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Endocrine manifestations of HIV

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Related Terms
  • Antibodies, auto recessive, B-cells, bone marrow, bone marrow transplant, CBC, genetic disorder, immune system, immunodeficiency, inherited disorder, inherited immunodeficiency, leukocytes, leukemia, lymphoma, lymphocytes, malignancy, platelets, pneumonia, red blood cells, T-cells, thrombocytes, thrombocytopenia, tumor, WASP, white blood cells, Wiskott Aldrich syndrome, Wiskott-Aldrich syndrome protein, X-linked.

Background
  • Wiskott-Aldrich syndrome (WAS) is an inherited, immunodeficiency disorder that occurs almost exclusively in males. The recessive genetic disorder is caused by a mutation in the WAS (Wiskott-Aldrich syndrome) gene, which is an X-linked trait. The gene mutation leads to abnormalities in B- and T-lymphocytes (white blood cells), as well as blood platelet cells. In a healthy individual, the T-cells provide protection against viral and fungal infection, the B cells produce antibodies, and platelets are responsible for blood clotting to prevent blood loss after a blood vessel injury.
  • Individuals diagnosed with WAS suffer from recurrent infections, eczema and thrombocytopenia (low levels of platelets).
  • Before 1935, patients only lived an average of eight months. Today, patients usually live an average of eight years, according to a recent case study. The cause of death is usually attributed to extensive blood loss. However, cancer (especially leukemia) is common and often fatal among WAS patients.
  • The only possible cure for WAS is a bone marrow transplant. However, if a patient's family member is not a possible match for a bone marrow donation, patients may have to wait years for a potential donor. Other aggressive treatments may also increase a patient's life expectancy. For instance, one study found that patients who underwent splenectomy (removal of the spleen) lived to be more than 25 years old. The spleen may harbor too many platelets, and cause a decrease in the number of platelets in circulation. Antibiotics, antivirals, antifungals, chemotherapeutic agents, immunoglobulins and corticosteroids have also been used to relieve symptoms and treat infections and cancer associated with WAS.
  • Researchers estimate that about four people per one million live male births develop the disease in the United States.
  • The syndrome is named after Dr. Robert Anderson Aldrich, an American pediatrician who described the disease in a family of Dutch-Americans in 1954, and Dr Alfred Wiskott, a German pediatrician who discovered the syndrome in 1937. Wiskott described three brothers with a similar disease, whose sisters were unaffected.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Binder V, Albert MH, Kabus M, et al. The genotype of the original Wiskott phenotype. N Engl J Med. 2006 Oct 26;355(17):1790-3.
  2. Jin Y, Mazza C, Christie JR, et al. Mutations of the Wiskott-Aldrich Syndrome Protein (WASP): hotspots, effect on transcription, and translation and phenotype/genotype correlation. Blood. 2004 Dec 15;104(13):4010-9. Epub 2004 Jul 29.
  3. Natural Standard: The Authority on Integrative Medicine. .
  4. St. Jude Children's Research Hospital. Inherited Immunodeficiencies: Wiskott-Aldrich Syndrome (WAS). .
  5. U.S. Immune Deficiency Foundation. The Wiskott Aldrich Syndrome. .

Integrative therapies
  • Note: Currently, there is a lack of scientific data on the use of integrative therapies for the treatment or prevention of Wiskott-Aldrich syndrome (WAS). The integrative therapies listed below should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.
  • Strong scientific evidence:
  • Probiotics: Probiotics are beneficial bacteria and are sometimes called friendly germs. They help maintain a healthy intestine by keeping harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. An increasing number of studies support the use of probiotics as a supplement to antibiotic therapy. Probiotic supplementation during a course of antibiotics has been studied for reducing adverse effects of antibiotics in the intestinal environment. This includes reducing growth of Clostridium difficile bacteria, which can lead to colitis, a common complication of antibiotics, especially in the elderly. Some probiotics may also help prevent the development of antibiotic resistance. In acutely ill children, synbiotics have been linked to greater weight gain and fewer bacterial illnesses after antibiotics are ended. The evidence consistently supports supplementation of antibiotics with probiotics.
  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Good scientific evidence:
  • Ginseng: For more than 2,000 years, the roots of ginseng have been valued in Chinese medicine. Several studies suggest that ginseng may be an effective agent for immune system enhancement. Additional high quality research is needed before a conclusion be made.
