title: Nutrition and pharmacology: general principles and implications for HIV.
abstract: Food and nutrition play an intimate and inextricable role in all aspects of drug metabolism, safety, and effectiveness. Antiretroviral therapies (ART) have assumed a preeminent position in the prevention, care, and treatment of HIV and its comorbidities. The interaction between food, nutrition, and ART has become an expanding area of interest both in terms of clinical standards of care and as a target for research. Since the original review of this topic by the WHO in 2005, much has been learned (8). This article contains a review of what is known about the general relationships between nutrition and pharmacology, as well as issues specific to ART, with particular attention to their use in low- and middle-resource settings. The importance of food and nutrition on the bioavailability of drugs and vice versa has been an area of historical interest. However, much has been learned about the importance of nutritional status on drug metabolism, distribution, and effectiveness. The impact of traditional therapies (herbal/botanical) is highlighted as an area of clinical concern and one in need of further research. Additional attention is focused on the impact of individual micronutrients on drug pharmacokinetics and pharmacodynamics. Finally, attention is given to the nutritional implications of the metabolic consequences of ART, which include the potential impact of "colliding epidemics" of infection (eg, HIV, tuberculosis) and noncommunicable diseases. Much has been learned, but much remains to be accomplished to ensure the effective integration of nutritional considerations into the effective and safe use of ART.
authors.affiliation: Endocrinology, Nutrition, and Growth Branch, Center for Research for Mothers and Children, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA. raitend@mail.nih.gov
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Raiten
mesh_terms: D044966:Anti-Retroviral Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D001682:Biological Availability; D003141:Communicable Diseases; D004032:Diet; D018565:Food-Drug Interactions; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D006295:Health Resources; D041743:Herb-Drug Interactions; D006801:Humans; D008659:Metabolic Diseases / Q000150:complications; D018977:Micronutrients / Q000494:pharmacology*; D009752:Nutritional Status; D008517:Phytotherapy; D028321:Plant Preparations / Q000494:pharmacology*; D011203:Poverty
chemical_list: D044966:Anti-Retroviral Agents; D018977:Micronutrients; D028321:Plant Preparations
references.citation: J Ethnopharmacol. 2008 Oct 28;119(3):588-92
references.pmid: 18640255
references.citation: Curr Infect Dis Rep. 2011 Feb;13(1):83-93
references.pmid: 21308459
references.citation: Nutr J. 2005 May 31;4:19
references.pmid: 15927053
references.citation: Toxicol Appl Pharmacol. 2007 Jan 1;218(1):37-44
references.pmid: 17123563
references.citation: MCN Am J Matern Child Nurs. 2005 Jan-Feb;30(1):10-7; quiz 18-9
references.pmid: 15622140
references.citation: Ann Clin Biochem. 2008 Jan;45(Pt 1):18-32
references.pmid: 18275670
references.citation: Clin Infect Dis. 2002 Jan 15;34(2):234-8
references.pmid: 11740713
references.citation: AIDS. 2009 Jun 1;23(9):1184-5
references.pmid: 19451798
references.citation: Cochrane Database Syst Rev. 2010 Dec 08;(12):CD008524
references.pmid: 21154399
references.citation: Am J Clin Nutr. 2011 Dec;94(6):1721S-1728S
references.pmid: 22089442
references.citation: Mol Nutr Food Res. 2010 May;54(5):661-8
references.pmid: 20169584
references.citation: Am J Clin Nutr. 2007 Feb;85(2):333-45
references.pmid: 17284727
references.citation: Biochem Pharmacol. 2010 Jan 15;79(2):270-6
references.pmid: 19686701
references.citation: Arch Biochem Biophys. 1997 Dec 15;348(2):268-77
references.pmid: 9434738
references.citation: Nutr Rev. 2006 May;64(5 Pt 1):226-33
references.pmid: 16770943
references.citation: Afr J Tradit Complement Altern Med. 2009 Dec 30;7(2):125-37
references.pmid: 21304624
references.citation: HIV Med. 2008 Oct;9(8):653-9
references.pmid: 18631258
references.citation: Toxicol In Vitro. 2006 Mar;20(2):187-210
references.pmid: 16289744
references.citation: J Nutr. 2010 Oct;140(10):1788-92
references.pmid: 20739447
references.citation: Pharmacotherapy. 2005 Feb;25(2):165-70
references.pmid: 15767232
references.citation: Am J Clin Nutr. 2010 Oct;92(4):881-6
references.pmid: 20739426
references.citation: FASEB J. 1992 Jan 6;6(2):737-44
references.pmid: 1537464
references.citation: Biochem Pharmacol. 2008 Jun 1;75(11):2204-13
references.pmid: 18400206
references.citation: Toxicol Sci. 2011 Mar;120(1):1-13
references.pmid: 21149643
references.citation: Drug Metab Pharmacokinet. 2010;25(6):521-30
references.pmid: 20930421
references.citation: Toxicol Lett. 2009 Dec 15;191(2-3):216-22
references.pmid: 19766177
references.citation: Pediatr Infect Dis J. 2009 May;28(5):429-30
references.pmid: 19395949
references.citation: J Perinatol. 2006 Jul;26 Suppl 2:S8-S12
references.pmid: 16801973
references.citation: J Nutr. 2007 May;137(5):1334-7
references.pmid: 17449601