Micronutrient Interventions and the HIV Pandemic - Term Paper Example

? Extended effect of multivitamins and selenium supplementation in HIV individuals in Botswana Literature review. Introduction. Selenium is one of the essential trace minerals that are found in the soil. It naturally appears in some plant food and water. It has been known to contain powerful antioxidant activity.Recent studies have indicated that it has its beneficial role in cancer, cold sores and shingles, osteoarthritis, cognitive decline, HIV and Aids supplementation, and cataracts and muscular degeneration. Other studies have shown that because of its antioxidant properties, it can be used as an antioxidant in protecting body cells from damage. Studies that focused on the usefulness of selenium, indicate that supplements of selenium may help in reducing the odds of prostate cancer. These studies further indicate that selenium does not affect the risk of lung cancer. According to Semba (1998) selenium content in a plant food depends on the levels of nutrients in the given soil. Schwarz (1996) shows that selenium is lost whenever food is refined or processed. This means that unless a lot of whole organic produce, one may be at high risk of experiencing a selenium deficiency. The facts explain why supplements known to contain selenium have been increasing in popularity especially in the United Kingdom and the United States. Studies have shown that close to 25% of Americans take multivitamins or selenium supplements. In other studies, it has been shown that in the United States, among the healthiest people, selenium deficiency is uncommon. However, some health conditions such as Crohn’s disease, HIV, and other diseases have also been associated with low levels of selenium (Kupka & Fawzi, 2002). However, most studies done on the effects of multivitamins and selenium supplementation in HIV-1 individuals have not been conclusive. A number of studies shave shown that the existence of nutritional deficiencies at the early stages of HIV infection can have an impact on its progression (Allard et al, 1998; Kupka & Fawzi, 2002; Baum et al, 1997). Allard et al, (1998) indicated that the deficiencies in certain nutrients are linked to increased opportunistic diseases, fast progression of diseases, as well as high cases of HIV-linked mortality. In yet another study, Schwarz (1996) shows that the progressive processes involve increasing the intracellular oxidative stress, replication of the virus, and reducing the amount of the circulating CD4 count that is linked with accumulated or individual deficiencies of nutrients. A number of randomized trials have suggested that those with HIV-infected individuals who use the supplement of micronutrients displayed a huge increase in the CD8 and CD4 cell counts (Semba, 1998). With most studies as discussed above, and as shall be seen in the body of literature focusing on the effect of multivitamins on the HIV patients, this study seeks to examine the extended effect of multivitamins and selenium supplementation on HIV-1 individuals in Botswana. Aim. This experiment aims at examining the extended effect of micronutrient supplementation on the HIV disease progression after one year of stopping supplementation in Botswana. Literature Review. A study conducted by Jiamton et al (2003)on a randomized trial of the effect of multiple supplementation of micronutrients on the mortality in HIV-infected person living in Bangkok, showed that the supplementation of multiple micronutrient may facilitate the survival of individuals who are affected by HIV with the CD4 cell counts lesser than two hundred million per l. According to Jiamton et al (2003), this result had vital implications on the health of the public in the developing world where the antiretrovirals are poor. These findings should be reproduced in different mechanisms and settings, especially those that appear to be independent of the changes in the CD4 cell count. In this study 481 men and women who were infected with HIV residing around Bangkok has CD$ cell counts in the range between 50 x 10^6 and 550 x 10^6/l was selected for the study. The participants were randomized in order to receive placebo or micronutrients for a duration of about 48 weeks. The participants on trial were observed clinically twelve each week and tested to observe the CD4 counts twenty four times weekly. The next subset was observed at the forty eighth week to identify the HIV viral plasma load. The obtained results showed out that about sixteen percent trial participants were lost during the follow-up, and five percent of the remaining subjects died. In this regard, the mortality rate was minimized in the micronutrient group recording a hazard mortality ratio of of 0.53 (0.22-1.25; p =0. 