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Presenters: Lauren Newman Kristen Oldham Lauren Flowers Punam Patel

Intro to HIV/AIDS
HIV (human Immunodeficiency virus)
Infection occurs by the transfer of blood, semen, vaginal fluid, or breast

milk. HIV present as both free virus particles and virus within infected immune cells. Virus that affects T-cells: leads to a low level of CD4+ T cell counts and in increase in viral load. CD4+ below a critical level, cell mediated immunity is lost and body becomes progressively more susceptible to infections. Causing a damage to the immune system Progression into AIDS

The studies we focused on were infected pregnant mothers

transferring the virus off to their child, since that is the second highest form of transmission after blood transfusion.

Prevalence of HIV
.6O % adult prevalence rate in United States
An estimated 1.1 million Americans have HIV, and

about 20 percent of them don't know it. The number of infected people getting treatment rose from 837 in 1996 to 5,413 in 2009.

Micronutrients
Micronutrients can be utilized as an inhibitor for the progression, morbidity, and anemia of HIV disease.
Reason for choosing vitamin A and selenium
Both help with immune function

Currently no treatment, but anti-retroviral: longer life expectancy

HAART: highly active antiretroviral therapy


Improve immune status by Selenium and Zinc
- Along with Selenium, Vitamin A helps with antioxidant

- Both studies used Tanzanian pregnant women.

T lymphocytes

Performed Vitamin A- background


Vitamin A is a group of compounds that play an

important role in vision, bone growth, reproduction, cell division and cell differentiation Vitamin A helps regulate the immune system, which helps prevent or fight off infections by making WBCs that destroy harmful bacteria and viruses. Studies: Performed Vitamin A= from animals
Absorbed as retinol (active form)
Sources: liver, milk, fortified foods.

Objective Vitamin A
Vitamin A along with micronutrients helps slow the

progression of HIV along with increasing CD4 cell counts?

Material and Methods- Vit A


Daily dose of supplementations Monthly visits and every 6 months: blood work to check T cell counts Viral Loads HIV related complications.
1,078 pregnant women infected with HIV tested Randomized study, 8 years, blood count once every 6 months, 1. vitamin A (30mg of Beta- Carotene + 5,000 IU of performed vitamin A) 2. Multivitamins (without vitamin A)- 20mg of B1 and B2, 25 mg of B6, 100mg of naicin, 50 mg of B12, 500mg of vitamin C, 30mg of Vitamin E, and .8 mg of Folic acid) 3. Multivitamin with vitamin A- dose combination of 1 and 2 4. placebo

Results: Vitamin A
Of the total analyzed, 299 women progressed to stage

4 or died or AIDS related causes.


67/271 died (multivitamin)- 25% 70/268 died (multivitamin + Vitamin A)- 26% 79/272 died (vitamin A)- 29% 83/267 died (placebo)- 31%

Table 1: baseline characteristics of the women.

Discussion- Vitamin A
Multivitamin alone had a greater impact in slowing the

progression of HIV/AIDS
Due to increasing the CD4 counts and lowering the viral load. Also lowered HIV-related complications.

Vitamin A had a weaker response than Multivitamin

supplements in delaying the progression of disease


Caused on significant effect on clinical outcomes, T-cell

counts or viral load. Vitamin A supplements resulted in a significant increase in mother-to-child transmission of HIV. Compared to no Vitamin A dose, Vitamin A supplementation increased the risk of progression to stage 4 or death.

Background of Selenium
Functions: Plays catalytic role in antioxidant enzymes,

glutathione peroxidase and iodothyronine 5-deiodinases


Participates in synthesis of leukotriene C4,

Selenium deficiency is common among HIV infected patients Glutathione peroxidase and Iodothyronine 5- deiodinases are diminshed due to infected T cells.

Viral cells use selenoproteins to replicate causing a decrease in selenium concentrations.

Low plasma selenium concentrations are related to increased risk of

mortality and mycobacterial disease among HIV infected people Low hemoglobin concentrations are associated with selenium among both HIV infected and un-infected populations.

Sources of Selenium
All dependent on soil content Mostly plants, nuts, legumes Meats Seafood Supplement used Selenomethionine

Objective- Selenium
Test effect of selenium supplements on hemoglobin

concentrations and morbidity amoung HIV-1 infected Tanzanian women.


Because the relationship between selenium, hemoglobin

concentrations, and infectious morbidity has not been study adequately in sub-Saharan Africa. To discover a low-cost immuno-modulating supplements.

Materials and Methods- Selenium


Daily dose of 200mg of selenomethionine Until 6 months postpartum 915 infected pregnant women Hemoglobin concentrations were measured at the

beginning, 6 weeks and 6 months postpartum


Normal hemoglobin for pregnant women is between 11-

12 g/dL Monthly visits Morbidity data

Diarrhea, cough, difficulty breathing, fatigue, fever, nausea or vomiting, ulcers in the mouth or throat, and oral thrush.

Results- Selenium
467 had baseline measurement of hemoglobin at the

first follow up visit


Mean hemoglobin at baseline:

9.79 +/- 1.28 g/dL in selenium group 9.63 +/- 1.44 g/dL in placebo group.

15 progressed to >8.5 g/dL. Overall, selenium did not affect progression of HIV

Selenium supplements reduced diarrheal related

morbidity by 40%

Effect of selenium supplements on hemoglobin concentrations in HIV1-infected pregnant women.

Kupka R et al. Clin Infect Dis. 2009;48:1475-1478

Effect of selenium supplements on hemoglobin concentrations in HIV1-infected pregnant women.

Kupka R et al. Clin Infect Dis. 2009;48:1475-1478

Discussion- Selenium
No effect on hemoglobin concentrations.
Decreased diarrheal morbidity and no effect on other

morbidities . Selenium as part of glutathione peroxidase, protects against hemolysis of erythrocytes and thus may be relevant to hemoglobin levels. However, the results of the study did not support this claim. One limitation to the study was that researchers relied only on patients recollection on morbidities which may lead to misclassification on morbidity data.

Summary
Vitamin A Even though Vitamin A is low in infected patients supplementation has no affect on progression of the disease or inhibition. Selenium Selenium deficiency is common however, has no affect on hemoglobin concentrations Decreases the risk of diarrheal morbidity
Results do not support supplementation of either

micronutrients.

Future Research
Test the beneficial effects of selenium on different

stages of the disease, because it is believed supplementation can increase the replication of the virus in early stages. More thorough assessment of morbidity data. Conduct future research on why selenium reduced diarrheal morbidities. Vitamin A: what about vitamin A increased transmission from mother to child.
Does the virus use vitamin A as a source of replication.

References
http://www.avert.org/aids/htm
http://www.nejm.org.doi/full/10.1056/NEJmoa040541 http://www.ncbi.nlm.nih.gov/pmc/articles/PMc277761

7/?tool=pubmed http://ods.od.nih.gov/factsheets/vitamina/

Questions ?

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