  • Avoid with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Probiotics: Research suggests that probiotics, especially those in milk or food, may be an effective agent for immune system enhancement. However, commercially produced yogurt may not be as effective. More studies are needed, particularly with yogurt, to give recommendations.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Zinc appears to be an essential trace element for the immune system, but research on the effect of zinc supplementation on immune function is scant and mostly focuses on patients with specific diseases. Zinc gluconate appears to exert beneficial effects on immune cells, improving CD3 and CD4 counts and increasing CD4/CD8 ratios in children. There are relatively few studies that examine zinc levels and the effects of zinc supplementation on the health of the elderly population. Further research is needed before a recommendation can be made.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
  • Unclear or conflicting scientific evidence:
  • Amaranth oil: Amaranth is grown in Asia and the Americas and harvested primarily for its grain, which is used as a food source for bread, pasta, and infant food. Limited evidence suggests that amaranth may stimulate the immune system when combined with a heart-healthy diet in patients with heart disease and high cholesterol. However, additional studies of amaranth alone are needed to determine if it is effective for immunomodulation.
  • Amaranth is generally considered safe. Avoid if allergic or sensitive to amaranth. Use cautiously with diabetes, low blood sugar, low blood pressure, immune system disorders, or kidney disorders. Use cautiously if pregnant or breastfeeding.
  • Arabinogalactan: Arabinogalactans belong to a group of carbohydrates called polysaccharides. When consumed in the diet, arabinogalactan comes from the wood of the larch tree (Larix species) and is approved for use as a dietary fiber by the U.S. Food and Drug Administration (FDA). Early research has suggested that arabinogalactan may cause immune stimulation; however, its effect on immunity in healthy volunteers is not clear. More evidence is needed.
  • Avoid if allergic or sensitive to arabinogalactan or larch. People who are exposed to arabinogalactan or larch dust may have irritation of the eyes, lungs, or skin. Use cautiously in people with diabetes, digestive problems, or immune system disorders, and in people who consume diets high in fiber or low in galactose. Arabinogalactan should not be used during pregnancy or breastfeeding.
  • Arginine (L-arginine): L-arginine helps maintain the body's fluid balance (urea, creatinine), and aids in wound healing, hair growth, sperm production (spermatogenesis), blood vessel relaxation (vasodilation), and fights infection. Preliminary study results suggest that arginine may cause immunomodulation. More studies are needed to confirm these results.
  • Avoid if allergic to arginine or with a history of stroke or liver or kidney disease. Avoid if pregnant or breastfeeding. Use cautiously if taking blood-thinning drugs (like warfarin or Coumadin®) or blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
  • Astragalus: In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. Western herbalists began using astragalus in the 1800s as an ingredient in various tonics. Astragalus has been suggested as an immune system stimulant in preliminary laboratory and animal research, and in traditional accounts. Reliable human studies are lacking. High quality human research is necessary before a firm conclusion can be drawn.
  • Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation or fever, stroke, transplant, or autoimmune diseases. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with a risk of bleeding. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
  • Beta-carotene: Beta-carotene is a member of the carotenoids, which are very colorful (red, orange, yellow), fat-soluble compounds. They are naturally found in many fruits, grains, oil, and vegetables, including green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers. Preliminary research of beta-carotene for immune system enhancement shows mixed results. Further research is needed before a conclusion can be drawn.
  • Avoid if sensitive to beta-carotene, vitamin A or any other ingredients in beta-carotene products.
  • Berberine: In low-quality research, berberine has been shown to significantly increase platelet production in individuals with thrombocytopenia both as a monotherapy and adjunctive therapy.
  • Avoid if allergic to berberine, to plants that contain berberine (Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric)), or to members of the Berberidaceae family. Berberine has been reported to cause nausea, vomiting, hypertension (high blood pressure), respiratory failure, and paresthesias; however, clinical evidence of such adverse effects is not prominent in the literature. Avoid if pregnant or breastfeeding.
  • Black currant: The black currant shrub is native to Europe and parts of Asia and is particularly popular in Eastern Europe and Russia. There is currently a lack of information in humans on the effectiveness of black currant seed for immunomodulation.
  • Avoid if allergic or hypersensitive to black currant, its constituents, or plants in the Saxifragaceae family. Avoid with hemophilia or in those taking blood thinners, unless otherwise recommended by a qualified healthcare provider. Use cautiously with venous disorders or gastrointestinal disorders. Use cautiously if taking MAOIs (antidepressants) or vitamin C supplements. Avoid if pregnant or breastfeeding.
  • Bovine colostrum: Bovine colostrum is the pre-milk fluid produced from cow mammary glands during the first two to four days after birth. Bovine colostrum confers growth, nutrient, and immune factors to the offspring. Bovine colostrum contains immunoglobulins or antibodies that are released into the bloodstream in response to infections. These immunoglobulins may help improve immune function and may be effective in treating immune system deficiencies. More evidence is required before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to dairy products. Use bovine colostrum with caution. Toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE) have been found in human colostrum and breast milk. Thus, it is possible that these agents may be found in bovine colostrum. Avoid with, or if at risk of developing, cancer. Use cautiously with immune system disorders, atherosclerosis (hardening of the arteries) or if taking medications, such as anti-diarrheal agents (e.g. immodium), insulin, or CNS agents (amphetamines, caffeine). Avoid if pregnant or breastfeeding.
