Pre-antiretroviral therapy selenium status predicts WHO stages 3, 4 or death but not virologic failure post-antiretroviral therapy

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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.

Shivakoti R, Gupte N, Yang W-T, Mwelase N, Kanyama C, Tang A, Pillay S, Samaneka W, Riviere C, Berendes S, Lama JR, Cardoso SW, Sugandhavesa P, Semba RD, Gupta A. Pre-antiretroviral therapy selenium status predicts WHO stages 3, 4 or death but not virologic failure post-antiretroviral therapy. Nutrients 2014 Nov 13;6(11):5061-78. PMID: 25401501
  • University of Witwatersrand, Johannesburg 2050, South Africa
  • University of North Carolina Lilongwe, Lilongwe, Malawi
  • Tufts University School of Medicine, Boston, MA 
  • Durban International Clinical Research Site, Durban University of Technology, Durban, South Africa 
  • University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe 
  • Les Centres GHESKIO, Port-Au-Prince, Haiti 
  • Liverpool School of Tropical Medicine, Liverpool, UK 
  • Asociacion Civil Impacta Salud y Educacion, Lima, Peru