Plasma Homocysteine Is Not Associated With HIV Serostatus or Antiretroviral Therapy in Women

Abstract

Background The effects of HIV serostatus and combination antiretroviral therapy (cART) on plasma homocysteine (Hcy) are uncertain. Methods Plasma Hcy was assayed in a cross-sectional study of 249 HIV-infected and 127 HIV-uninfected women at the Bronx Women’s Interagency HIV Study site. Results Mean plasma Hcy was 7.42 ± 2.68 in HIV-infected and 7.18 ± 2.66 µmol/L in HIV-uninfected women (P = 0.40). Hyperhomocysteinemia (defined as Hcy > 10 µmol/L) was seen in 16.9% and 13.4 % of HIV-infected and HIV-uninfected women, respectively (P=0.45). Among HIV-infected women, cART use was not associated with Hcy level. Compared to the lowest quartile, women with Hcy in the highest quartile had lower mean serum vitamin B12 and RBC folate levels. In multivariate analysis that did not include micronutrient levels, age, serum creatinine and lower CD4% were significantly associated with plasma Hcy level in HIV-infected women. Conclusions Plasma Hcy was not associated with HIV serostatus or use of cART in this cross-sectional study. Reduced availability of folate cofactors for Hcy remethylation in HIV-infected women with lower folate intake and decreased health status may influence Hcy levels.

HIV-Positive Patients Respond to Dietary Supplementation with Cysteine or Glutamine

“…Surprisingly, no significant association was found between Hcy levels and the use of ART by Guaraldi et al [64]. Additionally, plasma Hcy was not associated with HIV serostatus or use of ART in a cross-sectional study that found 16.9% of HHcy (>10 µmol/L) in HIV-infected individuals (n = 249) and 13.4% of HHcy in noninfected (n = 127) individuals [71]. In the study, the prevalence was 50% and 65%, respectively [54].…”

“…However, no significant correlations were observed between HHcy and length of exposure to HAART. In two articles [71,72], the reduced availability of folate was raised as a confounding factor in the association between HHcy and ART. In fact, before the advent of HAART, 20% and 10% of HIV-infected patients had low vitamin B12 and red blood cell folate concentrations, respectively; now, the prevalence of low vitamin B12 is significantly lower in patients receiving HAART (8.7% versus 27%); 22.5% with low vitamin B12 and 51.4% with low folate had HHcy (>17.5 µmol/L).…”

Elevated homocysteine levels in human immunodeficiency virus-infected patients under antiretroviral therapy: A meta-analysis

“…A meta-analysis performed on outcome 1 indicated that the plasma Hcy levels in HIV-infected patients were 2.05 µmol/L higher than the plasma Hcy levels in uninfected controls (95%CI: 0.13-4.01, P < 0.01; [30] Norway 15/21 CS 9.2 ± 7.3 9.0 ± 5.0 ---Naisbitt et al [31] England 33/33 CS 11.9 ± 4.7 14.5 ± 5.6 ---Bernasconi et al [32] Swaziland 80/73 COS 7.6 ± 3.6 8. 2 Remacha et al [23] Spain 128/235 CS 7.5 ± 7.8 14.3 ± 12.9 6.2% control; -B12 368.6 ± 219 Raiszadeh et al [35] United Castagna et al [29] Müller et al [30] Naisbitt et al [31] Vilaseca et al [33] Bernasconi et al [32] Remacha et al [23] de Larrañaga et al [34] Raiszadeh et al [35] Vigano et al [36] Borges-Santos et al [38] Abdollahi et al [37] Deminice et al [39] Total (95%CI) …”

“…Mercié et al [40] Larrañaga et al [34] Remacha et al [23] Martí-Carvajal et al [41] Currier et al [4] Raiszadeh et al [35] Coria-Ramirez et al [43] Total (95%CI) associated adverse metabolic effects [47,49] . However, a lack of data in the revised papers prevents us from determining the contributions of different drug classes and durations of ART on Hcy levels (Table 2).…”

“…The present study demonstrates that HHcy can be included on this list. Different classes of antiretroviral drugs and time exposed to the treatment may generate different ART- Mercié et al [42] France 78/304 COS 12.5 ± 4.8 11.5 ± 4.3 --de Larrañaga et al [34] Argentina 31/128 CS 9.7 ± 7.1 8.0 ± 6.1 --Remacha et al [23] Spain 128/235 CS 17.3 ± 13 8.2 ± 7.8 -Patients under ART (taking > 3 antiretroviral drugs) Martí-Carvajal et al [41] Venezuela 14/40 CS 10 ± 7.5 9.2 ± 6.7 48.6% non-ART; 45.5% ART -Currier et al [42] United 40/41 COS 9.6 ± 5 8.0 ± 6.1 -Patients on ART including a PI continuously for 2 yr States Raiszadeh et al [35] United 127/249 COS 7.5 ± 2.8 7.3 ± 2.4 --States Coria-Ramirez et al [43] Mexico 69/69 CC 24.8 ± 14.6 7.9 ± 3.4 7.3% non-ART; 79.9% ART Patients who began ART and maintained the treatment for 6 mo Table 2 Characteristics of studies included in the outcome 2 CC: Case-control; CS: Cross-sectional; COS: Cohort study; Hcy: Homocysteine; HHcy: Hyperhomocysteinenemia; PI: Protease inhibitors; ART: Antiretroviral therapy.…”