  • Cat's claw: Cat's claw is widely used in the United States and Europe, and it is one of the top herbal remedies sold despite a lack of high-quality human evidence. Preliminary research of cat's claw for immune system enhancement shows mixed results. Further research is needed before a conclusion can be drawn.
  • Avoid if allergic to Cat's claw or Uncaria plants or plants in the Rubiaceae family such as gardenia, coffee, or quinine. Avoid with a history of conditions affecting the immune system (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, or lupus). Use cautiously with bleeding disorders or history of stroke, or if taking drugs that may increase the risk of bleeding. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Cat's claw may be contaminated with other Uncaria species. Reports exist of a potentially toxic, Texan grown plant, Acacia gregii being substituted for cat's claw. Avoid if pregnant, breastfeeding, or trying to become pregnant.
  • Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs, (e.g. liver and kidney). Copper is involved in the development of immune cells and immune function in the body. Severe copper deficiency appears to have adverse effects on immune function, although the exact mechanism is not clear.
  • Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states, including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The U.S. Recommended Dietary Allowance (RDA) is 1,000 micrograms for pregnant women. The U.S. RDA is 1,300 micrograms for nursing women.
  • Dong quai: Poor-quality research reports benefits of Dong quai in patients diagnosed with idiopathic thrombocytopenic purpura (ITP). However, these patients were not compared to individuals who were not receiving Dong quai. Therefore, the results can only be considered preliminary.
  • Avoid if allergic to Angelica radix or members of the Aplaceae/Umbelliferae family (anise, caraway, carrot, celery, dill, parsley). Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is not known. There are no reliable long-term studies of side effects. Most precautions are based on theory, laboratory research, tradition, or isolated case reports. Avoid if pregnant or breastfeeding.
  • Echinacea: Echinacea is a perennial herb that has been used to treat a variety of medical conditions. Echinacea has been studied alone and in combination preparations for immune system stimulation. It remains unclear if there are clinically significant benefits. Additional studies are needed in this area before conclusions can be drawn regarding safety or effectiveness.
  • Avoid if allergic to echinacea, its constituents, or any members of the Asteraceae/Compositae family (ragweed, chrysanthemums, marigolds, daisies). Use cautiously in patients prone to atopic reactions and in those with hemochromatosis and diabetes. Some natural medicine experts discourage the use of echinacea by people with conditions affecting the immune system, such as HIV/AIDS, some types of cancer, multiple sclerosis, tuberculosis, and rheumatologic diseases (such as rheumatoid arthritis or lupus). Use parenteral preparations of echinacea(no longer approved for use in Germany) cautiously. Use tinctures cautiously with alcoholic patients or in patients taking disulfiram or metronidazole. Avoid using echinacea in patients presenting for anesthesia. Use cautiously if pregnant or breastfeeding.
  • Gamma linolenic acid (GLA):Gamma linolenic acid (GLA) is a dietary fatty acid that is found in many plant oil extracts. Few clinical trials have investigated the effect of GLA on immune responses in healthy human subjects. GLA, as blackcurrant seed oil, may offer some benefits. Further study is required to determine if GLA is beneficial for immune enhancement.
  • Use cautiously with drugs that increase the risk of bleeding like anticoagulants and anti-platelet drugs. Avoid if pregnant or breastfeeding.
  • Goldenseal: Goldenseal is one of the five top-selling herbal products in the United States. Goldenseal is sometimes suggested to be an immune system stimulant. However, there is little clinical evidence in this area. More research is needed before a firm conclusion can be drawn.
  • Avoid if allergic or hypersensitive to goldenseal or any of its constituents (like berberine and hydrastine). Use cautiously with bleeding disorders, diabetes, or low blood sugar levels. Avoid if pregnant or breastfeeding.
  • Licorice: Early study has suggested that recombinant roasted licorice decoction combined with low-dose glucocorticoids may be more effective than glucocorticoids alone in treating idiopathic thrombocytopenic purpura. This combination has also shown a lower adverse effect rate than glucocorticoids alone.
  • Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or with diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
  • Maitake mushroom: Maitake mushrooms (Grifola frondosa) are fungi that can be eaten. Maitake has been used both as a food and for medical conditions. Beta-glucan extracts from maitake have been studied for immune stimulation. Additional high quality research is needed to make a conclusion.
  • Maitake has not been studied thoroughly in humans, and its effects are not well known. Because it has been used historically as a food, it is thought that low doses may be safe. Avoid if allergic or hypersensitive to maitake or its constituents. Use cautiously with low blood pressure, diabetes, or low blood sugar. Use cautiously if taking blood pressure medications, antidiabetic agents, immunostimulants, immunosuppressants, or interferons. Avoid if pregnant or breastfeeding.
