Can a few milligrams of nutritional supplements send your CD4 count soaring?
Twenty years after his HIV diagnosis, there’s no stopping Michael Stokes, 56. The San Franciscan runs his own office-cleaning business, works out several times a week and is learning Spanish. “I even have to push the boys away,” he reports. His secret, he says, is a daily superdose of micronutrients.
Many positive people swear by their vitamins and minerals, but controversy has chased these regimens for years. For every personal testimonial of renewed health and stamina, you’ll find a naysayer who insists that the typical Western diet is more than adequate and that no research has shown that supplements enhance the well-being of positive people who eat such diets.
Stokes’ high-dose brew—concocted by his HIV doc, Jon Kaiser, MD—is the first to undergo the rigors of a study in positive Americans. Called K-PAX, it holds 33 nutritional items, from vitamins A, C and B to the less familiar boron and betaine HCL. Kaiser made news last summer when the Journal of AIDS published his 40-person trial, in which folks on HIV meds plus K-PAX averaged a 24% CD4-cell rise in 12 weeks, compared with no CD4 change in those not taking supplements.
Critics blasted the study: It was small and short, they said, and when its original aim—measuring micronutrients’ impact on med-related peripheral neuropathy (PN)—found no benefit, Kaiser shifted the emphasis to the CD4 jump. But George Carter, founder of New York City’s Foundation for Integrative AIDS Research, finds the results reasonable. “With HIV, you must replenish nutrients lost in the gut,” he says. Carter says PN didn’t improve in Kaiser’s trial because the acetyl L-carnitine dose (1,000 mg) was too low. He cites a trial showing that 3,000 mg eased PN.
Clinician and researcher Cal Cohen, MD, is skeptical. He says Kaiser’s study “is the first demonstration” of micronutrients’ benefit, while “past studies of adding vitamins to Western diets were disappointing.” So he says it’s “hard to know why this is working, and more details and verification are needed.”
Kaiser says the majority of the 250 or so patients in his own practice who take K-PAX—with HIV meds or not—see a 25% average CD4 boost. Carter says K-PAX works because it’s a high-dose multivitamin plus antioxidants key to immune health (such as alpha- lipoic acid, N-acetyl cysteine, acetyl L-carnitine). He adds that high quality supplements and vitamins may work as well. Christine Wanke, MD, a Tufts University infectious disease and nutrition expert, agrees that there’s no evidence that Kaiser’s formula outperforms a more affordable multi. But Kaiser says a K-PAX equivalent would run nearly $180 a month; his powder costs $100. (New York’s ADAP and Medicaid cover K-PAX; Kaiser is urging other states to sign on.)
A large Canada/UK/U.S. study to determine who can safely delay starting HIV meds—those on K-PAX or those on a standard multi—is Kaiser’s next project. “If it’s a tie, I’ll switch all my patients from K-PAX to a multi,” he vows.
Stokes won’t be switching anytime soon. “I don’t need evidence,” he says, “to prove how I feel.”
