Nutrition importance for adult and pediatric patients has always been recognized since epidemics beginning. 15 years after this event, nutrition is one of the most important trouble for scientists and one of research less known field.
Metabolism equilibrium is one of the fundamental items for prognosis and life quality of persons who live with HIV and AIDS (PlwHA), also if it is not yet controlled by research or therapy.
Wrong nutrition makes disease prognosis worse, increases secondary infection prevalence and risks of infections, in particular maternal-fetal ones.
Combined therapies change natural disease history and its complications; immuno depression and secondary infections are decreasing and partially leave free field to more chronic complications and pathologies: but, on the other hand we cannot  exclude that not completely understood therapeutic progresses may amplify some metabolic troubles. Global clinical results greatly depend on individual genetical predisposition.
The attention to this matter derives from the above general affirmation.
It is a wide and complex argument and we want to speak about some more commonly involved micronutrients aspects in HIV infection.
Micronutrients are a little considered and very difficult to insert in a therapy or in a dietetic scheme substances; nevertheless, their role is often fundamental and unreplaceable.

Malnutrition and disease progression
Some studies are made with the purpose to understand relationship between nutrition state and AIDS development: it has been shown that decrease of body weight in 3-9 months before AIDS evolution has a negative prognostic value only if it is very important. In  previous studies, the same authors tried to establish a correlation between micronutrient dietary supply and delay of AIDS evolution. They showed that a low or excessive supply of  vitamin A was surely associated to a more rapid disease evolution. Also a high vitamin C and niacina consumption was associated to a better prognosis, while an excess of zinc had an immunodepressive effect with a more rapid disease evolution. These results are confirmed by two studies made in developing countries hundreds of patients, where a consistent diminution of mortality in chidren receiving   vitamin A  supply, was demonstrated.
6-years long studies in 296 HIV positive showed a statistically significant reduction of AIDS development in persons who were assuming silver, vitamin E and riboflavina and an almost  statistically significant decrease in constantly  using  vitamin C, tiamina and  vitamin A people. Strong consumption of  vitamin A, riboflavina, tiamina and niacina was associated with CD4 increase; while great consumption of vitamin A, retinolo, vitamin E, riboflavina and tiamina  was associated to a low risk to have less than 500 cells/mm3 CD4.
Use of some minerals or vitamins surely finds is indicated  when there is a real deficit associated to a worsening of health condition. The role of single micronutrients is less clear if they are assumed by asymptomatic persons for long periods. Nobody knows if this consumption takes to a slower progression of disease.

Copper
Copper containing enzymes are widely diffuse in biological tissues and they participate in many metabolic reactions, especially those involved with energy and oxygen consumption during cellular respiration, synthesis of fundamental compounds for connective, bone, nervous tissue. Copper circulates  in red blood cell and plasma.
Lacking of copper is constantly followed by neutropenia. It is almost always due to malnutrition, either in babies, or in adults: It has been assumed for a long time that a varied diet would contain at least 2 mg per day (the need is rather 0.7-0.8 mg per day).  In reality, often, diets contains a lower quantity of  copper: copper is diffused in foods, but its absorption vary according to what and how  we eat (for example sulfate and copper nitrate  are highly soluble while copper sulphide is totally not soluble). An interesting aspect for seropositive persons may be also competition between zinc and copper absorption: often zinc supplementation decrease copper bioavailability.

Selenium
Selenium has a well known antioxidant action, being present in the composition of peroxidase glutatione, an enzyme which, with  vitamin E and with other enzymes, realizes one of the antioxidant systems. Further studies are showing its role also in thyroid hormone metabolism, in particular it is involved in the synthesis of triiodotironina from tireoxina.
Selenium deficiency depress neutrophil antimicrobic action. Moreover, recent discoveries showed that Selenium or vitamin E deficiency allow normally benign B coxachievirus to become virulent in mice, probably  through a viral genetic change: if this observation results true also for other RNA viruses (also HIV), it should further confirm nutrition importance for infections control. Some researchers are also trying to prepare rich in selenium foodstuffs, with the purpose to use its properties on immune system, in particular on lymphocytes proliferation and NK stimulation.
Selenium dietary intake changes according to individual  habits and geographical areas of food production. For instance, if diet is rich of cereals and these are cultivated in a poor of selenium ground, assumption may be insufficient. Very often  assumption changes day by day. But it has been fortunately established that each person is able to keep body equilibrium even in presence of great assumption change, through fecal and urinary escretion.

