Pre-antiretroviral therapy serum selenium concentrations predict WHO stages 3, 4 or death but not virologic failure post-antiretroviral therapy.
A case-cohort study, within a multi-country trial of antiretroviral therapy (ART) efficacy (Prospective Evaluation of Antiretrovirals in Resource Limited Settings (PEARLS)), was conducted to determine if pre-ART serum selenium deficiency is independently associated with human immunodeficiency virus (HIV) disease progression after ART initiation. Cases were HIV-1 infected adults with either clinical failure (incident World Health Organization (WHO) stage 3, 4 or death by 96 weeks) or virologic failure by 24 months. Risk factors for serum selenium deficiency (<85 μg/L) pre-ART and its association with outcomes were examined. Median serum selenium concentration was 82.04 μg/L (Interquartile range (IQR): 57.28-99.89) and serum selenium deficiency was 53%, varying widely by country from 0% to 100%. In multivariable models, risk factors for serum selenium deficiency were country, previous tuberculosis, anemia, and elevated C-reactive protein. Serum selenium deficiency was not associated with either clinical failure or virologic failure in multivariable models. However, relative to people in the third quartile (74.86-95.10 μg/L) of serum selenium, we observed increased hazards (adjusted hazards ratio (HR): 3.50; 95% confidence intervals (CI): 1.30-9.42) of clinical failure but not virologic failure for people in the highest quartile. If future studies confirm this relationship of high serum selenium with increased clinical failure, a cautious approach to selenium supplementation might be needed, especially in HIV-infected populations with sufficient or unknown levels of selenium.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. rshivak1@jhmi.edu.
Rupak
R
Shivakoti
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. ngupte1@jhmi.edu.
Nikhil
N
Gupte
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. weiteng.yang@gmail.com.
Wei-Teng
WT
Yang
Department of Medicine, University of Witwatersrand, Johannesburg 2050, South Africa. tmwelase@witshealth.co.za.
Noluthando
N
Mwelase
University of North Carolina Lilongwe, Lilongwe, Private Bag A-104, Malawi. ckanyama@unclilongwe.org.
Cecilia
C
Kanyama
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA. Alice.Tang@tufts.edu.
Alice M
AM
Tang
Durban International Clinical Research Site, Durban University of Technology, Durban 4001, South Africa. Pillay@ukzn.ac.za.
Sandy
S
Pillay
University of Zimbabwe Clinical Research Centre, Harare 999, Zimbabwe. wsamaneka@uzcrc.co.zw.
Wadzanai
W
Samaneka
Les Centres GHESKIO, Port-Au-Prince, HT-6110, Haiti. criviere@gheskio.org.
Cynthia
C
Riviere
International Public Health Department, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK. sima.berendes@googlemail.com.
Sima
S
Berendes
Asociacion Civil Impacta Salud y Educacion, Lima, 4, Peru. jrlama@impactaperu.org.
Javier R
JR
Lama
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. sandra.wagner@ipec.fiocruz.br.
Sandra W
SW
Cardoso
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. patcharaphan@rihes-cmu.org.
Patcharaphan
P
Sugandhavesa
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. tmwelase@witshealth.co.za.
Richard D
RD
Semba
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. ckanyama@unclilongwe.org.
Parul
P
Christian
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. Alice.Tang@tufts.edu.
Thomas B
TB
Campbell
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. agupta25@jhmi.edu.
Amita
A
Gupta
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000069446:Atazanavir Sulfate; D048588:Benzoxazines / Q000627:therapeutic use; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D018791:CD4 Lymphocyte Count; D003521:Cyclopropanes; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016049:Didanosine / Q000627:therapeutic use; D018450:Disease Progression; D000068679:Emtricitabine; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009842:Oligopeptides / Q000627:therapeutic use; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use; D012307:Risk Factors; D012643:Selenium / Q000097:blood* / Q000172:deficiency*; D014944:World Health Organization; D015215:Zidovudine / Q000627:therapeutic use
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D009842:Oligopeptides; D011725:Pyridines; D003841:Deoxycytidine; D019259:Lamivudine; D015215:Zidovudine; D000069446:Atazanavir Sulfate; D002097:C-Reactive Protein; D000068679:Emtricitabine; D012643:Selenium; C098320:efavirenz; D016049:Didanosine