Plasma Selenium Concentrations Are Sufficient and Associated with Protease Inhibitor Use in Treated HIV-Infected Adults.
BACKGROUND
Selenium is an essential constituent of selenoproteins, which play a substantial role in antioxidant defense and inflammatory cascades. Selenium deficiency is associated with disease states characterized by inflammation, including cardiovascular disease (CVD). Although HIV infection has been associated with low selenium, the role of selenium status in HIV-related CVD is unclear.


OBJECTIVE
We sought to assess associations between plasma selenium and markers of inflammation, immune activation, and subclinical vascular disease in HIV-infected adults on contemporary antiretroviral therapy (ART) and to determine if statin therapy modifies selenium status.


METHODS
In the Stopping Atherosclerosis and Treating Unhealthy bone with RosuvastatiN trial, HIV-infected adults on stable ART were randomly assigned 1:1 to rosuvastatin or placebo. Plasma selenium concentrations were determined at entry, week 24, and week 48. Spearman correlation and linear regression analyses were used to assess relations between baseline selenium, HIV-related factors and markers of inflammation, immune activation, and subclinical vascular disease. Changes in selenium over 24 and 48 wk were compared between groups.


RESULTS
One hundred forty-seven HIV-infected adults were included. All participants were on ART. Median current CD4+ count was 613, and 76% had HIV-1 RNA ≤48 copies/mL (range: <20-600). Median plasma selenium concentration was 122 μg/L (range: 62-200). At baseline, higher selenium was associated with protease inhibitor (PI) use, lower body mass index, and a higher proportion of activated CD8+ T cells (CD8+CD38+human leukocyte antigen-DR+), but not markers of inflammation or subclinical vascular disease. Over 48 wk, selenium concentrations increased in the statin group (P < 0.01 within group), but the change did not differ between groups (+13.1 vs. +5.3 μg/L; P = 0.14 between groups).


CONCLUSIONS
Plasma selenium concentrations were within the normal range for the background population and were not associated with subclinical vascular disease in HIV-infected adults on contemporary ART. The association between current PI use and higher selenium may have implications for ART allocation, especially in resource-limited countries. Also, it appears that statin therapy may increase selenium concentrations; however, larger studies are necessary to confirm this finding. This trial was registered at clinicaltrials.gov as NCT01218802.
Department of Medicine, Division of Infectious Diseases, MetroHealth Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH;
Corrilynn O
http://orcid.org/0000-0001-9849-0914
CO
Hileman
Case Western Reserve University School of Medicine, Cleveland, OH; Department of Pediatrics, Division of Pediatric Infectious Diseases and Rheumatology, Rainbow Babies and Children's Hospital, Cleveland, OH; and.
Sahera
S
Dirajlal-Fargo
Department of Pediatrics, Division of Pediatric Infectious Diseases and Rheumatology, Rainbow Babies and Children's Hospital, Cleveland, OH; and.
Suet Kam
SK
Lam
Department of Pediatrics, Division of Pediatric Infectious Diseases and Rheumatology, Rainbow Babies and Children's Hospital, Cleveland, OH; and.
Jessica
J
Kumar
Grand Forks Human Nutrition Research Center, USDA Agricultural Research Service, Grand Forks, ND.
Craig
C
Lacher
Grand Forks Human Nutrition Research Center, USDA Agricultural Research Service, Grand Forks, ND.
Gerald F
GF
Combs
Case Western Reserve University School of Medicine, Cleveland, OH; Department of Pediatrics, Division of Pediatric Infectious Diseases and Rheumatology, Rainbow Babies and Children's Hospital, Cleveland, OH; and grace.mccomsey@case.edu.
Grace A
GA
McComsey
D000328:Adult; D058070:Asymptomatic Diseases / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003677:Deficiency Diseases / Q000139:chemically induced / Q000209:etiology / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015497:HIV-1 / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000187:drug effects*; D009820:Ohio / Q000453:epidemiology; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D000068718:Rosuvastatin Calcium / Q000009:adverse effects* / Q000627:therapeutic use; D012643:Selenium / Q000097:blood* / Q000172:deficiency; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D015415:Biomarkers; D017320:HIV Protease Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D012367:RNA, Viral; D000068718:Rosuvastatin Calcium; D012643:Selenium
cardiovascular disease; human immunodeficiency virus; immune activation; inflammation; selenium