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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There is a complex relationship between malnutrition and immune function. Patients with chronic immunological disorders often become malnourished as a result of disease complications. On the other hand, macronutrient deficiencies are associated with the development of immunological deficiencies which are reversible on nutritional repletion. Deficiencies of macronutrients lead to diminished function of T and B lymphocytes in all patients, irrespective of HIV status. Lymphopenia is a characteristic finding in malnourished patients and includes loss of helper lymphocytes (CD4). This paper provides an overview of the gastrointestinal problems in AIDS and concludes that, because of the complex nature of the human immunodeficiency virus (HIV), a multidisciplinary team approach is essential, with the nurse playing a major role.
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PMID:Gastrointestinal problems in patients with AIDS. 802 74

The relationships among nutritional status, infectious disease, and the immune system suggest that nutrition may be a cofactor in human immunodeficiency virus (HIV) progression. We examined nutrition as a cofactor in HIV disease by reviewing the current literature on the interactions of nutrition, infectious disease processes, and immune system dysfunction. Studies demonstrate that poor nutritional status and infection affect the immune system and interact with each other. This relationship leads to the development of opportunistic infections and malignancies, which may result in a diagnosis of acquired immunodeficiency syndrome. Moreover, evidence from our review indicates that nutritional status may play a role in HIV disease progression. We recommend that clinical trials be conducted to evaluate general malnutrition and the efficacy of supplementation with specific nutrients at various stages of HIV disease.
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PMID:Nutrition: a cofactor in HIV disease. 807 83

Malnutrition and growth failure are frequent clinical consequences of human immunodeficiency virus (HIV) infection in children. Tube feeding is a means by which to increase the enteral intake of nutrients. We examined the effect of tube feeding in 18 children, median age 6 months (range, 3-159). Tube feedings were initiated due to growth failure in all, which was also associated with dysfunctional swallowing or aspiration in seven children and gastroesophageal reflux in two. Tube feedings were infused via nasogastric tube (n = 4) or gastrostomy tube (n = 14) and were continued for a median of 8.5 months (range, 2-24). Stoma complications developed in three children with gastrostomy tubes; these were the only tube-related side effect. Tube feedings were discontinued due to noncompliance (n = 3), gastrostomy leakage (n = 2), intolerance (n = 2), and death (n = 3). Anthropometric changes were evaluated comparing mean standard deviation scores (Z) before and after tube feeding. Tube feeding resulted in significantly increased weight for age (Z, -2.13 +/- 0.7 vs. -1.46 +/- 1.4; p = 0.04), weight for height (Z, -1.07 +/- 1.0 vs. -0.13 +/- 1.0; p = 0.004), and arm fat area (Z, -1.75 +/- 1.3 vs. -0.62 +/- 1.2; p = 0.01). However, tube feeding did not result in significant changes in height for age (Z, -1.93 +/- 0.8 vs. -1.74 +/- 1.6) or arm muscle area (Z, -1.24 +/- 0.9 vs. -0.57 +/- 1.2). Tube feedings effectively increased the weight of HIV-infected children in this study, but they were not sufficient to correct linear growth deficits.
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PMID:Effect of enteral tube feeding on growth of children with symptomatic human immunodeficiency virus infection. 807 77

Despite association with adverse clinical outcome, human immunodeficiency virus (HIV)-associated malnutrition has been relatively refractory to conventional nutrition management. Consequently, a prospective randomized trial was conducted to evaluate a new peptide-based enteral formula (NEF) in contrast to a standard enteral formula (SEF) in patients with HIV infection. Eighty early-stage largely asymptomatic patients were randomized into a dietary regimen supplemented with either a ready-to-feed NEF (18.7% protein, 65.5% carbohydrate, 15.8% fat; 1.28 kcal/ml) or SEF (14% protein, 55% carbohydrate, 31% fat; 1.06 kcal/ml). Patients received 2-3 8-oz cans of the NEF or SEF supplement per day for 6 mo. Parameters evaluated at 0 (baseline), 3, and 6 mo included adherence, weight change, anthropometric measurements, serum biochemical indices, gastrointestinal symptoms, physical performance, and intercurrent health events (including hospitalizations). For the 56 evaluable patients, those supplemented with NEF maintained their body weight significantly (p = 0.04) better, had significantly (p = 0.03) more stable triceps skin-fold measurements, and had significantly (p = 0.04) lower blood urea nitrogen than patients consuming the SEF supplement. Consumption of the NEF supplement was also associated with significantly reduced hospitalizations during the 3- to 6-mo evaluation period (p = 0.02). The NEF supplement was well tolerated and did not result in untoward clinical effects. These data suggest that supplemental use of an NEF provides superior nutritional management compared with an SEF for patients with early-stage HIV infection.
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PMID:Long-term effects of early nutritional support with new enterotropic peptide-based formula vs. standard enteral formula in HIV-infected patients: randomized prospective trial. 811 Nov 47