Zinc
Zinc is present in many enzymes and its fundamental roles are participation to polinucleotides trascription and translation, lipids and proteins synthesis and degradation and of subcellular membraness stabilization. It is evidently essential for life.
Zinc deficiency can induce a delay in organism growth, increased catabolism processes and immune system deficits. In zinc deficiency infections are more likely because of lower immunocellular competence due to consequent deficiency and lower activity of zinc-dependent timuline hormone. Timuline activity strongly decreases in early phases of seropositivity, when total timuline serum levels are conserved. It is important to underline that timuline can be active only when zinc is present and when timuline anomaly appears zinc levels are apparently still normal. We can conclude that serum zinc levels are unreliable.
Zinc is important also because it inhibits TNF mediated  cito-toxicity and it also inhibits TNF action increasing IL-4 production.
Zinc is present in all tissues and body fluids; serum zinc represents only a little part. It is escreted through kidney, skin and feces. It is absorbed through intestine, in particular during fasting. Dietary zinc content is influenced not only by individual habits (meats, legume, cereals are rich in zinc) but  it depends also by cereal refining and by fitates presence which have a negative effect on zinc absorption.

Vitamin B6 and B12
Folic acid and B12 vitamin deficiency is frequent and caused by a lot of causes: inadequate diet supply, bad adsorption, infective processes, digestive system tumors, concomitant therapies.
Vitamin B6 deficiency is precocious ijn HIV infection: many studies show a relationship between  vitamin B6 pool and immune system also in seronegative persons,  other studies revealed a good correlation between  vitamin B6  and lymphocyte proliferation

Vitamin A
Role of vitamin A in T and B lymphocyte functions is recognized. Seropositive and AIDS affected persons often present vitamin A low levels; repeated infective episodes  decrease reserves because of diminuished introduction and adsorption or of increased urinary escretion. Excessive vitamin A  may have toxic effects, above all at cutaneous and hepatic level but it may  also change immune defenses. When we talk about supplementation, we normally refer to pro-vitamin A (or beta-carotene),which present well known immunomodulating effects.

Vitamin E
Vitamin E is often decreased in seropositive persons: this is a very negative factor for free radicals accumulation. Their production is stimulated by TNF which  in turn stimulates virus expression. Laboratory in vivo data confirm  vitamin E role in immune  equilibrium at different levels (T lymphocytes activity, Il-2 production, ecc), but they are not supported  by equivalent clinical studies in seropositive persons therapy.

Vitamin C
Vitamin C has a documented but rather aspecific influence on immune system: it is known that ascorbic acid assumption is useful in  impaired immune defense with impaired phagocytosis (viral infections, burns, surgical interventions). In vitro tests have also demonstrated vitamin C decrease inverse trascriptase activity. Vitamin C megadoses (50-200 g/die)  with good clinical results have been reported by one author; but in reality they are of difficult and doubtful interpretation. Clinical studies are very difficult to be evaluated for the diffuse autosupply habit.

Some practical conclusion. We may affirm that:
The first important rule is to maintain a rich in natural micronutrients diet
It is useful to correct micronutrients deficiency in seropositive persons
Early and heavy supplementations, autosupplementation in particular, not always reach the wished benefic results; on the contrary, sometimes they can have  undesired effects
It seems good and wise to keep medium supply dosages, based  on   available literature, prescribed by a practitioner or a therapist who also knows clinical effects.This can prevent   overdosage negative effects