South Africa: Chewing Over the Research On HIV/Aids And Food

By, Barry Mendelow, Business Day (Johannesburg), August 22, 2007

There is an astonishing abundance of over-the-counter products, extracts made from food and food supplements, which claim somehow to modulate the human immune system to prevent or treat deadly infections such as HIV and tuberculosis. Such mixed messages about nutrition have been harmful from an individual level all the way up to the level of government policy and implementation. An unambiguous message has emerged from a 16-month analysis of all the relevant research, which we did, with many colleagues, under the auspices of the Academy of Science of SA: there is no evidence that better nutrition is an alternative to the correct medications at the correct times.

We are not saying nutrition is insignificant. Healthy eating habits still have a hugely important role to play in managing these infections. Eating a variety of food, including fruit and vegetables, daily is especially important in developing countries, where nutritional deficiencies are rife.

Nutritional support is helpful. But nutritional support cannot substitute for the specific combinations of drugs required to cure the TB infection or reduce the amount of HIV to undetectable levels.

Much of the previous coverage of the intersection of nutrition, HIV and tuberculosis has focused on politics and personalities. We suggest that some of the factors contributing to the uncertainty are scientific in nature.

One is the desire for a solution without the evidence to back up the claims. The academy panel has noted the startling lack of welldesigned, relevant studies in the field of nutritional intervention for people with HIV and/or TB. This absence of thorough research, before or after specific medical treatment is started, is a sad reflection in a country and continent in which hunger and micronutrient deficiencies are common.

Another factor that may be contributing to the confusion in the debate about nutrition and infections is simply the astonishing complexity of food. Plants have evolved to contain thousands of chemicals. Some affect humans. Few are well understood.

Another issue is the need for common guidelines. We need to agree on the best ways to test how malnourished a person is. We need reliable, appropriate, affordable tests. We need more sensitive ways to measure the depletion of vitamins and minerals. We need intensive research on vitamins, now known to be far more active in parts of the body that play a critical role during HIV infection.

We need much more research into whether specific kinds of nutritional support can assist in staving off the day when antiretroviral drugs are absolutely required.

And recent research showing how the gastrointestinal tract (the gut) plays a pivotal role in the speed and severity of HIV replication suggests that the intestine will be a major site of new advances against AIDS.

We have recommended to the science and technology and health departments that this absence of sound scientific research should be tackled as a priority.

We need to make it clear that we did not conduct new research ourselves. That is not the role of an academy. It is not meant to replace a university or a research council. What we can do is bring our particular skills to analyse and assess the existing research.

In this case, given the controversies, we thought it was essential that all the evidence, international and local, was thoroughly reviewed by an independent, impartial, multidisciplinary and authoritative panel.

So in 2005 the Academy of Science appointed a panel of 15 researchers with a wide variety of experience and expertise, including nutritionists, immunologists, biochemists, infectious disease physicians and paediatricians, policy experts and epidemiologists.

Many of these fields have been isolated from each other. This consensus panel was beneficial as it forced people to confront the latest news in areas outside their own specialisations. Since then, these researchers have systematically picked away at the myths, marketing hype and salesmanship that have thrived like weeds around two of the most serious diseases facing humanity.

For 16 months, we have carefully reviewed a vast amount of research. We are probably pioneers in bringing together separate medical fields that have seldom met, in what has been a very creative process. Many promising new avenues of research have opened up.

It is possible that in future, some types of foods may be confirmed in exhaustive and reputable scientific analyses as having some beneficial power to reduce the onslaught of HIV, especially if they dampen the early inflammation caused by the virus in the gut.

But there is enough evidence currently to suggest caution in any case in which exaggerated claims are made on behalf of any food, nutritional supplement or plant chemical. And under no circumstances should people be going off medically prescribed drugs in favour of a particular diet or vitamin.

Mendelow, a professor emeritus based at Wits University and the National Health Laboratory Service, chaired the panel investigation. Dr Ncayiyana, editor of the South African Medical Journal, Dr Dhansay of the Medical Research Council, and Vorster, a nutrition professor from the University of the North West, helped assess the research.

Source: http://allafrica.com/stories/200708220209.html