title: Potential health impacts of heavy metals on HIV-infected population in USA.
abstract: OBJECTIVE
  Noninfectious comorbidities such as cardiovascular diseases have become increasingly prevalent and occur earlier in life in persons with HIV infection. Despite the emerging body of literature linking environmental exposures to chronic disease outcomes in the general population, the impacts of environmental exposures have received little attention in HIV-infected population. The aim of this study is to investigate whether individuals living with HIV have elevated prevalence of heavy metals compared to non-HIV infected individuals in United States.
  
  
  METHODS
  We used the National Health and Nutrition Examination Survey (NHANES) 2003-2010 to compare exposures to heavy metals including cadmium, lead, and total mercury in HIV infected and non-HIV infected subjects.
  
  
  RESULTS
  In this cross-sectional study, we found that HIV-infected individuals had higher concentrations of all heavy metals than the non-HIV infected group. In a multivariate linear regression model, HIV status was significantly associated with increased blood cadmium (p=0.03) after adjusting for age, sex, race, education, poverty income ratio, and smoking. However, HIV status was not statistically associated with lead or mercury levels after adjusting for the same covariates.
  
  
  CONCLUSIONS
  Our findings suggest that HIV-infected patients might be significantly more exposed to cadmium compared to non-HIV infected individuals which could contribute to higher prevalence of chronic diseases among HIV-infected subjects. Further research is warranted to identify sources of exposure and to understand more about specific health outcomes.
authors.affiliation: Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Xu
authors.forename: Hui
authors.initials: H
authors.lastname: Hu
authors.forename: Amy B
authors.initials: AB
authors.lastname: Dailey
authors.forename: Greg
authors.initials: G
authors.lastname: Kearney
authors.forename: Evelyn O
authors.initials: EO
authors.lastname: Talbott
authors.forename: Robert L
authors.initials: RL
authors.lastname: Cook
mesh_terms: D000293:Adolescent; D000328:Adult; D004781:Environmental Exposure / Q000032:analysis; D004785:Environmental Pollutants / Q000097:blood* / Q000633:toxicity*; D005260:Female; D015658:HIV Infections / Q000097:blood*; D006262:Health; D006801:Humans; D008297:Male; D019216:Metals, Heavy / Q000097:blood* / Q000633:toxicity*; D008875:Middle Aged; D014481:United States; D055815:Young Adult
chemical_list: D004785:Environmental Pollutants; D019216:Metals, Heavy
references.citation: Semin Liver Dis. 2012 May;32(2):167-76
references.pmid: 22760656
references.citation: AIDS. 2010 Jun 19;24(10):1537-48
references.pmid: 20453631
references.citation: BMJ. 2009 Jan 26;338:a3172
references.pmid: 19171560
references.citation: Clin Lab. 2011;57(11-12):867-78
references.pmid: 22239016
references.citation: Environ Pollut. 2007 Jan;145(1):324-8
references.pmid: 16635539
references.citation: Gig Sanit. 2003 Sep-Oct;(5):42-4
references.pmid: 14598750
references.citation: Clin Lab Med. 2006 Mar;26(1):67-97, viii
references.pmid: 16567226
references.citation: Pharmacol Biochem Behav. 1990 Sep;37(1):11-5
references.pmid: 2263651
references.citation: J Epidemiol Community Health. 2002 Mar;56(3):167-70
references.pmid: 11854334
references.citation: Am J Respir Crit Care Med. 2001 Aug 15;164(4):542-5
references.pmid: 11520712
references.citation: Med Tr Prom Ekol. 2010;(4):1-6
references.pmid: 20564796
references.citation: Epidemiology. 2013 May;24(3):421-9
references.pmid: 23514838
references.citation: Diabet Med. 2013 Apr;30(4):e143-8
