人类免疫缺陷病毒感染成人多样化多国队列抗逆转录病毒疗法前后微营养素缺乏的发生率及危险因素

Clin Nutr. 2016 Feb;35(1):183-9.

Prevalence and risk factors of micronutrient deficiencies pre- and post-antiretroviral therapy (ART) among a diverse multicountry cohort of HIV-infected adults.

Shivakoti R, Christian P, Yang WT, Gupte N, Mwelase N, Kanyama C, Pillay S, Samaneka W, Santos B, Poongulali S, Tripathy S, Riviere C, Berendes S, Lama JR, Cardoso SW, Sugandhavesa P, Tang AM, Semba RD, Campbell TB, Gupta A; NWCS 319 and PEARLS Study Team.

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Medicine, University of Witwatersrand, Johannesburg, 2050, South Africa; UNC Lilongwe, Lilongwe, Private Bag A-104, Malawi; Durban International Clinical Research Site, Durban University of Technology, Durban, 4001, South Africa; University of Zimbabwe Clinical Research Centre, Harare, 999, Zimbabwe; Hospital Nossa Senhora de Conceição, Porto Alegre, 91350-200, Brazil; YR Gaitonde Center for AIDS Research and Education, Chennai, 600113, India; National AIDS Research Institute, Pune, 411026, India; Les Centres GHESKIO, Port-Au-Prince, HT-6110, Haiti; Malawi College of Medicine-Johns Hopkins University Research Project, Blantyre, Malawi; Asociacion Civil Impacta Salud y Educacion, Lima, 4, Peru; STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clinica Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, 21045-900, Brazil; Research Institute for Health Sciences, Chiang Mai, 50200, Thailand; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, 02111, MA, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, 21287, MD, USA; Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, 80045, USA.

BACKGROUND & AIMS: HIV-infected adults have increased risk of several individual micronutrient deficiencies. However, the prevalence and risk factors of concurrent and multiple micronutrient deficiencies and whether micronutrient concentrations change after antiretroviral therapy (ART) initiation have not been well described. The objective of this study was to determine the prevalence and risk factors of individual, concurrent and multiple micronutrient deficiencies among ART-naïve HIV-infected adults from nine countries and assess change in micronutrient status 48 weeks post-ART initiation.

METHODS: A random sub-cohort (n = 270) stratified by country was selected from the multinational PEARLS clinical trial (n = 1571 ART-naïve, HIV-infected adults). We measured serum concentrations of vitamins A, D (25-hydroxyvitamin), E, carotenoids and selenium pre-ART and 48 weeks post-ART initiation, and measured vitamins B6, B12, ferritin and soluble transferrin receptor at baseline only. Prevalence of single micronutrient deficiencies, concurrent (2 coexisting) or conditional (a deficiency in one micronutrient given a deficiency in another) and multiple (≥3) were determined using defined serum concentration cutoffs. We assessed mean changes in micronutrient concentrations from pre-ART to week 48 post-ART initiation using multivariable random effects models.

RESULTS: Of 270 participants, 13.9%, 29.2%, 24.5% and 32.4% had 0, 1, 2 and multiple deficiencies, respectively. Pre-ART prevalence was the highest for single deficiencies of selenium (53.2%), vitamin D (42.4%), and B6 (37.3%) with 12.1% having concurrent deficiencies of all three micronutrients. Deficiency prevalence varied widely by country. 48 weeks post-ART initiation, mean vitamin A concentration increased (p < 0.001) corresponding to a 9% decrease in deficiency. Mean concentrations also increased for other micronutrients assessed 48 weeks post-ART (p < 0.001) but with minimal change in deficiency status.

CONCLUSIONS: Single and multiple micronutrient deficiencies are common among HIV-infected adults pre-ART initiation but vary between countries. Importantly, despite increases in micronutrient concentrations, prevalence of individual deficiencies remains largely unchanged after 48 weeks on ART. Our results suggest that ART alone is not sufficient to improve micronutrient deficiency.

KEYWORDS: Antiretroviral therapy; Cohort studies; HIV; Micronutrient deficiency; Multiple micronutrients; Vitamins

PMID: 25703452

PMCID: PMC4531105

DOI: 10.1016/j.clnu.2015.02.002