  • Massage: The main goal of massage is to help the body heal itself. Touch is fundamental to massage therapy and is used by therapists to locate painful or tense areas, to determine how much pressure to apply, and to establish a therapeutic relationship with clients. Preliminary evidence suggests that massage therapy may preserve immune function. Further research is needed before a firm conclusion can be made.
  • Avoid with bleeding disorders, low platelet counts, or if taking blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
  • Meditation: Many forms of meditation have been practiced for thousands of years throughout the world, with many techniques originating in Eastern religious practices. Preliminary research reports increased antibody response after meditation. Further study is needed to better determine if meditation affects immune function.
  • Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professionals before starting meditation and should explore how meditation may or may not fit in with their current treatment plans. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.
  • Melatonin: Increased platelet counts after melatonin use has been observed in patients with decreased platelets due to cancer therapies (several studies reported by the same author). Stimulation of platelet production has been suggested but not clearly demonstrated. Additional research is necessary to better understand the role of melatonin in thrombocytopenia.
  • There are rare reports of allergic skin reactions after taking melatonin by mouth. Melatonin has been linked to a case of autoimmune hepatitis. Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses for short-term use. Melatonin supplementation should be avoided in women who are pregnant or attempting to become pregnant, based on possible hormonal effects. High levels of melatonin during pregnancy may increase the risk of developmental disorders. In animal studies, melatonin is detected in breast milk and therefore should be avoided during breastfeeding. In men, decreased sperm motility and decreased sperm count are reported with use of melatonin.
  • Mistletoe: Once considered a sacred herb in Celtic tradition, mistletoe has been used for centuries for high blood pressure, epilepsy, exhaustion, anxiety, arthritis, vertigo (dizziness), and degenerative inflammation of the joints. A few small trials found mistletoe to be promising as an immunostimulant in individuals with the common cold. Further study is needed to determine if mistletoe is effective for immunomodulation.
  • Avoid if allergic or hypersensitive to mistletoe or to any of its constituents. Anaphylactic reactions (life threatening shock) have been described after injections of mistletoe. Avoid with acute, highly febrile, inflammatory disease, thyroid disorders, seizure disorders, or heart disease. Use cautiously with diabetes, glaucoma, or if taking cholinergics.
  • Qi gong: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. It is traditionally used for spiritual enlightenment, medical care, and self-defense. There is some evidence suggesting that internal Qi gong may help with treatment of immune deficiencies. However, the evidence is still unclear, and further research is needed to understand how Qi gong may potentially benefit immune function. Based on preliminary study, Chan-Chuang Qi gong therapy may be used to treat leukopenia (low white blood cell count) in breast cancer patients treated with chemotherapy. Further study is warranted.
  • Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
  • Probiotics: Results are mixed regarding the ability of probiotics to reduce complications of infections from medical treatment. Reduced incidence of infection has been seen in patients treated for brain injury, abdominal surgery, and liver transplantation. Other studies have shown no such reduction in elective abdominal surgery and critical care patients.More research is needed in this area before a conclusion can be drawn.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Reflexology: Reflexology involves the application of manual pressure to specific points or areas of the feet called "reflex points" that are believed to correspond to other parts of the body. Some research suggests that self-administered reflexology may be beneficial for immune enhancement. Additional study is needed in this area.
  • Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle or with severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, kidney stones, or with a pacemaker. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
  • Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose plant. It is unclear if rose hips affect immune function. More studies are needed in this area.
  • Avoid if allergic to rose hips, rose pollen, their constituents, or members of the Rosaceae family. Use cautiously if taking anticoagulant or anti-platelet aggregating agents, anticancer agents, anti-HIV medications, anti-inflammatory agents, antilipemics, aluminum-containing antacids, antibiotics, salicylates or salicylate-containing herbs, or laxatives. Use cautiously in patients who are avoiding immune system stimulants.
  • Shiitake: Lentinan, a constituent of shiitake, has been shown to modulate the immune system in some studies. However, there is currently a lack of reliable human evidence supporting the use of lentinan or shiitake for immunomodulation. Additional study is needed in this area.
  • Avoid if allergic or hypersensitive to shiitake mushrooms. Avoid if pregnant or breastfeeding.
  • Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th Century China. Tai chi techniques aim to address the body and mind as an interconnected system and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility, and strength. Tai chi may increase the body's immune response in older adults. For example, patients receiving varicella vaccines and who practiced tai chi showed increased immune responses. Although early study is promising, more study is needed to better determine if tai chi is effective for immune system stimulation.
  • Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.
  • Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Preliminary evidence suggests that thymus extract increases white blood cell counts. Additional study is needed to determine if thymus extract is effective for immune system stimulation.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to the potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if taking hormonal therapy or immunosuppressants. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
  • Vitamin A: Vitamin A is a fat-soluble vitamin. Vitamin A deficiency may compromise immunity, but there is no clear evidence that additional vitamin A supplementation is beneficial for immune function in patients who are not vitamin A deficient.