Deficiency in antioxidant micronutrients have been observed in patients with AIDS. These observations concerning only some isolated nutrients demonstrate a defect in zinc, selenium, and glutathione. An increase in free radical production and lipid peroxidation has been also found in these patients, and takes a great importance with recent papers presenting an immunodeficiency and more important an increase in HIV-1 replication secondary to free radicals overproduction. We have assessed different studies, trying to obtain a global view of the antioxidant status of these patients. In adults we observe a progressive decrease for zinc, selenium, and vitamin E with the severity of disease, except that selenium remains normal at stage II. However, the main dramatic decrease concerns carotenoids whose level at stage II is only half the normal value. To understand if these decreases in antioxidant and increases in oxidative stress occur secondary to the aggravation of the disease or, conversely, are responsible for it, we undertook a longitudinal survey of asymptotic patients. The preliminary results of this evaluation are presented. Paradoxically, lipid peroxidation is higher at stage II than at stage IV. This may be consecutive to a more intense overproduction of oxygen free radicals by more viable polymorphonuclear (PMN) at the asymptomatic stage. The free radicals production and lipid peroxidation seem secondary to a direct induction by the virus of PMN stimulation and cytokines secretion. N-Acetyl cysteine or ascorbate have been demonstrated in cell culture to be capable of blocking the expression of HIV-1 after oxidative stress and N-acetyl cysteine inhibits in vitro TNF-induced apoptosis of infected cells. In regard to all these experimental data, few serious and large trials of antioxidants have been conducted in HIV-infected patients, although some preliminary studies using zinc or selenium have been performed. In our opinion it is now time to evaluate in humans the beneficial effect of antioxidants. The more promising candidates for presenting synergistic effects when associated with N-acetyl cysteine seem to be beta-carotene, selenium and zinc.
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PMID:Antioxidant status and lipid peroxidation in patients infected with HIV. 819 33

As part of the Hemophilia Growth and Development Study, we investigated the impact of human immunodeficiency virus (HIV) infection on statural growth, weight gain, and skeletal and sexual maturity in more than 300 boys with moderate to severe hemophilia, of whom 62% were infected with HIV. Age-adjusted height and weight were reduced in the HIV-infected subjects (p < 0.001). However, mean weight for height and triceps skin-fold thickness of the infected-boys closely resembled those of the uninfected group. In HIV-infected boys, height for age was positively related to the CD4+ lymphocyte count when the count was < 200 cells/mm3. Age-adjusted serum testosterone levels did not differ by HIV status, but in the infected participants the mean age-adjusted bone age was significantly reduced (p = 0.038) and the distribution of Tanner stages, adjusted for age, differed significantly (p = 0.003). The probability of advancing one or more Tanner stages in the first study year was significantly slowed in HIV-infected boys more than 14 years of age (p = 0.0003). We conclude that linear growth was significantly impaired in boys with hemophilia and HIV infection, but the wasting of malnutrition was not found. The delays in bone age and pubertal maturation strongly suggest that part of the growth failure seen in acquired immunodeficiency syndrome can be attributed to pubertal delay. We speculate that the lack of demonstrable difference in age-adjusted testosterone concentrations might reflect subtle differences in the pattern of secretion of testosterone or in the concentration of sex-hormone binding globulin.
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PMID:Delayed somatic growth and pubertal development in human immunodeficiency virus-infected hemophiliac boys: Hemophilia Growth and Development Study. 820 73

