinc 
ratio compared to that in TB patients without HIV coinfection (P<0.05). The 
serum concentration of zinc had significantly increased at the end of 
intensive phase of anti-TB chemotherapy in patients without HIV coinfection 
(P<0.05). An increase in serum selenium level was observed in TB patients 
with or without HIV coinfection after therapy. On the contrary, serum 
copper concentration and copper/zinc ratio declined significantly after 
anti-TB chemotherapy irrespective of HIV serostatus 
(P<0.05).Conclusions:The results indicate that TB patients have altered 
profile of trace elements in their sera. This warrants the need for further 
investigations so that strategies for trace elements supplementation can be 
planned in addition to their potential as diagnostic parameters in 
monitoring responses to anti-TB chemotherapy.European Journal of Clinical 
Nutrition advance online publication, 7 December 2005; 
doi:10.1038/sj.ejcn.1602352.

**
Kupka R, Msamanga GI, Spiegelman D, Rifai N, Hunter DJ, Fawzi WW. Selenium 
levels in relation to morbidity and mortality among children born to 
HIV-infected mothers. Eur J Clin Nutr. 2005 Nov;59(11):1250-8.

Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, 
USA. rkupka@post.harvard.edu

OBJECTIVE: To examine the relation between selenium status and child 
mortality and morbidity among children born to HIV-infected mothers. 
DESIGN: Prospective cohort study. METHODS: Study participants were 
originally part of a trial to study the effect of maternal vitamin 
supplements on maternal and child health outcomes. Morbidity information 
was collected during monthly clinic visits until the child reached 24 
months of age. Out of 984 livebirths, 806 had morbidity information, and 
610 also had data on plasma selenium levels available. SETTING: A study 
clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania, a 
tertiary-care hospital. RESULTS: The median age at baseline was 10.5 weeks. 
A total of 117 (19%) of the 610 study children died during follow-up. In a 
multivariate model, child plasma selenium levels were inversely associated 
with risk of all-cause mortality (P-value, test for trend=0.05). Plasma 
selenium levels were not significantly associated with risk of diarrhea or 
respiratory outcomes. CONCLUSIONS: Among infants born to HIV-infected women 
in sub-Saharan Africa, selenium status may be important to prevent child 
mortality. These preliminary findings warrant future reexamination.

**
van Lettow M, West CE, van der Meer JW, Wieringa FT, Semba RD. Low plasma 
selenium concentrations, high plasma human immunodeficiency virus load and 
high interleukin-6 concentrations are risk factors associated with anemia 
in adults presenting with pulmonary tuberculosis in Zomba district, Malawi. 
Eur J Clin Nutr. 2005 Apr;59(4):526-32.

Johns Hopkins University School of Medicine, Baltimore, USA. 
mvlettow@imailbox.com

BACKGROUND: Although anemia is common among adults with pulmonary 
tuberculosis and human immunodeficiency virus (HIV) infection in 
sub-Saharan Africa, the factors contributing to its pathogenesis have not 
been well characterized. OBJECTIVE: To characterize the antioxidant 
micronutrient status, interleukin-6 (IL-6) concentrations, and HIV load in 
relationship with anemia in adults with pulmonary tuberculosis. SETTING: 
Zomba district, Malawi. METHODS: Erythropoietin, IL-6, plasma HIV load, and 
markers of micronutrient status (hemoglobin (Hb), plasma concentrations of 
retinol, alpha-tocopherol, carotenoids, ferritin, zinc, and selenium) were 
measured in 500 adults who presented with pulmonary tuberculosis in Zomba 
Central Hospital, Malawi. RESULTS: Among 370 HIV-positive and 130 
HIV-negative adults, the prevalence of anemia was 88 and 77%, respectively 
(P = 0.002), and moderate to severe anemia (Hb < 80 g/l) occurred in 30 and 
15%, respectively (P = 0.001). Geometric mean IL-6 concentration was 21.1 
pg/ml, with no difference between HIV-positive and -negative adults. The 
erythropoietin response to anemia was not different between adults with 
elevated IL-6 and those with lower IL-6 concentrations. In a multivariate 
logistic regression model, HIV load, and lower plasma selenium 
concentrations were associated with moderate to severe anemia. In a final 
multivariate linear regression model, IL-6, plasma HIV load, and plasma 
selenium concentrations were associated with Hb concentrations. CONCLUSION: 
This study suggests that low selenium concentrations, high HIV load, and 
high IL-6 concentrations are associated with anemia in adults with 
pulmonary tuberculosis in sub-Saharan Africa.