Nutrition and HIV infection in children

Evaluation of serum level of carnitine in HIV-positive individuals and its possible explanatory factors

Aims: This cross-sectional study evaluated the status of serum carnitine level and its possible explanatory factors in Iranian HIV-positive patients. Materials & methods: During a 1-year period, 210 HIV-positive patients older than 18 years of age were enrolled in the study. Serum carnitine concentrations of the patients were measured using radioimmunoassay kits. Probable correlations between the patients’ demographic and clinical characteristics with their serum levels of carnitine were determined in this study. Results: In comparison with normal serum concentration of carnitine in a healthy population, 63.45% of the patients had carnitine deficiency. Receiving antiretroviral regimen, duration of HIV infection, receiving fibrate drugs, serum total cholesterol, fasting blood sugar and serum triglyceride had significant correlations with serum level of carnitine of the patients. Conclusion: The results of the present study showed that carnitine deficiency is prevalent in Iranian HIV/AIDS patients. Nutritional risk assessment of HIV-positive individuals at first visit and in the follow-up is essential.

Potential benefits of carnitine in HIV-positive patients

Carnitine is a nonessential amino acid that has a central role in lipid peroxidation and mitochondrial metabolism. Carnitine deficiency is rare in adult human subjects who have a normal diet and no underlying chronic diseases. Studies have shown that HIV-infected patients are at increased risk of carnitine deficiency due to decreased intake, increased metabolism, gastrointestinal problems, HIV infection itself, concomitant infections, underlying disease, concomitant drugs and antiretroviral therapy. Decreased serum and muscle carnitine content was reported following antiretroviral therapy in HIV-positive patients. The beneficial effects of carnitine on the human immune system, such as prevention of CD4 cell apoptosis, was reported in these patients. Additionally, polyneuropathy, myopathy, lactic acidosis, dyslipidemia and lipodystrophy are complications of antiretroviral therapy that have been proposed to potentially be related to carnitine deficiency and mitochondrial dysfunction. Carnitine may have a significant role in improving some aspects of mitochondrial toxicity induced by an antiretroviral regimen, such as lipodystrophy. Also, there are nearly sufficient data to support the beneficial effects of carnitine in improving the symptoms of lactic acidosis following antiretroviral therapy. According to available data, it is concluded that carnitine may have beneficial effects in the treatment of antiretroviral-induced neuropathy. Most of the evidence supports carnitine supplementation as a treatment strategy rather than prophylaxis for antiretroviralinduced complications. Several studies have shown the prevalence of carnitine deficiency and its role in different aspects of infection and antiretroviral-induced complications in HIV-positive patients, but the probable beneficial effects of carnitine supplementation are not clear in this population. In this review, we have collected and categorized available evidence regarding the potential benefits of carnitine supplementation in HIV-infected individuals.