In many countries, the human immunodeficiency virus (HIV) epidemic has become one of young people, mainly women, and children because of cultural values and the status of women and girls in society. In India and Southeast Asian countries, 80-90% of HIV infection results from heterosexual intercourse; men seek unprotected sex with multiple casual partners because of taboos concerning sexual intercourse during menstruation or after childbirth. Since a woman's status depends on her ability to bear sons, the use of barrier methods is precluded. Women are at greater risk of HIV infection, whether on a percent or per partnership basis. Because men tend to choose younger female sex partners, there is a tendency for the level of HIV infection to be higher in women than in men in the same age cohort. Although serosurveillance in India initially demonstrated a higher prevalence in men, the ratio is reversing. Lower levels of education among women lead to misconceptions about disease prevention, reduce receptivity to public health interventions, and limit access to health care. Repeated pregnancies, poor reproductive hygiene, a tradition of not seeking care, the use of multiple partners by men, and normal labor and operative procedures place women at greater risk of sexually transmitted disease (STD) and HIV infection. Regardless of HIV transmission rates, the World Health Organization recommends breast feeding. Women living in settings where the risk of the infant dying from infectious disease or malnutrition is high should breast feed, even if infected with HIV; in other settings, infected women should use an alternative. The choice of an artificial method and product should not be subject to commercial pressure. Counseling and family planning information and services should be provided to all infected adults. The first priority in all countries is to prevent women of childbearing age from being infected; education, access to condoms, and STD prevention and care are primary activities. The quality of care and access to maternal health and family planning services need to improve, especially with regard to pregnancy complications.
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PMID:Women and AIDS. 820 71

Chronic granulomatous disease (CGD) is a primary immunodeficiency disease which results from absence of the NADPH oxidase in the professional phagocytic cells neutrophils, monocytes, macrophages and eosinophils. Deficiency of this oxidase renders the patient liable to infection by bacteria and fungi, and, as the name of the disease suggests, to chronic granulomatous inflammation. These patients present with a great variety of infections and other complications of their disease, which often tax the clinical and therapeutic skill of the doctors responsible for their care. Collectively we look after, or advise on the management of, over 100 of these subjects, and have developed experience in the diagnosis and management of the infections and other clinical problems they present. We thought that it might be timely to provide guidelines for their management based upon this experience. The numbers of patients are still relatively small, and the clinical presentations very varied, so it is impossible to provide clear statistical proof of the veracity of this advice. It does, however, reflect the working practise of the physicians caring for many of these patients in Europe.
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PMID:The management of chronic granulomatous disease. 827 18

Animal and human studies suggest that vitamin B6 deficiency affects both humoral and cell-mediated immune responses. Lymphocyte differentiation and maturation are altered by deficiency, delayed-type hypersensitivity responses are reduced, and antibody production may be indirectly impaired. Although repletion of the vitamin restores these functions, megadoses do not produce benefits beyond those observed with moderate supplementation. Additional human studies indicate that vitamin B6 status may influence tumor growth and disease processes. Deficiency of the vitamin has been associated with immunological changes observed in the elderly, persons infected with human immunodeficiency virus (HIV), and those with uremia or rheumatoid arthritis. Future research efforts should focus on establishing the mechanism underlying the effects of vitamin B6 on immunity and should attempt to establish safe intake levels that optimize immune response.
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PMID:Vitamin B6 and immune competence. 830 91

Nutritional status is severely compromised in persons infected with the human immunodeficiency virus (HIV). One or a combination of several disease-related factors can contribute to substantial weight loss and malnutrition, accelerating the downhill course of the disease. Efforts to prevent weight loss should include early intervention aimed at appetite stimulation, nutritional supplementation with high-calorie, high-protein oral supplements, and diagnosis and treatment of underlying infections and malabsorption. Although enteral or parenteral feedings may be warranted, these forms of nutritional support pose special problems in HIV-infected persons, and the ultimate benefits of these measures are not yet clear. The recent use of pharmacologic agents to stimulate appetite or improve body composition shows promise, but more research is needed before these drugs can be widely recommended as adjuncts to therapy. In general, unproven remedies should be avoided, as their risks may well outweigh their benefits.
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PMID:Interactions between nutrition and infection with human immunodeficiency virus. 830 92


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