  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity may occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Vitamin B6: Major sources of vitamin B6 include: cereal grains, legumes (beans), vegetables (like carrots, spinach, peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Vitamin B6 has been shown to be important for immune system function in older individuals. One study found that the amount of vitamin B6 required to reverse immune system impairments in elderly people was more than the current recommended dietary allowance (RDA). Well-designed clinical trials on vitamin B6 supplementation for this indication are needed before a conclusion can be made.
  • Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA). Avoid if sensitive or allergic to any vitamin B6 product ingredients. Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Use cautiously if pregnant or breastfeeding.
  • Vitamin D: Vitamin D is found in many foods, including fish, eggs, fortified milk, and cod liver oil. The sun also helps the body produce vitamin D. Preliminary human evidence suggests that vitamin D and its analogues, such as alfacalcidol, may act as immunomodulatory agents. High quality clinical studies are needed to better understand the effects of vitamin D on immunomodulation.
  • Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.
  • Vitamin E: Vitamin E exists in eight different forms ("isomers"): alpha, beta, gamma and delta tocopherol; and alpha, beta, gamma, and delta tocotrienol. Alpha-tocopherol is the most active form in humans. Studies of the effects of vitamin E supplementation on immune system function have yielded mixed results. Further research is needed before a clear conclusion can be drawn.
  • Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid doses greater than the recommended daily level in pregnant women and breastfeeding women.
  • Fair negative scientific evidence:
  • DHEA: DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. It is suggested by some textbooks and review articles that DHEA may be effective for immune system stimulation. However, current scientific evidence does not support this claim.
  • Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders or if taking anticoagulants or drugs, herbs, or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
  • Lycopene: Lycopene is a carotenoid found in human serum, and skin, liver, adrenal, lung, prostate, and colon tissue. It has been proposed that lycopene and other carotenoids, such as beta-carotene, may stimulate the immune system. However, several studies of lycopene supplements and tomato juice intake in humans do not report effectiveness for immune stimulation.
  • Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding

Addison's disease
  • Overview: Addison's disease, also called adrenal insufficiency or hypocortisolism, is a rare endocrine (hormonal) disorder that is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and occasional darkening of the skin.
  • The adrenal glands, located just above each of the two kidneys, secrete cortisol, also called hydrocortisone. Cortisol regulates proper glucose metabolism, blood pressure, and insulin release for blood sugar maintenance. It is also involved in the inflammatory response. When the adrenal glands do not produce enough cortisol, symptoms of Addison's disease develop.
  • Causes: Most cases of Addison's disease in HIV patients are caused by medications. Certain drugs used to treat patients with advanced HIV disease may affect adrenal function and cause adrenal insufficiency. For instance, an antifungal called ketoconazole (Nizoral®) has been shown to inhibit the production of cortisol. This drug prevents the adrenal glands from responding to a hormone called adrenocorticotropic hormone (ACTH). Normally, when the pituitary gland secretes ACTH, the adrenal glands are stimulated to produce cortisol. However, patients taking this drug may not produce cortisol in response to ACTH.
  • Rifampin (Rifadin®, Rimactane®), a drug used to treat tuberculosis infections that are often associated with HIV, changes the way the body breaks down cortisol in the body. As a result, the body needs higher levels of cortisol in order for the hormone to have proper effects on the body.
  • Symptoms: Symptoms of Addison's disease usually go unnoticed until about 90% of the adrenal cortex has been destroyed. Common symptoms include fatigue, decreased appetite, nausea, vomiting, diarrhea, abdominal pain, weight loss, muscle weakness, dizziness when standing, dehydration, anxiety, and depression. Some patients may also experience increased bronze pigmentation of the skin and mucous membranes, as well as decreased tolerance to cold. Women may lose pubic and underarm hair and may stop having normal menstrual periods.
  • Diagnosis: If it is suspected that a patient has Addison's disease, a healthcare provider may measure the cortisol levels of the patient's blood in the morning. Healthy individuals typically have plasma cortisol levels that range from 5-23 micrograms per deciliter of blood. Plasma cortisol levels less than 10 micrograms per deciliter of blood are suggestive of Addison's disease.
  • The standard diagnostic test for Addison's disease is the adrenocorticotropic hormone (ACTH) stimulation test. The adrenocorticotropic hormone (ACTH) test measures the level of cortisol in the blood and urine 30-60 minutes before and after an injection of man-made ACTH. Individuals who do not have adrenal damage will begin producing cortisol in response to the injection. Patients with Addison's disease will produce minimal or no cortisol in response to the injection.
  • The physician may also perform a computerized tomography (CT) scan of the abdomen to check the size of the adrenal glands and look for other abnormalities that might give insight to the cause of adrenal insufficiency.
