Prevalence and risk factors of micronutrient deficiencies pre- and post-antiretroviral therapy (ART) among a diverse multicountry cohort of HIV-infected adults

Abstract

Background and Aims HIV-infected adults have increased risk of several individual micronutrient deficiencies. However, the prevalence and risk factors of concurrent and multiple micronutrient deficiencies and whether micronutrient concentrations change after antiretroviral therapy (ART) initiation have not been well described. The objective of this study was to determine the prevalence and risk factors of individual, concurrent and multiple micronutrient deficiencies among ART-naïve HIV-infected adults from nine countries and assess change in micronutrient status 48 weeks post-ART initiation. Methods A random sub-cohort (n=270) stratified by country was selected from the multinational PEARLS clinical trial (n=1571 ART-naïve, HIV-infected adults). We measured serum concentrations of vitamins A, D (25-hydroxyvitamin), E, carotenoids and selenium pre-ART and 48 weeks post-ART initiation, and measured vitamins B6, B12, ferritin and soluble transferrin receptor at baseline only. Prevalence of single micronutrient deficiencies, concurrent (2 coexisting) or conditional (a deficiency in one micronutrient given a deficiency in another) and multiple (≥3) were determined using defined serum concentration cutoffs. We assessed mean changes in micronutrient concentrations from pre-ART to week 48 post-ART initiation using multivariable random effects models. Results Of 270 participants, 13.9%, 29.2%, 24.5% and 32.4% had 0, 1, 2 and multiple deficiencies, respectively. Pre-ART prevalence was the highest for single deficiencies of selenium (53.2%), vitamin D (42.4%), and B6 (37.3%) with 12.1% having concurrent deficiencies of all three micronutrients. Deficiency prevalence varied widely by country. 48 weeks post-ART initiation, mean vitamin A concentration increased (p<0.001) corresponding to a 9% decrease in deficiency. Mean concentrations also increased for other micronutrients assessed 48 weeks post-ART (p<0.001) but with minimal change in deficiency status. Conclusions Single and multiple micronutrient deficiencies are common among HIV-infected adults pre-ART initiation but vary between countries. Importantly, despite increases in micronutrient concentrations, prevalence of individual deficiencies remains largely unchanged after 48 weeks on ART. Our results suggest that ART alone is not sufficient to improve micronutrient deficiency.

Changes in Bone Mineral Density, Body Composition, Vitamin D Status, and Mineral Metabolism in Urban HIV-Positive South African Women Over 12 Months

“…Unlike previous reports (eg, Shivakoti and colleagues, van den Bout‐van den Beukel and colleagues, Kwan and colleagues), there was no indication that either HIV infection or ART exposure was associated with compromised vitamin D status in these South African women. The mean 25(OH)D concentration in all three groups exceeded 50 nmol/L at both baseline and 12 months with no decrease over time in Ppres or Plow.…”

Vitamin A and D Deficiencies Associated With Incident Tuberculosis in HIV-Infected Patients Initiating Antiretroviral Therapy in Multinational Case-Cohort Study

“…Using established deficiency cutoffs, 7% of cases and 3% of non-cases were deficient in vitamin A (<0.7 µmol/L), 31% and 37% in vitamin B6 (<19 nmol/L), 6% and 9% in vitamin B12 (<148 pmol/L), 22% and 14% in vitamin D (<20 ng/mL), 2% and 0% in α-tocopherol (vitamin E isoform) [<9.3 µmol/L], and 76% and 51% in selenium (<85 mg/L). Baseline micronutrient deficiency prevalence in the sub-cohort was previously described 49 .…”

Vitamin D Status and Its Consequences for Health in South Africa

“…Seasonal vitamin D deficiency was significantly associated with disease or HIV-1 replication in three studies from the Western Cape [38,64,65], with vitamin D deficiency more severe in patients co-infected with HIV-1 and Mycobacterium tuberculosis [64]. Three multinational cohort studies which included participants from Gauteng and/or KwaZulu-Natal also found vitamin D deficiency in approximately 40%–50% of HIV-1-infected patients, but there was no control comparison group so that disease association could not be assessed [67,68,69]. Participants from the PEARLS (Prospective Evaluation of Antiretrovirals in Resource Limited Settings) trial were used in two of these studies.…”

“…At 24 weeks after initiation of antiretroviral therapy (ART), patients receiving efavirenz-containing regimes had significantly decreased serum 25(OH)D concentration, with the greatest decrease occurring in those with higher baseline 25(OH)D levels. Notably ART did not improve micronutrient deficiency in HIV-1-infected persons [67,68]. …”