November 29, 2006

Micronutrient Deficiency Rare in Treated Patients

(AIDSmeds.com)—Low micronutrient levels were uncommon in a study of HIV-positive people receiving antiretroviral therapy, according to a report published in the December 1 issue of the Journal of Acquired Immune Deficiency Syndromes. The authors also indicate decreased retinol levels, and increased selenium and zinc levels, may be associated with better viral load suppression while on treatment.

Low levels of micronutrients – important nutrients needed in small amounts by humans – in the blood have been reported since the early days of the HIV epidemic. Some studies have found a link between low micronutrients – such as retinol (essential for proper vision and healthy skin and mucous membranes), zinc (important for cell division and repair), and the antioxidants alpha (α)-tocopherol and selenium – and worsened HIV disease and death. Before the widespread use of combination HIV treatment, decreased levels of these micronutrients was associated with poor dietary intake, increased physical stress caused by uncontrolled HIV replication, and AIDS-related opportunistic infections.

But what about micronutrient levels in HIV-positive people receiving antiretroviral therapy? To help answer this question, Clara Jones, MD, of Tufts University School of Medicine and her colleagues evaluated micronutrient levels in blood samples collected from 171 HIV-positive men and 117 HIV-positive women. All of the study volunteers were on antiretroviral therapy; 69% of the men and 62% of the women had undetectable viral loads.

Levels of retinol, α-tocopherol, zinc, and selenium were measured. Low levels of retinol were defined as being below 30 micrograms (μg) per deciliter (dL) of blood serum, low selenium was defined as being less than 85 μg/L, low α-tocopherol was a serum level less than 500 μg/dL, and low zinc was a serum level below 670 μg/L.

Five percent of the HIV-positive men and 14% of the HIV-positive women had low retinol levels. Eight percent of the men and 3% of the women had low selenium and 7% of the men and no women had low α-tocopherol levels. As for zinc, 40% of the men and 36% of the women were found to have low levels.

Men and women with the highest zinc levels were most likely to have undetectable viral loads while on HIV treatment. However, this was only statistically significant for the women. Men and women with higher selenium levels were also more likely to have undetectable viral loads, but these findings were not statistically significant. With α-tocopherol, there was no association between serum levels and viral load. Surprisingly, however, lower levels of retinol were associated with undetectable viral loads, a finding that was statistically significant among the women in the study.

CD4 cell counts were not found to be associated with micronutrient levels in the study. However, in men with CD4 cell counts higher than 350, higher retinol levels were more likely to be associated with higher viral loads. In men with CD4 counts below 350, higher retinol levels were more likely to be associated with lower viral loads.

In conclusion, Dr. Jones and her colleagues state that low retinol, α-tocopherol, and selenium are uncommon in HIV-positive people receiving antiretroviral therapy. Zinc deficiency remains common. Decreased retinol levels in women and men with CD4 cell counts above 350 and increased zinc and selenium levels in both genders, they write, may be associated with improved virologic control.

The authors also noted that micronutrient supplementation was relatively common among the study subjects, but this was not found to be significantly associated with improved HIV disease status. And contrary to previous studies, demonstrating that zinc supplementation is associated with worsening disease progression in HIV-positive patients, the current study did not find any evidence of impaired health in patients on antiretroviral therapy taking zinc-inclusive supplements.