  • Treatment: If a medication is causing Addison's disease, the patient should slowly taper off the medication under the supervision of a healthcare provider. Prolonged suppression of the adrenal glands can lead to atrophy (shrinkage) and may take several weeks to months for the patient to recover to full function after the drug is discontinued. Since patients with Addison's disease do not produce enough hormones, treatment may include one or more hormones to replace the deficiency. Corticosteroids, such as hydrocortisone (A-hydroCort®, Cortef®, Hydrocortone®, Hydrocortone® Acetate, Hydrocortone® Phosphate, and Solu-Cortef®) are used to replace cortisol. Mineralocorticoids, such as fludrocortisone (Florinef®), are used to replace aldosterone.
  • Prevention: Ketoconazole and rifampin should be used cautiously and adrenal function should be monitored.

Male hypogonadism
  • Overview: Male HIV patients have an increased risk of developing hypogonadism. Hypogonadism is a condition in which the sex organs, also called gonads, are underactive. The gonads (testes or ovaries) help the body maintain normal physiological function. They secrete hormones essential for reproductive function, development of secondary sexual characteristics, body composition, and mood.
  • Primary hypogonadism occurs when the gonads are directly affected. Secondary hypogonadism occurs when other parts of the body, such as the hypothalamus or pituitary gland, are causing the gonads to be underactive.
  • Hypogonadism is prevalent among men with HIV, according to researchers. In early studies, more than half of all men with AIDS had low testosterone levels. It is estimated that males with advanced HIV disease have a lower prevalence of 25% for hypogonadism than men with less advanced HIV.
  • Causes: Hypogonadism may develop in males if HIV affects the hypothalamus, pituitary gland, and/or the testes, causing a decrease in testosterone levels.
  • In rare cases infections (such as toxoplasmosis) or HIV-related cancers (such as lymphoma) have been shown to cause lesions on the pituitary gland and/or hypothalamus. These lesions may prevent the pituitary and hypothalamus from secreting hormones necessary for proper gonadal function.
  • In addition, certain medications may also cause secondary hypogonadism in HIV-infected males. For instance, a man-made hormone called egestrol acetate (such as Megace®) may cause severe hypogonadism in HIV-infected males.
  • Malnutrition and/or chronic illness may cause secondary hypogonadism in HIV-infected men.
  • Symptoms: If the body does not produce enough testosterone during fetal development, the growth of male sex organs may be impaired. Male children born with HIV and hypogonadism may have female genitals, ambiguous genitals that are neither male or female, or underdeveloped male genitals. If hypogonadism occurs during puberty, the male may experience decreased development of muscle mass, impaired growth of body hair, impaired growth of genitals, excessive growth of the arms and legs in proportion to the trunk of the body, development of breast tissue, and lack of deepening of the voice. Hypogonadism during adulthood may cause erectile dysfunction, infertility, decreased body hair growth, increased body fat, decreased testicle size, decreased muscle mass, development of breast tissue, and osteoporosis (hollow, brittle bones).
  • Diagnosis: Hypogonadism is diagnosed when a patient experiences symptoms that are characteristic of the disorder and has low levels of testosterone in the blood. If tests confirm that the patient has low levels of testosterone, hypogonadism is diagnosed. Additional tests may be performed to determine the underlying cause. If a patient with hypogonadism is receiving hormone therapy, the medication is the suspected cause.
  • A blood test is performed to measure the levels of testosterone in the blood. This test is typically performed early in the day because testosterone levels are generally highest in the morning. Healthy males typically have 300-1,000 nanograms of testosterone per deciliter of blood.
  • Treatment: HIV patients typically experience an improvement in symptoms once the underlying cause is treated.
  • If hormone replacement therapy is the suspected cause of symptoms, a healthcare provider may recommend a different dose or medication.
  • If HIV is the suspected cause, patients should begin treatment with highly active antiretroviral therapy (HAART). This is a combination of different antiretrovirals that suppresses HIV and boosts the body's immune system.
  • If an infection is the suspected cause, patients typically receive medications called antimicrobials. Antibiotics are used to treat bacterial infections, antifungals are used to treat fungal infections, and antivirals are used to treat viral infections. The specific drug and dose depend on the type and severity of the infection, as well as the patient's overall health.
  • Only in rare cases do HIV patients require testosterone injections. This is because most HIV patients with hypogonadism do not experience testicular failure. If testosterone therapy is needed, patients typically receive injections with the hormone once every two to three weeks.
  • Prevention: Since most cases of hypogonadism in HIV patients are caused by infections, patients should receive HAART. This combination therapy suppresses HIV, which subsequently boosts the immune system, making patients less vulnerable to infections.

Pancreatitis
  • Overview: Patients infected with the human immunodeficiency virus (HIV) have an increased risk of developing pancreatitis, a severe inflammation of the pancreas. Pancreatitis occurs when the digestive enzymes in the organ become active too soon. Instead of becoming active in the intestines, they become active inside the pancreas, where they can cause organ damage.
