EFFECT OF MICRONUTRIENT SUPPLEMENTATION ON SOME INDICES OF HIV INFECTION PROGRESSION AMONG ANTIRETROVIRAL NAÏVE PATIENTS ATTENDING HIV CLINICS IN NIGERIA
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Abstract
Nigeria has the second highest HIV/AIDS burden in the world with an estimated 3,391,546 people living with HIV and AIDS; an estimated 239,155 people acquired new infections in 2013; and about 174,253 people died from AIDS related illness (s) in 2014. HIV infection causes a chronic disease that progresses from stage one (seroconversion or asymptomatic) to stage four (advanced disease/AIDS) over a median period of 5 years. The course of the HIV infection is characterized by a persistent prooxidant state that leads to programmed CD4+ cell apoptosis, elaboration of proinflammatory cytokines and acute phase proteins, HIV RNA replications, hypercatabolism, increased utilization of antioxidants and micronutrients, and subsequent micronutrient deficiencies. The aim of this study was to evaluate the effect of micronutrient supplementationon some indices of HIV infection progression among ART-naïve patients. To achieve the aim of the study, 90 ART naïve HIV infected adult patients with CD4+ cell count ≥520/µL were enrolled. After obtaining informed written consent, their sociodemographic data, CD4+ cell counts (cc), body mass index (BMI), vital signs, symptoms and signs of HIV infection, were obtained, and blood samples for plasma HIV RNA load (pVL), haemoglobin, and serum C-reactive protein (CRP), interleukin-6 (IL-6), albumin, lipids and micronutrients (vitamin B12, zinc, and copper) were collected. After these, each patient was given a daily dose of one capsule of SynovitTM supplements and two tablets of co-trimoxazole. Eligible patients were reevaluated every 12 weeks, and data onvital signs, BMI, symptoms and signs of HIV infection, CD4+ cc, and haemoglobin were obtained; while bloodsamples for pVL, CRP, IL-6, albumin, lipids and micronutrients werecollected at 24 weeks and 48 weeks viii of SynovitTM supplementation respectively.Patients who defaulted from one scheduled clinic visit, became pregnant, or became eligible for ART before the 48 weeks of SynovitTM supplementation were dropped. The socio-demographic characteristics, vital signs, BMI, haemoglobin, and serum albumin, zinc, copper and vitamin B12 of the patients were compared with those of 90 age and sex-matched HIV negative apparently healthy volunteers from the same environments.Patients comprised 21 males and 69 females, aged 42.9±9.8 years and 34.6±8.6 years respectively (p≤0.05). They were mainly low income earners and were enrolled within a median of 4 months of HIV infection diagnosis. Ninety (90) patients were initially evaluated, 78 and 68 were reevaluated at 12 and 24 weeks respectively, while 57 patients were re-evaluated at 36 and 48 weeks respectively. The sociodemographic factors that determined retention of patients on micronutrient supplementation were found to be the age, occupation and source of income of the patients. The patients‘ baseline median CD4+ cc (704.5/µL) was within reference range(365-1571/µL) for healthy Nigerians. Their vital signs (temperature=38.2±0.7oC; pulse rate=78.0±10.1 beats/minute; respiratory rate=12.0±3.0 breaths/minutes; systolic blood pressure=128.0±13.7 mmHg) were higher than those of healthy controls (temperature=36.8±0.2oC; pulse rate=72.0±21.1 beats/minute; respiratory rate=16.0±1.0 breaths/minutes; systolic blood pressure=138.0±37.4 mmHg) (p≤0.05). Although theywere overweight (median BMI of 25.8kg/m2 ), their baseline median haemoglobin (11.0 g/dL), serum albumin (36.0g/L), zinc (0.01ppm), copper (- 0.4ppm), vitamin B12 (15.0ng/L) and total cholesterol (4.6mmol/L)were significantly lower than those of healthy volunteers (p≤0.05). Their serum CRP (27.8 ng/ml), and IL6 (1.9 pg/ml) were also significantly higher than reference values ix (p≤0.05).Micronutrient supplementation significantly decreased incidence of opportunistic illnesses (OIs), pVL, CRP and IL-6; and increased haemoglobin, serum zinc, copper, vitamin B12, total cholesterol and high density lipoproteins (p≤0.05); but did not increase CD4+ cc. The pVL maintained significant negative correlations with CD4+ cc, zinc and copper (p≤0.05), and positive correlations with IL-6 and CRP (p≤0.05). Significant predictors of HIV RNA load at baseline were zinc(p=0.00) and IL6 (p =0.05); while serum IL-6 (p=0.00) and haemoglobin (p=0.02) were the predictors at 24 weeks and 48 weeks of micronutrient supplementation respectively. In conclusion,micronutrient supplementation enhanced retention of patients on the preART care and support service programme and reduced the indices of progression of HIV infection with the exception of CD4+ cell counts.
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