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Nutrition and AIDS, 2nd ed.

Department of Human Nutrition and Food Science, California State Polytechnic University, Pomona and, GI Motility Program and Section of Nutrition, Cedars-Sinai Medical Center, Los Angeles

Nutrition and AIDS, 2nd ed. (CRC Series in Modern Nutrition.) by Ronald R. Watson, PhD, ed. Boca Raton, FL: CRC Press, 2000.

Nutrition and AIDS summarizes current knowledge in biochemical, metabolic, nutritional and lifestyle aspects of HIV infection and AIDS. In this second edition, contributors from around the world present recent scientific findings about nutrition-related issues from the perspective of a variety of disciplines. The book is well organized, progressing from wasting through nutritional treatments to lifestyle issues that modulate the immune system. Topics addressed include the use of foods and micronutrients as therapeutic tools, detrimental effects of drugs of abuse, pros and cons of alternative medicine and growth of the affected infant. Included are updates on nutritional aspects of HIV/AIDS in Japan and sub-Saharan Africa. This compendium is intended for the AIDS researcher or the nutrition support practitioner (physicians, nurses and dietitians).

The first chapter on wasting is unbalanced with respect to etiology and treatment of wasting in HIV/AIDS. In addition to metabolic origins, there exists sufficient evidence of gastrointestinal dysfunction with or without diarrhea in HIV-infected individuals [cf. Knox et al., Am J Gastroenterol 95:3482–3489, 2000] to warrant a less dismissive treatment of this subject. Additionally, maldigestion and malabsorption may be present in the absence of symptomatic intestinal infection, as in chronic small intestine bacterial overgrowth.

The second chapter discusses nutrient factors important in immune cell proliferation but fails to mention the potential roles of folate and B₁₂, both critical in DNA replication [cf. Baum et al., AIDS 9:1051–1056, 1995). The third chapter discusses the role of antioxidant nutrients and their potential therapeutic applications in immune function. However, Chapter 11 gives the most thorough treatment of the role of vitamins in the disease process, and both of the earlier chapters might have been easily combined with Chapter 11 for greater readability and a "one-stop" reference point for micronutrients and immunity.

The editor has stepped beyond the traditional boundaries of nutritional biochemistry and AIDS. Included are chapters on broader nutrition subjects, including food safety, lifestyle (recreational-drug use, including alcohol, smoking, cocaine and heroin) and patient-use of complementary alternative medicine. The latter is exceptionally important due to the desperate nature of the disease and the widespread use of CAM by those afflicted with HIV or AIDS, and even includes the often underestimated "therapeutic value of hope."

Lipodystrophy will become increasingly important as the lifespans of AIDS patients are extended by improvements in therapeutic approaches. Risks for metabolic diseases secondary to increased visceral adiposity may well result in a shift from infectious to metabolic morbidity and mortality. The discussion of lipodystrophy written by Jennifer Bowers is excellent. The editor could better focus attention on the metabolic aspects of AIDS by combining or, at least, juxtaposing the metabolic changes associated with wasting with those of body fat redistribution.

One drawback is the density of the text, with only a few tables and figures to break the monotony. Explanatory data tables and figures are very effectively used in the chapter discussing HIV/AIDS in Japan, and this chapter should be used as a model for other chapters in the next edition.

Nutrition and AIDS is a fascinating and thought-provoking volume, which combines basic issues of nutritional biochemistry in HIV/AIDS with therapeutic uses of food and dangers associated with drugs of abuse. This text is focused on research and should be very useful for AIDS researchers, physicians and dietitians alike. One hopes that a future edition will address many of the complex clinical issues associated with treatment of men, women and children afflicted with this devastating disease. Until then, complementary texts such as Schreiner’s Nutrition Handbook for HIV/AIDS and Fields-Gardner’s A Clinician’s Guide to Nutrition in HIV and AIDS are recommended to supplement this fine reference.

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