Correlation of selenium and zinc levels to antiretroviral treatment outcomes in Thai HIV-infected children without severe HIV symptoms.
OBJECTIVE
Deficiencies in antioxidants contribute to immune dysregulation and viral replication. To evaluate the correlation of selenium (Se) and zinc (Zn) levels on the treatment outcomes in HIV-infected children.


METHODS
HIV-infected Thai children 1-12 years old, CD4 15-24%, without severe HIV symptoms were included. Se and Zn levels were measured by graphite furnace atomic absorption spectrometry at baseline and 48 weeks. Deficiency cutoffs were Se <0.1 μmol/l and Zn <9.9 μmol/l. Serum ferritin and C-reactive protein (CRP) were measured every 24 weeks. No micronutrient supplement was prescribed.


RESULTS
In all, 141 children (38.3% male) with a median (interquartile range (IQR)) age of 7.3 (4.2-9.0) years were enrolled. Median baseline CD4% was 20%, HIV-RNA was 4.6 log(10)copies/ml. At baseline, median (IQR) Se and Zn levels were 0.9 (0.7-1.0) μmol/l and 5.9 (4.8-6.9) μmol/l, respectively. None had Se deficiency while all had Zn deficiency. Over 48 weeks, 97 initiated antiretroviral therapy (ART) and 81% achieved HIV-RNA <50 copies/ml with 11% median CD4 gain. The mean change of Se was 0.06 μmol/l (P=0.003) and Zn was 0.42 μmol/l (P=0.003), respectively. By multivariate analysis in children who received ART, predictors for greater increase of CD4% from baseline were lower baseline CD4% (P<0.01) and higher baseline Zn level (P=0.02). The predictors for greater decrease of HIV-RNA from baseline were higher baseline HIV-RNA and higher ferritin (both P<0.01). No association of CRP with the changes from baseline of CD4% or HIV-RNA was found.


CONCLUSIONS
In HIV-infected Thai children without severe immune deficiency who commenced ART, no correlation between Se and ART treatment outcomes was found. Higher pre-ART Zn levels were associated with significant increases in CD4% at 48 weeks.
HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand. torsak.b@hivnat.org
T
T
Bunupuradah
S
S
Ubolyam
R
R
Hansudewechakul
P
P
Kosalaraksa
C
C
Ngampiyaskul
S
S
Kanjanavanit
J
J
Wongsawat
W
W
Luesomboon
S
S
Pinyakorn
S
S
Kerr
J
J
Ananworanich
S
S
Chomtho
J
J
van der Lugt
N
N
Luplertlop
K
K
Ruxrungtham
T
T
Puthanakit
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D002097:C-Reactive Protein / Q000378:metabolism; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D016014:Linear Models; D008297:Male; D018977:Micronutrients / Q000097:blood; D012367:RNA, Viral / Q000302:isolation & purification; D012643:Selenium / Q000097:blood*; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome; D015032:Zinc / Q000097:blood*
D019380:Anti-HIV Agents; D018977:Micronutrients; D012367:RNA, Viral; D002097:C-Reactive Protein; D012643:Selenium; D015032:Zinc