  • The pancreas is located behind the stomach. It produces enzymes that are released into the small intestine to break down protein in food. The pancreas also produces insulin, a hormone that helps regulate the amount of sugar in the blood.
  • Although HIV patients are more likely to develop pancreatitis than HIV-negative patients, it is still considered a rare condition. For instance, researchers from one study found that less than one percent of 976 HIV patients who were receiving anti-HIV drugs (antiretrovirals) developed the condition.
  • Causes: HIV patients may develop pancreatitis as a result of heavy alcohol consumption, gallstones that block a tube in the pancreas called the pancreatic duct, infections (such as mycobacterium avium complex), or medications such as pentamidine (Pentam®).
  • Symptoms: Acute symptoms of pancreatitis appear suddenly and may lasts for several hours or even days. Common symptoms include nausea, rapid pulse, fever, vomiting, and severe abdominal pain and swelling. The abdomen may be tender when touched. Drinking alcohol causes the symptoms to worsen.
  • If the underlying cause of pancreatitis is not treated, the condition may become chronic (long-term). Common symptoms of chronic pancreatitis include nausea, vomiting, fever, and unintentional weight loss. Chronic pancreatitis may lead to complications, such as temporary diabetes, malnutrition, and severe pain.
  • Diagnosis: A blood test may be performed to determine whether the digestive enzymes from the pancreas are present in the blood. Patients with pancreatitis will test positive for these enzymes. This is because the enzymes in the pancreas leak outside of the organ and into the bloodstream.
  • Imaging studies, such as an abdominal X-ray or computerized tomography (CT) scan, may be performed to determine whether the pancreas is larger than normal. Both of these tests, which are performed at the hospital, produce images of the internal organs. Patients with pancreatitis will have an inflamed pancreas.
  • An endoscopic retrograde cholangiopancreatography (ERCP) may be performed at the hospital to evaluate the damage of the pancreas. During the procedure, a thin, flexible tube with a camera is inserted through the mouth and into the small intestine. The tube then hooks into the bile duct, allowing the healthcare provider to see the pancreas. During the test, a small tissue sample may be removed and analyzed in a laboratory for infections or cancer. Because this procedure may damage the pancreas if not performed by a qualified physician, it is only conducted if all other tests are nondiagnostic. There is also a slight risk of infection.
  • Treatment: Acute pancreatitis usually improves after about one week of treatment. Most cases of acute pancreatitis require hospitalization for a few days, and patients typically experience a full recovery. However, if the condition is left untreated, scarring may occur in the organ. Once the organ becomes scarred, the condition cannot be reversed and the patient requires long-term treatment to manage the symptoms. Alcohol avoidance and pain medications can effectively relieve symptoms of chronic pancreatitis.
  • If a medication is suspected to be causing acute pancreatitis, a healthcare provider may recommend an alternative dose or medication.
  • Oral pain relievers, such as meperidine (Demerol® Hydrochloride), have been used to treat pain caused by pancreatitis. Oral anti-inflammatories, such as naproxen (Naprosyn®, Synflex®), or high doses of aspirin may also help reduce pain.
  • Antimicrobials are used to treat infections that cause pancreatitis. Antibiotics are used to treat bacterial infections, antifungals are used to treat fungal infections, and antivirals are used to treat viral infections.
  • If a gallstone is causing acute pancreatitis, a surgical procedure called endoscopic sphincterotomy is usually required. This procedure is used if the gallstone is blocking the biliary ducts. During the procedure, which is performed at a hospital, the patient receives general anesthesia and is asleep during the surgery. Then, a thin flexible tube, called an endoscope, is inserted through the patient's anus. Additional surgical tools are inserted through the tube to remove the gallbladder. Once the gallbladder is removed, patients can expect a full recovery. Some patients may experience more frequent bowel movements and/or loser-than-normal stools or diarrhea. In some cases, these symptoms may gradually improve over time. Complications are rare but may include damage to the common bile duct, bleeding, and infection. Non-surgical procedures, such as bile salt tablets or sound wave therapy, are only considered if the patient is unable to undergo surgery or the stone is primarily made up of cholesterol. This is because gallstones usually recur when non-surgical procedures are used.
  • Patients with chronic pancreatitis typically receive enzyme therapy with supplements, such as pancrelipase (Pancrease®, Viokase®). These are man-made versions of the pancreatic enzymes that are leaking out of the organ. These supplements are typically taken before and during meals and snacks.
  • Because the pancreatic enzymes may damage the cells that produce insulin, insulin injections may be given to patients who are experiencing symptoms of diabetes.
  • In severe cases, patients may undergo a surgical procedure to destroy the nerves near the pancreas. Once the nerves are dead, they can no longer transmit pain signals to the brain and the patient does not feel pain. Surgery is only performed in patients who have severe pain that cannot be managed with other treatments.
