Micronutrient supplementation increases genital tract shedding of HIV-1 in women: results of a randomized trial.
To test the hypothesis that micronutrient supplementation decreases genital HIV-1 shedding, a double-blind, randomized, placebo-controlled trial of 6 weeks of multivitamin plus selenium supplementation vs. placebo was conducted among 400 HIV-1-seropositive, nonpregnant, antiretroviral-naive women in Mombasa, Kenya. Primary outcome measures included cervical and vaginal shedding of HIV-1-infected cells and RNA. Secondary outcomes included plasma viral load and CD4 count. Surprisingly, the odds of detection of vaginal HIV-1-infected cells were 2.5-fold higher (P = 0.001) and the quantity of HIV-1 RNA in vaginal secretions was 0.37 log10 copies/swab higher (P = 0.004) among women who received micronutrients in comparison to placebo, even after adjustment for potential confounders including baseline HIV-1 shedding and CD4 count. The increase in vaginal HIV-1 shedding was greatest among women who had normal baseline selenium levels. Micronutrient supplementation resulted in higher CD4 (+23 cells/microL, P = 0.03) and CD8 (+74 cells/microL, P = 0.005) counts compared with placebo but did not alter the plasma viral load. In this randomized trial, micronutrients resulted in higher levels of genital HIV-1 shedding compared with placebo. The potential benefit of micronutrient supplementation in HIV-1-seropositive women should be considered in relation to the potential for increased infectivity.
McClelland
R Scott
RS
Department of Medicine, University of Washington, Seattle, WA 98104, USA. mcclell@u.washington.edu
Baeten
Jared M
JM
Overbaugh
Julie
J
Richardson
Barbra A
BA
Mandaliya
Kishorchandra
K
Emery
Sandra
S
Lavreys
Ludo
L
Ndinya-Achola
Jeckoniah O
JO
Bankson
Daniel D
DD
Bwayo
Job J
JJ
Kreiss
Joan K
JK
D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000821:virology*; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D018977:Micronutrients / Q000008:administration & dosage*; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D012643:Selenium / Q000008:administration & dosage*; D014621:Vagina / Q000821:virology*; D017201:Virus Shedding / Q000187:drug effects*; D014815:Vitamins / Q000008:administration & dosage*
D018977:Micronutrients; D012367:RNA, Viral; D014815:Vitamins; D012643:Selenium