title: Plasma n-6 Fatty Acid Levels Are Associated With CD4 Cell Counts, Hospitalization, and Mortality in HIV-Infected Patients.
abstract: BACKGROUND
  Fatty acids, including n-6 series, modulate immune function, but their effect on CD4 cell counts, death, or hospitalization in HIV-infected patients on antiretroviral therapy is unknown.
  
  
  METHODS
  In a randomized trial for effects of multivitamins in HIV-infected patients in Uganda, we used gas chromatography to measure plasma n-6 fatty acids at baseline; determined CD4 counts at baseline, 3, 6, 12, and 18 months; and recorded hospitalization or death events. The associations of fatty acids with CD4 counts and events were analyzed using repeated-measures analysis of variance and Cox regression, respectively.
  
  
  RESULTS
  Among 297 patients with fatty acids measurements, 16 patients died and 69 were hospitalized within 18 months. Except for linoleic acid, n-6 fatty acids levels were positively associated with CD4 counts at baseline but not during follow-up. In models that included all 5 major n-6 fatty acids, age; sex; body mass index; anemia status; use of antiretroviral therapy, multivitamin supplements, and alcohol; and the risk of death or hospitalization decreased significantly with an increase in linoleic acid and gamma-linolenic acid levels, whereas associations for dihomo-gamma-linolenic acid, arachidonic acid, and aolrenic acid were null. The hazard ratios (95% confidence intervals) per 1 SD increase in linoleic acid and gamma-linolenic acid were 0.73 (0.56-0.94) and 0.51 (0.36-0.72), respectively. Gamma-linolenic acid remained significant (hazard ratio = 0.51; 95% confidence interval: 0.35 to 0.68) after further adjustment for other plasma fatty acids.
  
  
  CONCLUSIONS
  Lower levels of gamma-linolenic acid are associated with lower CD4 counts and an increased risk of death or hospitalization. These results suggest a potential for using n-6 fatty acids to improve outcomes from antiretroviral therapy.
authors.affiliation: Division of Epidemiology, Department of Medicine and the Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37203.
authors.forename: Edmond K
authors.initials: EK
authors.lastname: Kabagambe
authors.affiliation: Department of Epidemiology and Biostatistics, The University of Georgia, Athens, GA 30602.
authors.forename: Amara E
authors.initials: AE
authors.lastname: Ezeamama
authors.affiliation: Department of Epidemiology and Biostatistics (DG), School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Guwatudde
authors.affiliation: Department of Nutrition and Departments of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115.
authors.forename: Hannia
authors.initials: H
authors.lastname: Campos
authors.affiliation: Department of Nutrition and Departments of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115.
authors.forename: Wafaie
authors.initials: W
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D043371:Fatty Acids, Omega-6 / Q000097:blood*; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D015658:HIV Infections / Q000276:immunology / Q000401:mortality* / Q000473:pathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry* / Q000166:cytology*; D018570:Risk Assessment; D016019:Survival Analysis; D014454:Uganda
chemical_list: D043371:Fatty Acids, Omega-6