More than a decade and a half after the beginning of the AIDS epidemic there is still general agreement in the medical community that there "remains an urgent need for interventions" that include, in addition to an effective vaccine, safe and inexpensive drug therapies to treat individuals already infected with HIV-1. Such therapies should include effective adjunct nutritional support regimens.

Since the current research suggests that individuals infected with the HIV-1 virus progress more rapidly to AIDS when they have higher levels of the virus RNA, it is clear that alternative treatment modalities that help to lower the virus load would be useful. Although some of the recent studies (reported in 1996), using multiple drug cocktails, have been shown to lower viral load and look promising, the expense of such treatment is considerable (more that $15,000 per person per year). There are also concerns that there may be increased risk that such treatment might lead to drug-resistant viral strains. Thus, the potential benefit of regularly including in diets inexpensive and safe components that can help to lower the viral load, such as the lauric oils, represents a desirable nutritional support regimen for HIV-infected individuals worth investigating.

Medium-chain saturated fatty acids are well-known for their virucidal effects against viruses with lipid membranes as well as against numerous other pathogenic microorganisms. These antimicrobial fatty acids and their derivatives are essentially non-toxic to man; they are produced in vivo by humans when they ingest those foods that contain adequate levels of the appropriate medium-chain saturated fatty acids such as lauric acid.

In this chapter, a diet regimen that utilizes adequate sources of those anti-viral, anti-bacterial, and anti-protozoal monoglycerides and their fatty acid precursors that are found principally in lauric oils is proposed and described. The lauric oils such as coconut oil or palm kernel oil, both of which are GRAS, can provide a unique source of both antimicrobial lipids and needed calories. The scientific rationale for their use is reviewed and documented.  [BACK TO TABLE OF CONTENTS]

Information about the nutritional needs, and development of systems of nutritional support for individuals infected with the human immunodeficiency virus known as HIV-1 (or HIV+ for short) or those suffering from the frank acquired immune deficiency syndrome (AIDS), has been gradually increasing over the past several years. In part, recognition of the importance of this specialized nutrition information has come about because of the realization that nutrition plays a critical role in maintaining an efficiently functioning immune system.

The individual with HIV+/AIDS, whose immune system is already compromised by being HIV+ or who has progressed to a frank AIDS, is further disadvantaged by a diet that is inadequate in calories or a diet that has inappropriate balance of macro and micro nutrients. The individual with AIDS will become readily malnourished as well as progressively more immune-compromised under circumstances with frequent bouts of infection such as those precipitated by opportunistic microorganisms, e.g., cytomegalovirus, candida, cryptosporidium.

A comprehensive review in 1990 by Raiten was directed at providing "..a scientific report on all aspects of nutrition and HIV-related disease for the use of health care providers.." The review was prepared by the Life Sciences Research Office of the Federation of American Societies for Experimental Biology for the Center for Food Safety and Applied Nutrition of the Food and Drug Administration. Although the review included discussions of both conventional and unconventional diet therapies, information on antimicrobial lipids was not included.  [BACK TO TABLE OF CONTENTS]

Aron has reviewed the use of nutritional interventions in early HIV disease, latent stage HIV, and late stage HIV/AIDS. During early HIV infection there is an increase in resting energy expenditure (REE), a decrease in lean body mass, and altered triglyceride status. Recommendations during this early stage include increased energy intake with emphasis on avoidance of low or no-calorie foods and beverages. Also recommended is supplementation with certain vitamins and trace elements, as well as experimental fish oil supplementation.

During latent stage HIV infection there are further increases in REE as well as futile lipid cycling with difficulty maintaining body weight. Recommendations during this stage include the addition of enteral feeding supplementation using intact formulas (e.g., Ensure, Nutren, Replete, etc.) or special formulas (e.g., Impact, Peptamen) and various digestive aids.

Further metabolic disturbances during late stage HIV disease: AIDS include the problems of major lipid futile cycling with increased de novo lipogenesis, increased whole body fat oxidation, increased endogenous cholesterogenesis, increased free fatty acid production, greatly increased REE, decreased nitrogen balance, and increased hepatic gluconeogenesis. Further complications stem from multiple infections caused by opportunistic microorganisms (e.g., cytomegalovirus, candida, cryptosporidia). Nutritional intervention in this late stage disease has been focused on aggressive parenteral nutrition; an upper daily limit for lipids given parenterally has been set at 0.11 g/kg · h.

Aron(7) also notes that "the use of nutrient components for their pharmacologic properties rather than for their nutrient effects warrants investigation," and suggests the attractiveness of studying a "superlipid" composed of fish oil, medium chain triglyceride and phospholipid in AIDS patients who require TPN.  [BACK TO TABLE OF CONTENTS]

Current published dietary regimens for individuals infected with HIV invariably address the concept of "eating right" as a means of improving immune status, since, as noted by Dwyer(8), "...conventional or standard treatments are relatively ineffective in halting the underlying immunodeficiency..." Different clinicians understand the meaning of "eating right" differently. For example, Dwyer et al consider the Dietary Guidelines for Americans an appropriate basic diet; Wickwire, on the other hand, points to the inappropriateness of such a diet for individuals with AIDS.