Lower Plasma Zinc Levels in Hyperglycemic People Living with HIV in the MASH cohort

Effectiveness of a 6-Month Nutrition Intervention in People Living with HIV and Prediabetes Progressing through Stages of Change towards Positive Health Behavior

The prevalence of prediabetes in people living with human immunodeficiency virus (HIV) is two to three times higher than that of the general population. The aim of this study was to assess the effectiveness of an intervention in guiding low-income people living with HIV (PLWH) and prediabetes through the stages of change and promote self-efficacy of positive health behavior.

METHODS

A 6- month randomized, controlled intervention was conducted where participants (N = 38) were randomized into the intervention group (n = 20) or the control group (n = 18). The participants' stages of change, nutrition knowledge, and self-efficacy were assessed using questionnaires. Participants were recruited in August 2017-December 2018, were HIV seropositive, had undetectable viral load, were prediabetic, and not currently receiving glucose-altering medications. Participants randomized into the intervention group received medical nutrition therapy/counseling and nutrition education; participants randomized into the control group received educational material related to nutrition, HIV, and prediabetes at baseline. Primary outcome measures were progression through the stages of change as measured by the transtheoretical ("stages of change") model, improvements in nutrition knowledge, and self-efficacy of the participants.

RESULTS

Significant improvement in stage of behavioral change was observed in the intervention group for physical activity, fruit/vegetable intake, fiber intake as well as nutrition knowledge and self-efficacy; however, no significant changes were observed in the control group.

CONCLUSIONS

A nutrition intervention was effective in promoting positive health behavior by progressing participants through the stages of behavioral change in low-income people living with HIV and prediabetes.

Adjunct Therapy of Zinc Supplementation Increases Immunological Response in HIV-Infected Patients: A Systematic Review and Meta-Analysis

Introduction:

Malnutrition greatly accelerates the impairment of immune function among HIV-infected patients. Zinc deficiency is often found in people living with HIV/AIDS, affecting their immune function. Several studies have evaluated the effect of zinc in HIV-infected patients, including CD4+ T-cells. However, the results have varied. This review aimed to evaluate the effect of zinc supplementation in HIV patients, particularly its effect on CD4+ T-cells count.

Methods:

Relevant publications were obtained from PubMed database, Google Scholar, COCHRANE, and Science Direct. The primary outcome was CD4+ T-cells count, while the secondary outcomes were viral load and zinc levels. Year of publication, type of study, population, doses of zinc given, duration of zinc administration, sample size, age, and baseline CD4+ T-cells counts were also obtained and reported. Quantitative data from the publications were analyzed using a fixed-effect model or a random-effect model.

Results:

We evaluated 13 full-text articles on zinc supplementation in HIV-infected patients, involving 802 subjects for the experiment group and 742 subjects for the control group. Overall, zinc supplementation, whether as zinc supplementation-only or prepared as multiple micronutrient or multivitamin preparation, increases CD4+ T-cells counts by 33.14 cells/mm3 (p =0.02; 95% CI: 6.09 to 60.19), irrespective of age. Subgroup analysis revealed CD4+ T-cells counts also increase in patients who receive zinc supplementation-only preparation by 33.56 cells/mm3 (p = 0.04; 95% CI: 1.5 to 65.63). Zinc supplementation increases serum zinc levels with pooled mean difference of 15.41 µg/dl (p < 0.05; 95% CI: 12.77 to 18.06). However, the viral load did not significantly decrease with zinc supplementation, with a pooled mean difference of -4.02 copies/ml (p =0.7; 95% CI: -24.78 to 16.75), based on the random-effect model.

Conclusion:

Zinc supplementation in HIV-infected patients enhances immunological response, characterized by an increase in CD4+ T-cells counts. In addition, it increases zinc serum levels in HIV-infected patients, indicating the importance of zinc supplementation in this group of patients.

Serum vitamin E deficiency among people living with HIV and undergoing antiretroviral therapy at Ho Teaching Hospital, Ghana

Vitamin E is a potent antioxidant that helps to counteract oxidative stress in the body. Oxidative stress is known to greatly affect people living with HIV (PLWH) through the stimulation of HIV replication and apoptosis of CD4+ T cells. There is however, a paucity of scientific data on the serum levels of vitamin E among PLWH in Ghana, and hence, there is a need to assess its level because of the pivotal role it plays in cell longevity determination and the immune system enhancement of such persons. This study aims to assess the serum levels of vitamin E among PLWH undergoing highly active antiretroviral therapy at Ho Teaching Hospital, Ghana. In a cross-sectional study, serum vitamin E levels of 103 randomly selected PLWH aged 24-88 years who attended an antiretroviral therapy clinic at the Ho Teaching Hospital, Ghana, were measured by following standard protocols. A 24-hour dietary recall and food frequency questionnaire were employed to assess dietary intake. The results show that a high level of serum vitamin E deficiency (82.5%) was observed among the participants. Majority (91.3%) of the participants had normal serum zinc status. Participants' serum vitamin E levels did not show significant correlation with their dietary intakes (correlation coefficient (ρ) = -0.094, p-value = 0.35). The prevalence of vitamin E deficiency among underweight, normal weight, overweight, and obese participants was 91.7%, 75.4%, 86.5%, and 91.7% respectively with no significant difference among these groups. There was no significant correlation between serum vitamin E levels and HIV infection duration (ρ = 0.010, p-value = 0.405) and HAART duration (ρ = 0.001, p-value = 0.313). The low serum vitamin E levels found in this study suggests that the participants could potentially be at an increased risk of developing oxidative stress and its effects.

Zinc and selenium indicators and their relation to immunologic and metabolic parameters in male patients with human immunodeficiency virus

OBJECTIVES

Micronutrient deficiencies are common among people living with HIV (PLWHIV). The clinical and immunologic consequences of micronutrient deficiencies have been poorly explored in the context of human immunodeficiency virus (HIV) infection. The aim of this study was to determine the prevalence of zinc and selenium deficiency (dietary intake and serum concentrations) and analyze their associations with absolute CD4+ T-cell counts, inflammation markers, and metabolic disorders in a cohort of antiretroviral-experienced HIV-infected individuals.

METHODS

The zinc and selenium intakes of 124 HIV-infected men were estimated using 3-d food records. In a subcohort of 45 individuals, serum zinc and selenium concentrations and proinflammatory cytokines were determined. Body composition, bone mineral density (BMD), CD4+ T-cell counts, lipid profile, glucose, and blood pressure were determined and were associated with zinc and selenium dietary intake and serum concentrations.

RESULTS

Of the PLWHIV studied, 58% had suboptimal intake of zinc and 8% demonstrated suboptimal intake of selenium. Serum deficiencies for zinc and selenium were 23.9% and 65.9%, respectively. Zinc and selenium intake were correlated with increased muscle mass. Selenium intake was associated with increased BMD of the lumbar region. An inverse correlation between serum selenium concentration and several proinflammatory cytokines (interleukin-1β, interleukin-6, and tumor necrosis factor-α) was found.

CONCLUSION

Suboptimal zinc and selenium intake and serum concentration deficiencies are highly prevalent in treated HIV-positive individuals and are associated with body composition, BMD, and inflammation. Clinical trials should be designed to explore the effect of zinc and selenium supplementation on metabolic, inflammatory, and immunologic parameters on the HIV-positive population.