  • Prevention: Avoid or minimize alcohol consumption because it may lead to pancreatitis. Patients should eat a reduced fat diet. High amounts of fat increase the risk of developing gallstones and gallstones may cause pancreatitis. Patients should receive highly active antiretroviral therapy (HAART) to help prevent infections that may cause pancreatitis. HAART is a combination of anti-HIV drugs (antiretrovirals) that suppresses HIV and boosts the body's immune system. In order to prevent complications of pancreatitis, patients should take medications exactly as prescribed.

Pituitary dysfunction
  • Overview: There have been reports of pituitary disorders in HIV/AIDS patients. The pituitary gland is a pea-sized gland located at the base of the brain. This gland secretes various hormones that regulate bodily functions, including growth. A part of the brain, called the hypothalamus, releases hormones that control the function of the pituitary gland.
  • There have been reports of HIV patients who developed underactive pituitary glands in response to a parasitic infection called toxoplasmosis. This has occurred when the parasite infiltrates the pituitary gland and forms lesions. As a result, the pituitary gland is unable to function properly.
  • The most common pituitary disorder associated with HIV is hyponatremia. This condition occurs when the patient has low levels of sodium in the blood. The pituitary gland and hypothalamus are involved in sodium regulation. They produce and release antidiuretic hormone (ADH) into the bloodstream. This hormone causes the kidneys to conserve water. Patients develop hyponatremia if too much water is conserved.
  • According to one study, more than 50% of hospitalized patients with advanced HIV had hyponatremia. Although hyponatremia is most common among acutely ill, hospitalized HIV patients with opportunistic infections, studies have also found that the incidence among stable HIV outpatients is also high, about 20%.
  • Causes: Some infections commonly associated with HIV, such as toxoplasmosis, may lead to an underactive pituitary gland. This happens when the infection causes lesions to form on the pituitary gland. Consequently, the gland is unable to secrete enough hormones needed for proper function.
  • Hyponatremia in HIV patients may be caused by the syndrome of inappropriate antidiuretic hormone secretion (SIADH), according to one study. This syndrome is characterized by excessive levels of antidiuretic hormone (ADH) in the bloodstream. Stress or medications are most likely to cause SIADH. Many HIV patients who developed hyponatremia were taking either opiate or barbiturate medications, which are known to stimulate the production of ADH.
  • In addition, low levels of blood in the body can also stimulate the pituitary gland to secrete more ADH. One study found that 88% of HIV patients with hyponatremia had decreased levels of blood circulating in the body in response to intravenous saline solution. HIV patients with severe infections often receive intravenous saline at the hospital.
  • Symptoms: Symptoms of an underactive pituitary gland vary depending on the affected hormones and severity of the deficiency. In general, symptoms may include sensitivity to cold, fatigue, weakness, decreased appetite, weight loss, abdominal pain, low blood pressure, headache, and vision problems.
  • Symptoms of hyponatremia may include fatigue, disorientation, headache, muscle cramps, and nausea. Extremely low levels of sodium can cause serious effects, including seizures and coma.
  • Diagnosis: A blood test is performed to diagnose an underactive pituitary gland. A healthcare provider will measure the amount of pituitary hormones present in the blood. Low or nonexistent levels of one or more pituitary hormones indicate an underactive thyroid.
  • Several blood and urine tests are available to diagnose hyponatremia. A serum sodium blood test may be conducted to determine the amount of sodium in the fluid portion of the blood, called the serum. Healthy patients typically have 135-145 milliequivalents of sodium per liter of blood. Patients with hyponatremia have less than 135 milliequivalents of sodium per liter of blood.
  • A serum osmolality test measures the amount of chemicals, including sodium, that are dissolved in the serum. Serum osmolality is controlled partly by ADH, also called vasopressin. The normal osmolality of blood is 275-295 milliosmoles per kilogram. Low serum osmolality indicates hyponatremia.
  • A urine osmolality test measures the amount of chemicals, including sodium, that are dissolved in the urine. The normal osmolality of urine is 50-1,400 milliosmoles per kilogram. A urine sodium test measures the amount of sodium in urine. Urine is collected over a 24-hour period and then analyzed in a laboratory. Normal urine sodium values are 15-250 milliequivalents per liter of urine a day.
  • Treatment: Treatment for an underactive pituitary gland varies depending on the severity of the condition and specific type of hormone deficiency. Some patients may return to normal function once the underlying infection is treated. Some patients may also require treatment with hormone therapy.
  • Patients who have hyponatremia that is caused by diuretics or an abnormal increase in ADH do not usually require medical treatment. Instead, the patient is encouraged to drink less water each day.
  • Injecting a solution of 5% sodium chloride into the bloodstream can treat severe hyponatremia.
  • Prevention: Patients should receive prompt treatment for infections, especially those that may lead to an underactive pituitary gland. Patients receiving either opiate or barbiturate therapy for lung disease should be monitored for hyponatremia

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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