title: Micronutrient levels and HIV disease status in HIV-infected patients on highly active antiretroviral therapy in the Nutrition for Healthy Living cohort.
abstract: BACKGROUND
  Low serum micronutrient levels were common before widespread use of highly active antiretroviral therapy (HAART) and were associated with adverse outcomes. Few data are available on micronutrient levels in subjects taking HAART.
  
  
  OBJECTIVE
  To determine the prevalence of low serum retinol, alpha-tocopherol, zinc, and selenium in HIV-infected subjects taking HAART and to assess the association of micronutrient levels with HIV disease status.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Nutrition for Healthy Living (NFHL) study.
  
  
  METHODS
  HIV-infected subjects on HAART.
  
  
  METHODS
  Retinol, alpha-tocopherol, zinc, and selenium were determined in frozen serum samples from 171 men and 117 women. Low serum levels were defined as retinol <30 microg/dL, selenium <85 microg/L, alpha-tocopherol <500 microg/dL, and zinc <670 microg/L. Association of micronutrient quartiles with CD4 cell count, CD4 count <200 cells/mm, HIV viral load (VL), and undetectable VL was assessed using adjusted multivariate regression.
  
  
  RESULTS
  Five percent of men and 14% of women had low retinol, 8% of men and 3% of women had low selenium, and 7% of men and no women had low alpha-tocopherol. Forty percent of men and 36% of women had low zinc, however. Subjects in the upper quartiles of zinc had lower log VL levels than those in the lowest quartile (significant for women). Subjects in the upper quartiles of selenium also tended to have lower VL levels compared with those in the lowest quartile. Surprisingly, women in the upper quartiles of retinol had higher log VLs than those in the lowest quartile. There was no significant association of any micronutrient with CD4 cell count or likelihood of CD4 count <200 cells/mm. The level of CD4 cell count influenced the association of retinol with log VL in men, however. In men with CD4 counts >350 cells/mm, those with higher retinol had higher log VLs compared with the lowest quartile, whereas in men with CD4 counts <350, those with higher retinol levels had lower log VLs compared with the lowest quartile.
  
  
  CONCLUSIONS
  Low retinol, alpha-tocopherol, and selenium are uncommon in HIV-infected subjects on HAART. Zinc deficiency remains common, however. Decreased retinol levels in women and in men with CD4 counts >350 cells/mm and increased zinc and selenium levels in both genders may be associated with improved virologic control.
authors.affiliation: Department of Public Health and Family Medicine, Tufts University School of Medicine, 200 Harrison Avenue-Posner 4, Boston, MA 02111, USA. clara.jones@tufts.edu
authors.forename: Clara Y
authors.initials: CY
authors.lastname: Jones
authors.forename: Alice M
authors.initials: AM
authors.lastname: Tang
authors.forename: Janet E
authors.initials: JE
authors.lastname: Forrester
authors.forename: Jinyong
authors.initials: J
authors.lastname: Huang
authors.forename: Kristy M
authors.initials: KM
authors.lastname: Hendricks
authors.forename: Tamsin A
authors.initials: TA
authors.lastname: Knox
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Richard D
authors.initials: RD
authors.lastname: Semba
authors.forename: Margo N
authors.initials: MN
authors.lastname: Woods
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology*; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D008019:Life Style; D008297:Male; D018977:Micronutrients / Q000097:blood*; D008875:Middle Aged; D012643:Selenium / Q000097:blood; D019562:Viral Load; D014801:Vitamin A / Q000097:blood; D015032:Zinc / Q000097:blood; D024502:alpha-Tocopherol / Q000097:blood
chemical_list: D018977:Micronutrients; D014801:Vitamin A; D024502:alpha-Tocopherol; D012643:Selenium; D015032:Zinc