Role of Micronutrients in HIV-Infected Intravenous Drug Users
Marianna K. Baum, Ph.D.
University of Miami School of Medicine
- OBJECTIVES OF STUDIES
Determination of nutritional profile and impact on HIV-1 disease.
Immune evaluation, nutritional profile.
- DESCRIPTION OF COHORTS
Miami cohorts: HIV-1 infected men who have sex with men, male and female drug abusers, pediatric cases.
- NUTRITIONAL PROFILE
Nutritional alterations are widespread even during early stages.
Different prevalence of deficiencies in homosexuals, drug users (men vs women).
- IMPACT OF NUTRITIONAL ALTERATIONS ON HIV-1 DISEASE
Alterations affect immune function, disease progression, and survival.
- 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.
- SELENIUM-INDEPENDENT PREDICTOR OF HIV DISEASE PROGRESSION
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.
- WASTING IN RELATIONSHIP TO MICRONUTRIENT STATUS
Wasting predicts mortality.
Selenium status may be a sensitive predictor of wasting.
- 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.
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).
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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.
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