Selenium improves ART response in Nigerian randomised study

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Selenium supplementation significantly improved CD4 cell responses to antiretroviral treatment in a large randomised Nigerian study presented on Monday August 14th at the Sixteenth International AIDS Conference in Toronto, Canada.

People living with HIV/AIDS have low levels of antioxidants and selenium; decreased levels of selenium are associated with immune impairment, disease progression, and increased mortality. Selenium levels are directly depleted by HIV replication.

The study examined the impact of selenium supplementation in Nigerians with advanced disease who are on HAART. One hundred and seventy one people with HIV on ART were randomized to receive 200micrograms of selenium daily and 170 people with HIV to receive antiretroviral therapy alone. All patients received an antiretroviral regimen of d4T/3TC and nevirapine.

Glossary

haemoglobin (HB)

Red-coloured, oxygen-carrying chemical in red blood cells.

opportunistic infection (OI)

An infection that occurs more frequently or is more severe in people with weakened immune systems, such as people with low CD4 counts, than in people with healthy immune systems. Opportunistic infections common in people with advanced HIV disease include Pneumocystis jiroveci pneumonia; Kaposi sarcoma; cryptosporidiosis; histoplasmosis; other parasitic, viral, and fungal infections; and some types of cancer. 

immunosuppression

A reduction in the ability of the immune system to fight infections or tumours.

disease progression

The worsening of a disease.

replication

The process of viral multiplication or reproduction. Viruses cannot replicate without the machinery and metabolism of cells (human cells, in the case of HIV), which is why viruses infect cells.

HIV viral load, CD4 counts, hematological and biochemical indices were measured at the start of the study (baseline) and then every three months. At each visit, adherence and nutritional counseling were given. Patients were followed for 72 weeks.

Among the 340 subjects recruited with advanced disease, CD4 cell counts were 3. Although the median time for undetectable viral load was similar in the two groups (p = 0.2), PLWA on HAART + selenium showed the following distinct advantages over those on HAART alone:

  • The rate of CD4 cell recovery was significantly higher; median CD4 count increment from baseline to 72 weeks was almost twofold higher in patients on supplementation (+120 cells/mm3 versus +50 cells/mm3).
  • The incidence of opportunistic infections were lower resulting in fewer hospital visits.
  • Weight gain was significantly higher (p = 0.004).
  • Haemoglobin increment from baseline to 64 weeks was 3-fold higher (+30 g/l versus +10g/l).

Selenium supplementation resulted in a higher CD4 count response and had a significant impact on the quality of life as evident by weight gain, hemoglobin increment, and fewer hospital visits.

The study suggests that selenium might be a useful complement to HAART in the management of people with HIV with severe immunosuppression, said Dr N Odunukwe, presenting the study.

She cautioned that selenium should not be considered as an alternative to antiretroviral therapy: "Our finding that selenium did not have an effect on viral load levels does not suggest that it can be given instead of ART," she emphasised.

References

Odonukwe NN et al. The role of selenium as adjunct to HAART among HIV-infected individuals who are advanced in their disease. Sixteenth International AIDS Conference, Toronto, Canada, abstract MoAb0403, 2006.