Micronutrient levels and HIV disease status in HIV-infected patients on highly active antiretroviral therapy in the Nutrition for Healthy Living Cohort

Background: Low serum micronutrient levels were common before widespread use of highly active antiretroviral therapy (HAART) and were associated with adverse outcomes. Few data are available on micronutrient levels in subjects taking HAART. Objective: To determine the prevalence of low serum retinol, alpha-tocopherol, zinc, and selenium in HIV-infected subjects taking HAART and to assess the association of micronutrient levels with HIV disease status. Design: Cross-sectional. Setting: Nutrition for Healthy Living (NFHL) study. Participants: HIV-infected subjects on HAART. Methods: Retinol, alpha-tocopherol, zinc, and selenium were determined in frozen serum samples from 171 men and 117 women. Low serum levels were defined as retinol < 30 mu g/dL, selenium < 85 mu g/L, alpha-tocopherol < 500 mu g/dL, and zinc < 670 mu g/L. Association of micronutrient quartiles with CD4 cell count, CD4 count < 200 cells/mm(3), HIV viral load (VL), and undetectable VL was assessed using adjusted multivariate regression. Results: Five percent of men and 14% of women had low retinol, 8% of men and 3% of women had low selenium, and 7% of men and no women had low a-tocopherol. Forty percent of men and 36% of women had low zinc, however. Subjects in the upper quartiles of zinc had lower log VL levels than those in the lowest quartile (significant for women). Subjects in the upper quartiles of selenium also tended to have lower VL levels compared with those in the lowest quartile Surprisingly, women in the upper quartiles of retinol had higher log VLs than those in the lowest quartile. There was no significant association of any micronutrient with CD4 cell count or likelihood of CD4 count < 200 cells/mm(3). The level of CD4 cell count influenced the association of retinol with log VL in men, however. In men with CD4 counts > 350 cells/mm(3), those with higher retinol had higher log VLs compared with the lowest quartile, whereas m men with CD4 counts < 350, those with higher retinol levels had lower log VLs compared with the lowest quartile. Conclusions: Low retinol, alpha-tocopherol, and selenium are uncommon in HIV-infected subjects on HAART. Zinc deficiency remains common, however. Decreased retinol levels in women and in men with CD4 counts > 350 cells/mm(3) and increased zinc and selenium levels in both genders may be associated with improved virologic control.