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

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• 作者：Rupak Shivakoti^a ; ^{rshivak1@jhmi.edu" class="auth_mail" title="E-mail the corresponding author} ; Parul Christian^b ; ^{pchrist1@jhu.edu" class="auth_mail" title="E-mail the corresponding author} ; Wei-Teng Yang^a ; ^{weiteng.yang@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Nikhil Gupte^a ; ^{nikhil_jhumit@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Noluthando Mwelase^c ; ^{tmwelase@witshealth.co.za" class="auth_mail" title="E-mail the corresponding author} ; Cecilia Kanyama^d ; ^{ckanyama@unclilongwe.org" class="auth_mail" title="E-mail the corresponding author} ; Sandy Pillay^e ; ^{Pillay@ukzn.ac.za" class="auth_mail" title="E-mail the corresponding author} ; Wadzanai Samaneka^f ; ^{wsamaneka@uzcrc.co.zw" class="auth_mail" title="E-mail the corresponding author} ; Breno Santos^g ; ^{breno@ghc.com.br" class="auth_mail" title="E-mail the corresponding author} ; Selvamuthu Poongulali^h ; ^{poongulali@yrgcare.org" class="auth_mail" title="E-mail the corresponding author} ; Srikanth Tripathyⁱ ; ^{directorjalma@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Cynthia Riviere^j ; ^{criviere@gheskio.org" class="auth_mail" title="E-mail the corresponding author} ; Sima Berendes^k ; ¹ ; ^{sima.berendes@googlemail.com" class="auth_mail" title="E-mail the corresponding author} ; Javier R. Lama^l ; ^{jrlama@impactaperu.org" class="auth_mail" title="E-mail the corresponding author} ; Sandra W. Cardoso^m ; ^{sandra.wagner@ipec.fiocruz.br" class="auth_mail" title="E-mail the corresponding author} ; Patcharaphan Sugandhavesaⁿ ; ^{patcharaphan@rihes-cmu.org" class="auth_mail" title="E-mail the corresponding author} ; Alice M. Tang^o ; ^{Alice.Tang@tufts.edu" class="auth_mail" title="E-mail the corresponding author} ; Richard D. Semba^p ; ^{rdsemba@jhmi.edu" class="auth_mail" title="E-mail the corresponding author} ; Thomas B. Campbell^q ; ^{Thomas.Campbell@ucdenver.edu" class="auth_mail" title="E-mail the corresponding author} ; Amita Gupta^a ; ^{agupta25@jhmi.edu" class="auth_mail" title="E-mail the corresponding author} ; for the NWCS 319 ; PEARLS Study Team
• 关键词：HIV ; Multiple micronutrients ; Micronutrient deficiency ; Antiretroviral therapy ; Cohort studies ; Vitamins
• 刊名：Clinical Nutrition
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：35
• 期：1
• 页码：183-189
• 全文大小：450 K

文摘

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.