Rupak Shivakoti1, Parul Christian2, Wei-Teng Yang3, Nikhil Gupte4, Noluthando Mwelase5, Cecilia Kanyama6, Sandy Pillay7, Wadzanai Samaneka8, Breno Santos9, Selvamuthu Poongulali10, Srikanth Tripathy11, Cynthia Riviere12, Sima Berendes13, Javier R Lama14, Sandra W Cardoso15, Patcharaphan Sugandhavesa16, Alice M Tang17, Richard D Semba18, Thomas B Campbell19, Amita Gupta20. 1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. Electronic address: rshivak1@jhmi.edu. 2. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. Electronic address: pchrist1@jhu.edu. 3. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. Electronic address: weiteng.yang@gmail.com. 4. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. Electronic address: nikhil_jhumit@yahoo.com. 5. Department of Medicine, University of Witwatersrand, Johannesburg, 2050, South Africa. Electronic address: tmwelase@witshealth.co.za. 6. UNC Lilongwe, Lilongwe, Private Bag A-104, Malawi. Electronic address: ckanyama@unclilongwe.org. 7. Durban International Clinical Research Site, Durban University of Technology, Durban, 4001, South Africa. Electronic address: Pillay@ukzn.ac.za. 8. University of Zimbabwe Clinical Research Centre, Harare, 999, Zimbabwe. Electronic address: wsamaneka@uzcrc.co.zw. 9. Hospital Nossa Senhora de Conceição, Porto Alegre, 91350-200, Brazil. Electronic address: breno@ghc.com.br. 10. YR Gaitonde Center for AIDS Research and Education, Chennai, 600113, India. Electronic address: poongulali@yrgcare.org. 11. National AIDS Research Institute, Pune, 411026, India. Electronic address: directorjalma@gmail.com. 12. Les Centres GHESKIO, Port-Au-Prince, HT-6110, Haiti. Electronic address: criviere@gheskio.org. 13. Malawi College of Medicine-Johns Hopkins University Research Project, Blantyre, Malawi. Electronic address: sima.berendes@googlemail.com. 14. Asociacion Civil Impacta Salud y Educacion, Lima, 4, Peru. Electronic address: jrlama@impactaperu.org. 15. STD/AIDS Clinical Research Laboratory, Instituto de Pesquisa Clinica Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, 21045-900, Brazil. Electronic address: sandra.wagner@ipec.fiocruz.br. 16. Research Institute for Health Sciences, Chiang Mai, 50200, Thailand. Electronic address: patcharaphan@rihes-cmu.org. 17. Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, 02111, MA, USA. Electronic address: Alice.Tang@tufts.edu. 18. Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, 21287, MD, USA. Electronic address: rdsemba@jhmi.edu. 19. Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, 80045, USA. Electronic address: Thomas.Campbell@ucdenver.edu. 20. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. Electronic address: agupta25@jhmi.edu.
Abstract
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.
RCT Entities:
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.
Authors: Rupak Shivakoti; Erin R Ewald; Nikhil Gupte; Wei-Teng Yang; Cecilia Kanyama; Sandra W Cardoso; Breno Santos; Khuanchai Supparatpinyo; Sharlaa Badal-Faesen; Javier R Lama; Umesh Lalloo; Fatima Zulu; Jyoti S Pawar; Cynthia Riviere; Nagalingeswaran Kumarasamy; James Hakim; Richard Pollard; Barbara Detrick; Ashwin Balagopal; David M Asmuth; Richard D Semba; Thomas B Campbell; Jonathan Golub; Amita Gupta Journal: Clin Nutr Date: 2018-05-29 Impact factor: 7.324
Authors: Mary Norval; Anna K Coussens; Robert J Wilkinson; Liza Bornman; Robyn M Lucas; Caradee Y Wright Journal: Int J Environ Res Public Health Date: 2016-10-18 Impact factor: 3.390
Authors: Lance S Weinhardt; Loren W Galvao; Alice F Yan; Patricia Stevens; Thokozani Ng'ombe Mwenyekonde; Emmanuel Ngui; Lindsay Emer; Katarina M Grande; Lucy Mkandawire-Valhmu; Susan C Watkins Journal: AIDS Behav Date: 2017-03
Authors: Rupak Shivakoti; Nikhil Gupte; Srikanth Tripathy; Selvamuthu Poongulali; Cecilia Kanyama; Sima Berendes; Sandra W Cardoso; Breno R Santos; Alberto La Rosa; Noluthando Mwelase; Sandy Pillay; Wadzanai Samaneka; Cynthia Riviere; Patcharaphan Sugandhavesa; Robert C Bollinger; Ashwin Balagopal; Richard D Semba; Parul Christian; Thomas B Campbell; Amita Gupta Journal: BMC Med Date: 2018-09-24 Impact factor: 8.775