RESEARCH PAPER
Micronutrients status among human immunodeficiency virus-infected children in Southern India
More details
Hide details
1
Department of Pediatrics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
2
Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
3
Department of Pathology, University of Texas, Galveston, Texas
Submission date: 2019-04-08
Final revision date: 2019-08-09
Acceptance date: 2019-08-09
Publication date: 2020-02-12
HIV & AIDS Review 2020;19(1):56-60
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Deficiencies of micronutrients play a role in human immunodeficiency virus (HIV) infection and its severity. Identifying the micronutrient status would guide supplementation, thus altering the disease progression and severity.
Material and methods:
A cross-sectional hospital-based study was conducted in Southern India on hundred HIV-infected children. Estimation of serum micronutrient levels (zinc, copper, and iron) and comparison of the deficient micronutrients with clinical stages, immunological categories, CD4 counts, and nutritional status was performed.
Results:
Among 100 HIV-infected children, zinc deficiency was the most common (62%), whereas copper and iron deficiency was present in 2% and 1%, respectively. Mean age of children was 11.20 ± 3.14 years, 52% were girls, 24% were malnourished, 76% were receiving antiretroviral therapy (ART), and four had CD4 counts < 200/mm2 indicating AIDS. Using Kruskalwallis test, serum iron levels (p = 0.000) and CD4 levels (p = 0.001) were significantly associated with clinical stages, while serum zinc levels (p = 0.043) and CD4 levels (p = 0.000) were significantly associated with various degrees of immune classification. Mean micronutrient levels did not correlate significantly with CD4 counts less than and greater than 350 by unpaired t test. Zinc deficiency did not correlate with clinical staging, immunological classification, nutritional status, and receipt of ART on multiple logistic regression analysis.
Conclusion:
In HIV-infected children, zinc deficiency was the most common and it did not correlate with clinical staging, immunological classification, nutritional status, and receipt of antiretroviral therapy. Hence, supplementation of zinc would be required along with initiation of ART.
REFERENCES (30)
1.
HIV/AIDS in the context of other global challenges, Global 2015. Special report for the UN high level meeting on AIDS, 8-10 June 2011.
2.
National Institute of Medial Statistics, ICMR & NACO, DAC, Ministry of Health & Family Welfare, Government of India, New Delhi 2012. National AIDS Control Organization. Technical report: India HIV estimates.
3.
Sudharshan S, Biswas J. Introduction and immunopathogenesis of acquired immune deficiency syndrome. Indian J Ophthalmol 2008; 56: 357-362.
4.
Calder PC, Kew S. The immune system: a target for functional foods? Br J Nutr 2002; 88 Suppl 2: S165-177.
5.
Friis H. Micronutrient interventions and HIV infection: a review of current evidence. Trop Med Int Health 2006; 11: 1849-1857.
6.
Fischer Walker C, Black RE. Zinc and the risk for infectious diseases. Annu Rev Nutr 2004; 24: 255-275.
7.
Allard JP, Aghdassi E, Chau J, Salit I, Walmsley S. Oxidative stress and plasma antioxidant micronutrients in with HIV infection. Am J Clin Nutr 1998; 67: 143-147.
8.
Bhaskaram P. Micronutrient malnutrition, infection, and immunity: an overview. Nutr Rev 2002; 60 (5 Pt 2): S40-45.
9.
O’Dell BL. Role of zinc in plasma membrane function. J Nutr 2000; 130 (5 Suppl): 1432S-1436S.
10.
Zhang ZY, Reardon IM, Hui JO, et al. Zinc inhibition of renin and the protease from human immunodeficiency virus type 1. Biochemistry 1991, 30: 8717-8721.
11.
Black RE. Zinc deficiency, infectious disease and mortality in the developing world. J Nutr 2003; 133 (5 Suppl 1): 1485S-1489S.
12.
Kurtz J, Wegner KM, Kalbe M, et al. MHC genes and oxidative stress in sticklebacks: an immuno-ecological approach. Proc Biol Sci 2006; 273: 1407-1414.
13.
Ndeezi G, Tumwine JK, Bolann BJ, Ndugwa CM, Tylleskar T. Zinc status in HIV infected Ugandan children aged 1-5 years: a cross sectional baseline survey. BMC Pediatr 2010; 10: 68.
14.
Anyabolu HC, Adejuyigbe EA, Adeodu OO. Serum micronutrient status of HAART-naïve, HIV infected children in South Western Nigeria: a case controlled study. AIDS Res Treat 2014; 2014: 351043.
15.
Yarhere IE, Ugwu RO, Eneh AU. Serum zinc levels in HIV infected children attending the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Niger J Paed 2014; 41: 110-115.
16.
Swetha GK, Hemalatha R, Prasad UV, Murali V, Damayanti K, Bhasker V. Health and nutritional status of HIV infected children in Hyderabad, India. Indian J Med Res 2015; 141: 46-54.
17.
WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight- for-length, weight-for-height and body mass index-for-age: Methods and development. World Health Organization, Geneva 2006.
18.
Indian Academy of Pediatrics Growth Charts Committee, Khadilkar V, Yadav S, Agrawal KK, et al. Revised IAP growth charts for height, weight and body mass index for 5 to18 year old Indian children. Indian Pediatr 2015; 52: 47-55.
19.
WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV related disease in adults and children. WHO Press, Geneva 2007.
20.
Wright M, Clifford W. Laboratory assessment of nutritional status. In: Duggan C, Watkins JB, Walker WA (eds.). Nutrition in Pediatrics: Basic Science, Clinical Applications. 4th ed. B.C. Decker Inc, Hamilton 2008; 15-25.
21.
Jiamton S, Pepin J, Suttent R, et al. A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok. AIDS 2003; 17: 2461-2469.
22.
van Lettow M, Harries AD, Kumwenda JJ, et al. Micronutrient malnutrition and wasting in adults with pulmonary tuberculosis with and without HIV co-infection in Malawi. BMC Infect Dis 2004; 4: 61.
23.
Miller WC, Powers KA, Smith MK, Cohen MS. Community viral load as a measure for assessment of HIV treatment as prevention. Lancet Infect Dis 2013; 13: 459-464.
24.
Rousseau MC, Molines C, Moreau J, Delmont J. