Low blood phosphorus levels are associated with high death rates in the initial weeks of antiretroviral therapy (ART) in AIDS patients in sub-Saharan Africa, according to new research conducted by University of Alabama at Birmingham (UAB) researchers at the UAB-affiliated Centre for Infectious Disease Research in Zambia (CIRDZ).
In findings published May 18 in PLoS ONE, the researchers say low phosphorus seems to be a strong predictor of early death among patients beginning ART therapy.
Studies done at CIRDZ and elsewhere had previously shown high mortality in AIDS patients within the first 30 days of starting ART. In 2006, Douglas Heimburger, M.D., at the time a professor of nutrition sciences at UAB and now the associate director for education and training at the Vanderbilt Institute for Global Health, began an observational study at CIDRZ in Lusaka, Zambia, after speculating that the cause might be linked to severe weight loss, a feature common in advanced AIDS.
“There is a precedent with a condition known as refeeding syndrome, seen in prisoners of war following World War II,” said Heimburger. “A significant number of prisoners who were underweight and malnourished upon release from captivity died within the first few weeks after access to unlimited amounts of food.”
Heimburger says studies done after the war showed that when the former prisoners ate their fill, their cells went on an uncontrolled phosphorus binge, consuming all the available phosphorus in the blood, leading to heart and lung failure.
The research team enrolled 142 patients initiating ART at the Chawama primary care clinic in Lusaka in 2006-07. Twenty five participants died during the 12-week follow up period, with 10 dying within the first four weeks. Baseline phosphorus levels were significantly higher among participants still alive at 12 weeks compared to those who had died. Thirteen patients received phosphorus supplementation due to exceedingly low levels at some time during the study.
“The scope and design of this trial do not let us conclusively claim that low phosphorus causes early mortality in these patients, but low blood phosphorus at the time of initiating ART does serve as a strong predictor of death among patients with advanced HIV disease,” said Edmond Kabagambe, DVM, Ph.D., assistant professor of epidemiology in the UAB School of Public Health and a study co-author. “The relation between low phosphorus and early mortality may represent a physiologic phenomenon similar to the refeeding syndrome. Additional research is warranted to establish a conclusive relationship and to examine potential therapeutic interventions.”
Heimburger says additional studies in Zambia are envisioned to better understand the link between phosphorus and death among this patient group and possibly to implement phosphorus supplementation programs for those with low phosphorus levels at the start of ART.
“Low phosphorus may be one of several factors that are involved in the observed high mortality rate,” said Heimburger. “The tragedy here is that ART is very successful in moderating AIDS symptoms and prolonging lifespan, assuming patients can survive the first few months on therapy.”
The study was funded by grants from the National Institutes of Health.
About CIRDZ
Internationally acknowledged as a leader in HIV/AIDS treatment and research, maternal-child health care and studies, and cervical cancer, malaria and tuberculosis practice, CIDRZ has remained rooted in local community health care while becoming a world-renown resource for infectious disease understanding and breakthroughs.
About the Vanderbilt Institute for Global Health
The Vanderbilt Institute for Global Health is a vital part of global health research and development activities at Vanderbilt University and the Vanderbilt University Medical Center (VUMC), based in Nashville, Tenn. VUMC is renowned for its dedication to patient care, education and cutting-edge research, while VIGH provides leadership in interdisciplinary global health education, research, service and advocacy for health and development in resource-limited settings around the world. For more information, see www.mc.vanderbilt.edu.
About UAB
Known for its innovative and interdisciplinary approach to education at both the graduate and undergraduate levels, the University of Alabama at Birmingham (UAB) is the state of Alabama’s largest employer and an internationally renowned research university and academic health center whose professional schools and specialty patient care programs are consistently ranked as among the nation’s top 50; find more information at www.uab.edu and www.uabmedicine.org.
EDITOR’S NOTE: The University of Alabama at Birmingham (UAB) is a separate, independent institution from the University of Alabama, which is located in Tuscaloosa. Please use University of Alabama at Birmingham on first reference and UAB on second reference.
The above article leaves much to be desired obviously written by pseudo scientists who are after nothing else but making money.The reason why patients died was because of the toxicity of the so called ARV or ART.Tenofovir, a toxic component of the so called ART depletes phosphorous and hence will result in early mortality for those whose levels are already compromised due to nutritional deficiency.The solution to AIDS is not the toxic drugs called ARVs or ART but the correction of the oxidative stress that leads to immune deficiency by using reducing agents through nutrition and naturaceuticals.
I hope the following article will help clear things:
Nutrient Deficiency Associated with New HIV Medication
By Kelly Williams, R.D., L.D., and Guy Pujol
December 2001
On October 26,…
” “There is a precedent with a condition known as refeeding syndrome, seen in prisoners of war following World War II,” said Heimburger. “A significant number of prisoners who were underweight and malnourished upon release from captivity died within the first few weeks after access to unlimited amounts of food.” ”
AIDS In Africa = Malnutrition
The high HIV prevalence levels are a statistical conceit based on the selective use of test populations and highly sensitive screening tests in surveys.
#1, Bess, i thought the conclusion spelt out this clearly that they can not conclusively nail down phosphorous depletion by cells leaving a deficit for the lungs and heart muscle, which highly depend on ATP/ADP and inorganic phosphorous pools for high functionality.
“The scope and design of this trial do not let us conclusively claim that low phosphorus causes early mortality in these patients, but low blood phosphorus at the time of initiating ART does serve as a strong predictor of death among patients with advanced HIV disease,” said Edmond Kabagambe, DVM, Ph.D., assistant professor of epidemiology in the UAB School of Public Health and a study co-author.