1) Generals, and 0.26 (). 07 – 0.97) 0.37 (0.13-1.06; P =0. 052) in those having the CD4 counts less than 200 x 10^6/l and less than 100 x 10^6/l. The results did not display the cases of effects on the CD4 cell count or the plasma viral load. Another similar study by Hurwitz et al (2007) on the suppression of the HIV type 1 viral load with the supplementation of selenium, showed that the daily supplementation of selenium could reduce the rate of progression of the HIV -1 Viral burden, providing the indirect improvement of the CD4 count. In this case, the observation was in the support of the use of selenium as a cheap, safe adjunct, and simple therapy in HIV disease spectrum. The conclusion of this study was similar to that of Jiamton et al (2003). The methodology employed in the study was relatively different from that of Jiamton et al (2003). In this study the supplementation of high selenium yeast was evaluated in randomized, double blind, placebo controlled trials. An assessment was done to ascertain the effect on the HIV-1 viral Load together with the CD4 counts after a duration of nine months of treatment. This was slightly different from the Jiamton et al (2003) methodology as it used 200 patients rather than 481 patients as seen in the later. The effect of micronutrients investigated in the two studies was similar. There was a positive return implying that the micronutrients reduced the mortality of the patients with HIV viral infections. Fwazi et al (2004) in the study which involved a randomized supplementation of multivitamin trial and HIV mortality and progression, asserted that the supplementation of multivitamin delayed the progression of HIV disease thus giving out an effective low-cost way of inhibiting the rate of initiation of the antiretroviral therapy for the women who were infected with HIV. This conclusion, though biased in terms of gender is similar to that of Jiamton et al (2003) ; Hurwitz et al (2007). The methodology of this study involved 1078 subjects who were pregnant women with HIV infection. This was a larger figure than that used in the studies of Jiamton et al (2003), and Hurtwitz et al. Fwazi et al (2004) examined the supplementation of vitamin A, multivitamin, and the use of both during the disease progression. The mean follow-up in terms of survival was about seventy one. Despite the number of participants, the methodology was similar to that of Jiamton et al (2003) and Hurtwitz et al (2007). A study conducted by Kaiser et al (2006) on the micronutrient supplementation concluded that the supplementation of micronutrients could better the reconstitution of the CD4 count among patients infected with HIV. This study also showed that the tested micronutrient was tolerated in an appropriate manner and could hold promise as a therapy in the treatment of HIV. This conclusion is similar to that of Fwazi et al (2004), Friis & Goma (2002), Jiamton et al (2003) and Hurtwitz et al (2007). The methodology of the study by Keiser et al ( 2006) involved 40 participants which a relatively low figure, though easy to manage. This study evaluated the influence of supplementation of micronutrients on the parameters of immunology. The other three studies ignored the aspects of immunology and micronutrients which was well covered by Keiser et al (2006). One recent study on the Micronutrients and HIV-1 progression by Baum et al (1995) concluded that deficiencies in micronutrients is linked to the progression of HIV-1 disease raising the possibility that normality could increase the chances of surviving with no symptoms. This conclusion is equally similar to that advanced by prior studies in this field. This study used 108 participants which was a number easy to deal with. Different from the prior studies, this study was done by HIV-1 Infected homosexual men. The study compared the changes in the status of nutrition with the parameters of