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Role of Micronutrients in HIV-Infected Intravenous Drug Users


Marianna K. Baum, Ph.D.
University of Miami School of Medicine


Lecture Outline

  1. OBJECTIVES OF STUDIES
    Determination of nutritional profile and impact on HIV-1 disease.

  2. ASSESSMENTS
    Immune evaluation, nutritional profile.

  3. DESCRIPTION OF COHORTS
    Miami cohorts: HIV-1 infected men who have sex with men, male and female drug abusers, pediatric cases.

  4. NUTRITIONAL PROFILE
    Nutritional alterations are widespread even during early stages. Different prevalence of deficiencies in homosexuals, drug users (men vs women).

  5. IMPACT OF NUTRITIONAL ALTERATIONS ON HIV-1 DISEASE
    Alterations affect immune function, disease progression, and survival.

  6. MICRONUTRIENT DEFICIENCIES AND RISK OF HIV-1-RELATED MORTALITY
    Subclinical malnutrition and individual deficiencies of vitamin A, vitamin B12, zinc, and selenium over time are associated with HIV-1-related mortality.

  7. SELENIUM-INDEPENDENT PREDICTOR OF HIV DISEASE PROGRESSION AND SURVIVAL
    Relative risk of 10.8, p<0.002 (Chronic drug users). Selenium deficiency associated with HIV-1-related mortality (OR=6.76, p=0.01) in MSM. Low levels of selenium in pediatric cohort associated with decreased survival.

  8. WASTING IN RELATIONSHIP TO MICRONUTRIENT STATUS
    Wasting predicts mortality. Selenium status may be a sensitive predictor of wasting.

  9. NUTRITIONAL CONSIDERATIONS
    To supplement or not supplement?

Two Learning Objectives

Upon completion of this lecture, the participants will:

  • Understand that nutritional alterations are prevalent in HIV-1 disease, vary among different cohorts, and affect the course of HIV-1 disease progression and survival.

  • Become familiar with the importance of specific micronutrients as sensitive markers of wasting and mortality.

Abstract

A major focus of our research investigations has been to evaluate the role of nutritional status as a cofactor in HIV-related disease progression and survival. Nutritional deficiencies are widespread in HIV-1-seropositive homosexual men (Beach et al., 1992; Baum et al., 1995) as well as male and female drug abusers (Baum et al., 1997a) and children, although the prevalence of nutritional alterations varies among the groups. Low levels of vitamin A, vitamin B12, zinc, and selenium are common and have been demonstrated to be associated with HIV-1-related mortality, independent of CD4 cell count <200/mm3 at baseline and CD4 cell count over time (Baum, 1997b). As multiple nutrient deficiencies tend to occur simultaneously, the joint effect of deficiencies that singly predicted HIV-related mortality was also investigated. In this multivariate analysis only deficiency of selenium was profoundly associated with decreased survival in HIV-1 disease, with a relative risk of 10.8, p<0.002 (Baum et al., 1997b). In other investigations, selenium deficiency has been demonstrated to be predictive of HIV-1-related prognosis (Constans et al., 1995) and in our cohort of HIV-1-infected pediatric patients has been associated with immune dysfunction (Bologna et al., 1994) and decreased survival. Moreover, our longitudinal studies indicate that selenium deficiency is significantly associated with both body weight and body mass index, independent of CD4 cell count, age, gender and race, suggesting that selenium status may be a sensitive predictor of wasting in HIV-1-infected individuals.

The profound impact of selenium deficiency on HIV-1 disease processes and survival underscores the importance of maintaining optimal nutritional status in HIV-1-infected cohorts. Supplementation with selenium may help to increase the enzymatic defense systems in HIV-1-infected patients (Sappey et al., 1994; Delmas-Beauvieux et al., 1996) and be an effective method of delaying disease progression, through its ability to modulate viral expression via selenoprotein genes (Taylor et al., 1997).

References

Baum MK, Shor-Posner G, Lu Y et al., Micronutrients and HIV-1 disease progression. AIDS 1995;9:1051-1056.

Baum MK, Shor-Posner G, Zhang G et al., HIV-1 infection in women is associated with severe nutritional deficiencies. J Acquir Immun Defic Syndr 1997a;16:272-278.

Baum MK, Shor-Posner G, Lai S et al., High risk of mortality in HIV infection is associated with selenium deficiency. J Acquir Immun Defic Syndr 1997b;15:370-374.

Beach RS, Mantero-Atienza E, Shor-Posner G et al., Specific nutrient abnormalities in asymptomatic HIV-1 infection. AIDS 1992;6:701-708.

Bologna R, Indocochea F, Shor-Posner G et al., Selenium and immunity in HIV-1 infected pediatric patients. J Nutr Imm 1994;3:41-49.

Constans J, Pellegrin JL et al., Serum selenium predicts outcome in HIV infection. J Acquir Immun Defic Syndr 1995;3:392.

Delmas-Beauvieux M-C, Peuchant E, Coucouron A et al., The enzymatic antioxidant system in blood and glutathione status in human immunodeficiency virus (HIV)-infected patients: effects of supplementation with selenium or B-carotene. Am J Clin Nutr 1996;64:101-107.

Sappey C, Legrand-Poels S, Best-Belpomme M, Favier A, Rentier B, Piette J. Stimulation of glutathione peroxidase activity decreases HIV type 1 activation after oxidative stress. AIDS Res Human Retrovir 1994;10:1451-1461.

Taylor EW, Bhat A, Nadimpalli R, Zhang W, Kececioglu J. HIV-1 encodes a sequence overlapping env gp41 with highly significant similarity to selenium-dependent glutathione peroxidases. J Acquir Immun Defic Syndr 1997;15:393-394.

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