#1 Bess again, you correctly singled out one such ARV whose side effect is iP depletion but you must have a problem to read further the article u cited. please know that not all bloggers are kaponyas, some of us we blog after doing too much lab work on the same field.
so next time please give a balanced opinion and not to just label Tenofovir as if the entire therapy is toxic. Yes almost all medicines are toxic substances, some cells are sacrificed in the process of healing my dear. i have put this in lay mans language but you have to understand issues of therapeutic indices in order to understand how drugs are released on the market. Drugs with a higher TI are normally administered as they will have a an LD-50 higher than ED-50 meaning the target population of 50 or more is killed LD=Lethal dose, not in the sense of killing the patient but the population said to be 50% killed is the parasite for which such s drug is/was formulated
ba LT how can u censor the.rauptic
Ba Che Guavara naimwe nifinshi muleponta? Naifwe ba kaponya tulasoma. Why should we all specialize in the same field? Just explain to us what you know rather than ukutuvundula, mwaumfuwa.
[-x
Otherwise, one Zambia one Nation bane l-)
The worldwide eradication of smallpox may, inadvertently, have helped spread HIV infection, scientists believe.
Experts say the vaccine used to wipe out smallpox offered some protection against the Aids virus and, now it is no longer used, HIV has flourished.
The US investigators said trials indicated the smallpox jab interferes with how well HIV multiplies.
But they say in the journal BMC Immunology it is too early to recommend smallpox vaccine for fighting HIV.
Kill no cure
Lead researcher Dr Raymond Weinstein, from Virginia’s George Mason University, said: “There have been several proposed explanations for the rapid spread of HIV in Africa, including wars, the reuse of unsterilised needles and the contamination of early batches of polio vaccine.
“However, all…
“However, all of these have been either disproved or do not sufficiently explain the behaviour of the HIV pandemic.”
It is a plausible explanation
Jason Warriner, clinical director for the Terrence Higgins Trust
Dr Weinstein and his colleagues believe immunisation against smallpox may go some way to explain the recent rises in HIV prevalence.
Smallpox immunisation was gradually withdrawn from the 1950s to the 1970s, following the worldwide eradication of the disease, and HIV has been spreading exponentially since then, they say.
Now, only scientists and medical professionals working with smallpox are vaccinated.
To test if the events may be linked, the researchers looked at the white blood cells taken from people recently immunised against smallpox and tested how…
To test if the events may be linked, the researchers looked at the white blood cells taken from people recently immunised against smallpox and tested how they responded to HIV.
They found significantly lower replication rates of HIV in blood cells from vaccinated individuals, compared with those from unvaccinated controls.
The smallpox vaccine appeared to cut HIV replication five-fold.
Immune boost
The researchers believe vaccination may offer some protection against HIV by producing long-term alterations in the immune system, possibly including the expression of a receptor called CCR5 on the surface of white blood cells, which is exploited by the smallpox virus and HIV.
Jason Warriner, clinical director for the Terrence Higgins Trust, said: “It’s impossible to say…
Jason Warriner, clinical director for the Terrence Higgins Trust, said: “It’s impossible to say whether the withdrawal of the smallpox vaccine contributed to the initial explosion of HIV cases worldwide, but it is a plausible explanation.
“This is an interesting piece of research, and not just as a history lesson. Anything that gives us greater understanding of how the virus replicates is another step on the road towards a vaccine and, one day, a cure.
“Further studies into the role receptor cells play are needed, and even then any discoveries are likely to be just one part of the solution.
“Until we find a way to eradicate the virus from the body, the focus should remain on stopping it being passed on in the first place.” BBC News
Back again to the usual arguments about HIV/AIDS and causation. Mainstream and westernised docs like Che Guavara, De Javu will toe the official line. Most AIDS doctors make a good living out of this disease with conference travels, allowances, research funding and publications to enhance their CVs.
My Zambia:
You may have a point because small pox and polio eradication may have had a role to play. In actual fact we now know at least 2 brain tumours that are associated with a polio vaccine that was contaminated with SV40. No one will accept responsibility now because to compensate 35 million people would be devastating. I believe that HIV/AIDS is a human creation, whether accidentally or intentionally. This should never happen again. We must be careful about ‘live’ vaccinations.
It is well known that dark skinned people have Vitamin D deficiency and this is more prevalent in HIV infected people. Phosphorus, calcium and magnesium metabolism are intricately associated. I wonder why the researchers make no mention of vitamin D levels in their subjects. On toxicity, a small study in Uganda found that those who took ARVs 5 days a week and off for 2 days had better outcome than those who take continuously (Interesting!). Longer breaks though, are not good.
this is good news hope they develop some thing very quickly :d
Chemical Pathology!… The Studies Are still Going on and they have Provided A Good Lead. But with Zambian poverty levels being so high, how will the afflicted manage to sustain themselves if and when the flow of supplements is not free flowing ?
AIDS in Africa = HIV, Poverty and Cultural abuse of women
17,000 gallons of Smallpox vaccine filled with HIV was sent to Africa in the 1950s.HIV/AIDS was created by whites to “eradicate” Africans so they can use our natural resources.Can someone tell me,why is it that in the UK there is nearly zero adverts on HIV and AIDS? Yet in Zambia everywhere you go you see stupid ads on AIDS.Promiscuity is very higher in Europe than conservative Africa and condomns are hadly used.
An interesting and a must read “WHO murdered Africa. You can google it on the internet.
Che,
Malcom X said; “If you throw a stone in crowd of dogs, the one who howls the loudest is the one hit.”
So can you explain to me
1.What ARVs treat. Start with AZT as the prototypic drug.
2.How they work
I don’t want multiple posts. I just want simple answers to the two straight forward questions.
Thank you for any other fantastic article. The place else may anybody get that type of information in such a perfect way of writing? I’ve a presentation subsequent week, and I am on the look for such information.