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P nutrition affects patient response to HIV/AIDS therapy

May 22, 2010

In a fascinating study, scientists at Univ of Alabama (Birmingham) show that patients in Zambia with initially low serum phosphate levels in their bloodstream (a sign of malnutrition and P deficiency) suffer unusually high mortality during treatment with retroviral therapy:  “participants alive at 12 weeks had a median value of 1.30 mmol/L …, compared to 1.06 mmol/L … among those who died”

LINK

The mechanism is unclear, but the authors postulate that it is similar to “refeeding syndrome”, which refers to observations that when starving prisoners were re-fed, they often had very high death rates because their internal serum phosphate levels dipped very low as phosphate was shifted into suddenly re-vitalized cells and tissues.  Since serum phosphate levels need to be tightly regulated in the body for proper organ function, this can have severe complications.  In the case of the HIV/AIDS patients receiving retroviral therapy, it is proposed that the therapy led to stimulation of appetite and activity level, bringing on a version of “refeeding syndrome”.

For purposes of the overall P story, this is quite an interesting wrinkle.  In Africa, many soils are highly P-deficient.  Furthermore, Africa has large P reserves which, unfortunately, are not co-located with human population density (the P is in Morocco, but of course most of the people facing food security challenges are in sub-Saharan Africa).  Thus, most of Africa’s P leaves Africa for processing as fertilizer, the cost of which is beyond what most African farmers can afford and thus it never returns.  Thus, agricultural yields in Africa are low and the crops that ARE grown are likely low in key nutrients and minerals, such as P.  This then only complicates  the problems dealing with the AIDS crisis, even if anti-HIV drugs can be provided.  So, it could be that the effectiveness of public health programs to address the HIV/AIDS crisis in Africa ultimately depend, at least in part, on improving “P accessibility” (sensu Dana Cordell).

Serum PO4's association with mortality during anti-retroviral treatment. The "p = 0.008" means that the correlation of mortality with PO4 has less than 1 in 100 (1/.008) chance of being just a coincidence. In turn, you can see that the other factors measured are thus considered "non-significant" correlates ( their "p" values are high).

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