Relationship between plasma selenium concentrations and lower genital tract levels of HIV-1 RNA and interleukin type 1beta.
ABSTRACT To examine the relationship between selenium nutritional status and intermediates of human immunodeficiency virus (HIV)-1 transmission.
Prospective cohort study.
A study clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania.
A total of 340 HIV-1-infected pregnant women with gestational ages 12-27 weeks.
Women's plasma selenium concentrations were determined at enrollment and modeled as tertiles (tertile 1: <114 microg/l (reference); tertile 2: 114-131 microg/l; tertile 3: >131 microg/l). Cervicovaginal lavage specimens were obtained at 36 weeks of gestation to determine HIV-1 RNA and interleukin-1beta (IL-1beta) levels. In subgroup analyses, 123 women with genital tract infections at enrollment were excluded.
Plasma selenium concentrations >or=114 microg/l were related to increased risk of lower-genital shedding of HIV-1 RNA. Excluding women with genital tract infections strengthened the associations (relative risk (RR) tertile 2: 1.46, 95% confidence interval (CI)=1.10, 1.92; RR tertile 3: 1.39, 95% CI=1.05, 1.84). There was evidence for an association between plasma selenium concentrations >or=114 microg/l and increased HIV-1 RNA levels among the entire cohort and after excluding women with genital tract infections. There was no association between plasma selenium and IL-1beta concentrations.
High selenium status may lead to increased risk of genital HIV-1 shedding, but data from other studies indicate that the evidence is mixed. Results from ongoing selenium trials are awaited to clarify the impact of selenium on HIV-1-related transmission endpoints. Sponsorship: National Institute of Child Health and Human Development (NICHD R01 32257) and the Fogarty International Center (NIH D43 TW00004).
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ABSTRACT: Selenium is found in soils and is essential for human antioxidant defense and immune function. In Malawi, low soil selenium and dietary intakes coupled with low plasma selenium concentrations in HIV infection could have negative consequences for the health of HIV-infected mothers and their exclusively breastfed infants. We tested the effects of lipid-based nutrient supplements (LNS) that contained 1.3 times the Recommended Dietary Allowance of sodium selenite and antiretroviral drugs (ARV) on maternal plasma and breast-milk selenium concentrations. HIV-infected Malawian mothers in the Breastfeeding, Antiretrovirals, and Nutrition study were randomly assigned at delivery to receive: LNS, ARV, LNS and ARV, or a control. In a subsample of 526 mothers and their uninfected infants, we measured plasma and breast-milk selenium concentrations at 2 or 6 (depending on the availability of infant samples) and 24 wk postpartum. Overall, mean (±SD) maternal (range: 81.2 ± 20.4 to 86.2 ± 19.9 μg/L) and infant (55.6 ± 16.3 to 61.0 ± 15.4 μg/L) plasma selenium concentrations increased, whereas breast-milk selenium concentrations declined (14.3 ± 11.5 to 9.8 ± 7.3 μg/L) from 2 or 6 to 24 wk postpartum (all P < 0.001). Compared with the highest baseline selenium tertile, low and middle tertiles were positively associated with a change in maternal plasma or breast-milk selenium from 2 or 6 to 24 wk postpartum (both P < 0.001). With the use of linear regression, we showed that LNS that contained selenium and ARV were not associated with changes in maternal plasma and breast-milk selenium, but maternal selenium concentrations were positively associated with infant plasma selenium at 2 or 6 and 24 wk postpartum (P < 0.001) regardless of the study arm. Selenite supplementation of HIV-infected Malawian women was not associated with a change in their plasma or breast-milk selenium concentrations. Future research should examine effects of more readily incorporated forms of selenium (ie, selenomethionine) in HIV-infected breastfeeding women. This trial was registered at clinicaltrials.gov as NCT00164736.American Journal of Clinical Nutrition 02/2014; 99(4). DOI:10.3945/ajcn.113.073833 · 6.92 Impact Factor
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ABSTRACT: Objective Selenium supplementation for HIV-infected women may increase genital shedding of HIV-1, but no studies have examined the effect on viral shedding in breast milk. Research Methods and Procedures: HIV-infected pregnant women enrolled at 12-27 weeks gestation in a randomized, double-blind, placebo-controlled trial of daily selenium (200 μg as selenomethionine) had cell-free HIV-1 RNA quantified in breast milk at 4-9 weeks postpartum. All participants received high dose multivitamins containing vitamin B-complex, C, and E as standard of care. Results The proportion of women with detectable (>50 copies/mL) HIV-1 RNA in breast milk appeared to be increased in the selenium group (36.4%) as compared to the placebo (27.5%) among the total cohort (n=420), but results were borderline statistically significant (RR: 1.32; 95% CI: 1.00-1.76; p=0.05). In secondary analyses, the proportion of women with detectable HIV-1 RNA in breast milk was significantly greater in the selenium group (37.8%) as compared to placebo (27.5%) among women who did not receive HAART (RR: 1.37; 95% CI: 1.03-1.82; p=0.03). This relationship was primarily due to a significant effect of selenium among primiparous women (RR: 2.24; 95% CI: 1.30-3.86; p<0.01), but not multiparous women (RR: 1.14; 95% CI: 0.81-1.59; p=0.54) (p-value for interaction=0.02). Too few women received HAART in this study (n=12) to establish the effect of selenium supplementation. Conclusions Selenium supplementation appears to increase HIV-1 RNA detection in breast milk among primiparous women not receiving HAART. Safety studies among pregnant women on HAART need to be conducted before providing selenium containing supplements.Nutrition 09/2014; DOI:10.1016/j.nut.2014.01.011 · 3.05 Impact Factor
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ABSTRACT: Selenium has an important role in antioxidant defense and cell mediated immunity. Plasma selenium is a useful biomarker for comparing selenium status across populations, and influenced by selenium levels of soils and plants. This cross-sectional study compared plasma selenium (by electrothermal atomic absorption spectrophotometry) of women at 24 weeks gestation in Malawi (n=152) and the Philippines (n=301), countries with low and high soil selenium levels, respectively. Data on anthropometry, smoking, intakes of energy, nutrients and food groups (via 24-h recalls), hemoglobin, serum zinc, and C-reactive protein (CRP) were also collected. Mean (95% CI) plasma selenium was lower for Malawian than Filipino women (0.79, 0.77, 0.82 μmol/L vs. 1.44, 1.41, 1.47 μmol/L; p<0.001); 83% had concentrations below 1.0 μmol/L compared to 3% in the Filipinos. Cereals provided 78% and 67% of the energy in Malawi and the Philippines, respectively compared to 4% and 8.5%, respectively for cellular animal protein. Plasma selenium was correlated modestly with BMI (r=-0.138; p=0.096) and elevated CRP (>5.0 mg/L) (r=-0.143; p=0.084) in Malawi, and significantly with intake of cellular animal protein (g/d) (r=0.23; p=0.020) and serum zinc (r=0.13; p=0.044) in the Philippines. No comparable relationships were observed in either group for smoking, hemoglobin, or cereal intakes. Differences in plasma selenium paralleled reported trends in selenium concentrations in soils and staple cereals in Malawi and the Philippines. The biological significance of the lower plasma selenium for the Malawian women, and the extent to which they pose a risk for fetal and neonatal development, is uncertain.Journal of Trace Elements in Medicine and Biology 11/2011; 25(4):230-5. DOI:10.1016/j.jtemb.2011.10.001 · 2.49 Impact Factor