references.pmid: 23278294
references.citation: Environ Health Perspect. 2012 Jul;120(7):1017-22
references.pmid: 22472185
references.citation: Curr Pharm Des. 2003;9(18):1475-81
references.pmid: 12769727
references.citation: Cardiovasc Hematol Agents Med Chem. 2013 Mar;11(1):58-66
references.pmid: 22946901
references.citation: Int J Occup Med Environ Health. 2001;14(4):375-86
references.pmid: 11885921
references.citation: Front Psychol. 2012 Jul 09;3:217
references.pmid: 22866040
references.citation: Environ Res. 2011 Jan;111(1):171-6
references.pmid: 21055738
references.citation: Semin Liver Dis. 2012 May;32(2):158-66
references.pmid: 22760655
references.citation: Toxicol Sci. 2011 Apr;120(2):499-506
references.pmid: 21252391
references.citation: J Acquir Immune Defic Syndr. 2010 Jan;53(1):124-30
references.pmid: 19730109
references.citation: Environ Toxicol. 2013 Jun;28(6):313-21
references.pmid: 21656642
references.citation: Int J Environ Res Public Health. 2012 Jun;9(6):2204-25
references.pmid: 22829799
references.citation: J Toxicol. 2011;2011:870125
references.pmid: 21912545
references.citation: J Food Prot. 2004 Sep;67(9):1927-32
references.pmid: 15453583
references.citation: Nature. 2001 Apr 19;410(6831):968-73
references.pmid: 11309626
references.citation: Environ Res. 2010 Jul;110(5):505-12
references.pmid: 20400068
references.citation: Environ Res. 1995 Apr;69(1):15-30
references.pmid: 7588491
references.citation: J Am Coll Nutr. 2005 Feb;24(1):1-9
references.pmid: 15670978
references.citation: Environ Health Perspect. 2002 Apr;110 Suppl 2:203-9
references.pmid: 11929729
references.citation: Environ Health Perspect. 2001 Jun;109 Suppl 3:357-74
references.pmid: 11427385
references.citation: AIDS. 1993 Aug;7(8):1075-9
references.pmid: 8397943
references.citation: Biometals. 2010 Oct;23(5):811-22
references.pmid: 20213268
references.citation: J Infect Dis. 2012 Jun;205 Suppl 3:S353-4
references.pmid: 22577207
references.citation: Environ Health Perspect. 2004 Apr;112(5):562-70
references.pmid: 15064162
references.citation: PLoS One. 2012;7(6):e38832
references.pmid: 22719959
references.citation: Environ Qual Saf Suppl. 1975;2:221-40
references.pmid: 1058106
references.citation: Chemosphere. 2008 May;71(10):1840-4
references.pmid: 18359060
references.citation: Cardiovasc Diabetol. 2013 Jan 09;12:9
references.pmid: 23302150
references.citation: J Clin Invest. 1976 Aug;58(2):260-70
references.pmid: 783195
references.citation: Toxicol Mech Methods. 2009 May;19(4):308-17
references.pmid: 19778222
references.citation: AIDS. 2008 Nov 30;22(18):2409-18
references.pmid: 19005264
references.citation: C R Seances Soc Biol Fil. 1976;170(4):886-91
references.pmid: 137061
references.citation: Am J Public Health. 1988 Jun;78(6):696-8
references.pmid: 3369603
references.citation: Coron Artery Dis. 2000 Feb;11(1):41-6
references.pmid: 10715805
references.citation: Curr HIV/AIDS Rep. 2012 Jun;9(2):139-47
references.pmid: 22528766
references.citation: Ann Intern Med. 2006 Sep 19;145(6):397-406
references.pmid: 16983127
references.citation: Scand J Work Environ Health. 1983 Aug;9(4):327-31
references.pmid: 6635611
references.citation: J Epidemiol Community Health. 2007 Aug;61(8):665-75
references.pmid: 17630363
references.citation: J Prev Med Public Health. 2005 Nov;38(4):401-7
references.pmid: 16358824
references.citation: Thorax. 1988 Jun;43(6):436-40
references.pmid: 3262243
references.citation: Clin Pharmacol Ther. 1990 Dec;48(6):641-51
references.pmid: 2249376
references.citation: Curr HIV/AIDS Rep. 2012 Sep;9(3):187-99
references.pmid: 22706955
references.citation: BMJ. 2011 Oct 11;343:d6015
references.pmid: 21990259