Pre-antiretroviral therapy serum selenium concentrations predict WHO stages 3, 4 or death but not vi 3, 4 or death but not virologic failure post-antiretroviral therapy
Shivakoti R, Gupte N, Yang WT, Mwelase N, Kanyama C, Tang AM, Pillay S, Samaneka W, Riviere C, Berendes S, Lama JR, Cardoso SW, Sugandhavesa P, Semba RD, Christian P, Campbell TB, Gupta A; NWCS 319 and PEARLS study team.
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.
Nutrients. 2014 Nov 13;6(11):5061-78. doi: 10.3390/nu6115061. PubMed PMID: 25401501; PubMed Central PMCID: PMC4245580.