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Book Review |
Division of Nutrition and Infection Tufts University School of Medicine Boston, MA 02111 E-mail: christine.wanke{at}tufts.edu
AIDS and nutrition is a difficult topic to review. This text is an honorable undertaking in an extremely difficult and controversial field. HIV research and the care of HIV-infected patients are generally undertaken by conservative infectious-disease specialists or by molecular virologists who believe in an old-fashioned approach to combating infectious diseases: find the pathogen, develop an agent that kills it, and assume that the complications of the disease caused by the pathogen (eg, malnutrition) will not need attention. HIV has consistently defied the attempts of these traditional scientists and does not behave as a traditional infectious agent; HIV is treatable but not curable. The nutritional status of patients infected with HIV, therefore, becomes an extremely important topic but one that is difficult to discuss in a way that will not be off-putting to HIV clinicians and scientists or to nutritional scientists. Classically, these 2 groups have not spoken the same scientific language. To complicate the matter even further, the treatment and status of patients with HIV has evolved through distinct "eras" so that nutritional and other data from one era become obsolete in the next era. Treatment with highly active antiretroviral therapy in the current era is particularly problematic because there is little pertinent nutritional data. Most nutritional studies of HIV were done in era 1 (recognition of the virus and the syndrome) or era 2 (use of effective therapies or prevention for opportunistic illnesses). It is extremely difficult to persuasively apply nutritional data collected from either of these previous eras—the hallmarks of which were early mortality and severe debility from oral, esophageal, gastric, or intestinal illnesses (often with systemic manifestations and fever)—to the current era, in which the focus has shifted to juggling the therapies and side effects of therapy with the long-term effects of the chronic viral infection on the host and host metabolism. The nutritional status of patients with HIV is also affected by whether the patients live in the developed or the developing world.
Therefore, the editor of this book has a problematic and ambitious agenda. With the above concerns in mind, some of the chapters are very effective at exploring novel approaches to HIV-related nutritional issues. Particularly successful in this regard are chapter 5 ("Use of Herbs and Non-Nutritive Supplements in HIV-Positive and AIDS Patients"), chapter 6 ("AIDS and Food Safety"), and chapter 14 ("Traditional and Popular Uses of Food as Therapy for HIV/AIDS"). Chapter 5 is an excellent and comprehensive review, as is chapter 6, which remains an important topic even though most HIV-infected patients are not as immunologically compromised as they were in the past. In addition, chapter 6 has excellent reference tables. Chapter 14 is unique in discussing traditional beliefs about food, the understanding of which is critical to knowing how to work effectively with any patient population to improve their nutritional intake and status.
Chapter 2 ("Supplementation and Undernutrition Affect Survival in Murine AIDS"), chapter 4 ("Trace Elements, Free Radicals, and HIV Progression"), and chapter 7 ("Thiols to Treat AIDS") provide comprehensive theoretical reviews of nutritional factors in HIV. The book contains intriguing chapters on the effects of cigarette smoking on the immune system (chapter 9), of alcohol on the immune system (chapter 8), and of HIV infection on the nutrient intakes of persons living in Japan (chapter 12). However, chapter 1 ("Wasting and AIDS in the Era of Highly Active Antiretroviral Therapy") and chapter 10 ("Lipodystrophy: The most Recent Development in HIV Nutrition Care") lack current clinical perspectives of active HIV practitioners.
Finally, an additional difficulty in designing a book on HIV and nutrition is determining which audience to target. The appropriate audience for this book is difficult to determine. It is not designed for a researcher who is active in designing HIV and nutritional studies nor for clinicians who are treating HIV patients because much of the clinical data are out-of-date and the clinical descriptive summaries are simplistic. This textbook is probably best directed toward laboratory-based scientists who have an interest in the theoretical questions raised by HIV and nutrition and could use the book as a basis for reaching a better understanding of these complex issues.
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