Antioxidants and progression of human immunodeficiency virus (HIV) disease

HIV infection is thought to lead to increased oxidative stress which may in turn lead to faster progression of HIV disease. Therefore, antioxidants ma y have a role in the treatment of HIV disease. We review the data on the re lations of selected antioxidants to HIV disease progression. Results from o bservational epidemiologic studies suggest that vitamin A deficiency may ac celerate HIV disease progression. In observational studies conducted among vitamin A replete populations, associations between intake or status of vit amin A (both preformed vitamin A and R-carotene) and HIV disease progressio n have been less consistent. Available data from intervention studies are n ot entirely consistent with a beneficial effect of supplementation with pre formed vitamin A or beta-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, lo w selenium levels were found to be associated with an increased risk of pro gression of HIV disease. Available epidemiologic data are consistent with a protective effect of multivitamin (or multivitamin-mineral) supplements, p reparations which typically include several of the above antioxidants. Fina lly, limited epidemiologic data support a protective role of N-acetylcystei ne (NAC) in HIV disease. Many studies conducted to date have been observati onal prospective studies; the interpretation of such studies is problematic , however, given the possibility of confounding by infection duration and o ther factors. Thus, well designed randomized trials are essential to proper ly investigate the role of antioxidants, particularly vitamin E, vitamin C, selenium, and NAG, in HIV disease. Such trials are urgently needed since d ietary administration of antioxidants to HIV infected persons would be an i nexpensive intervention appropriate for the developing world. (C) 1999 Else vier Science Inc.