immunology using autoregressive model. The methodology employed in this study was similar to that of Keiser et al (2006) since it considered the aspects of immunology during the study. This study was similar to that of Baum et al (1997). Range et al (2006) in the study of the effect of supplementation of Micronutrients argued that the supplementation of micronutrients could increase the survival of the HIV infected patients. This conclusion agrees with that of the prior studies. In this study, the impact of zinc and MVM tablet (Vitamin A, Vitamin B1, vitaminB2) daily supplementation was investigated. Different from the prior studies, this study involved TB patients. From the sampled studies, it is true to say that the micronutrient supplementation in the patients with HIV will reduce the mortality of these patients significantly. However, these findings demand a confirmation because, the conducted studies relied on secondary outcomes on subgroups of patients and also since the studies have no compliance data (Semba & Tang, 1999; Tang, Graham & Saah, 1996). Additionally, the effect of micronutrients could be different in different settings as a result of the interaction with co-infections, and nutrients. For this reason a study should be done to investigate extended effect of multivitamins and selenium supplementation on HIV-1 individuals in Botswana. This is so because there has been no prior study on multivitamin conducted in Botswana. References. Allard, J., Aghdassi, E., Chau, J., Salit, I., Walmsley, S. (1998). Oxidative stress and plasma antioxidant micronutrients in humans with HIV infection. Am J Clin Nutr, 67:143–147. Baum, M., Shor-Posner, G., Lu, Y., Rosner, B., Sauberlich, H., Fletcher, M, Szapocznik, J.,Eisdorfer, C., Burring, J. & Hennekens, C. (1995). Micronutrients and HIV-1 disease progression. AIDA, 9:1051-1056. Baum, M., Shor-Posner, G., Lai, S., Zhang, G., Lai, H. & Fletcher, M. (1997). High risk of HIV-related mortality is associated with selenium deficiency. J Acquir Immune Defic Syndr Hum Retro-virol,15:370–374. Friis, H. & Goma,M. (2002).Micronutrient interventions and the HIV pandemic. In Micronutrients and HIV infection . Edited by Friis H. London: CRC Press: 219–246. Fwazi, W.,Msamanga, G., Spiegelman, D., Wei, R., Kapiga, S., Villamor, E., Mwakagile, D., Mugusi, F., Hertzmark, E., Essex,M. & Hunter, D. (2004). A randomized trial of multivitamin supplements and HIV disease progression and mortality. The new England journal of medicine,351:23-32. Hurtwitz, B., Klaus,J.,Llabre, M.,Ganzalez, A., Lawrence, P.,Maher,K., Greeson, J., Baum, M., shor-Posner,G., Skyler, J. & Schneideman,N. (2007). Suppression of Human Immunodeficiency Virus type 1 viral load with selenium supplementation. Arch intem med,167: 148-154. Jiamton, S., Pepin, J., Suttent, R., Filteau,S., Manakkanukrauh,B., Hanshaoworakul, W., Chaisilwattana, p., Suthipinittharm,P., SHetty, P. & Jaffar, S. (2003). A randomized trial of the impact of multiple micronutrient supplementation on nortality among HIV-infected individuals living in Bangok. J of AIDS, 17:2461-2469. Kaiser, J.,Campa, A., Ondercin, J., Leoung, G., Pless, R. & baum,M. (2006). Micronutrient supplementation increases CD$ count in HIV-Infected Individuals on highly active antiretroviral therapy: A prospective, double-blinded, placebo-controlled trial.J AIDS,42: 523-528. Kupka, R. & Fawzi, W. (2002). Zinc nutrition and HIV infection. Nutr Rev,60:69–79. Moriguchi, S. &Muraga, M.(2000). Vitamin E and immunity. Vitam Horm, 59:305–336. Range, N., Changalucha, J., Krarup, H., Magnussen, O., Anndersen, A., & Friis, H. (2006). The effect of Multi-vitamin/mineral supplementation on mortality during treatment of pulmonary tuberculosis: a randomised two- by two factorial trial in Mwanza, Tanzania. British Journal of Nutrition, 95.762-770. Semba, R. (1998). The role of vitamin A and related retinoids in immune function. Nutr Rev, 56:S38–48. Semba, R.D. & Tang, A.M. (1999). Micronutrients and the pathogenesis of human immunodeficiency virus infection. Br J Nutr, 81:181–189. Schwarz, K. (1996). Oxidative stress during viral infection: a review. Free Radic Biol Med, 21:641–649. Tang, A., Graham, N. & Saah, A. (1996). Effects of micronutrient intake on survival in human immunodeficiency virus type 1 infection. Am J Epidemiol, 143:1244–1256. Read More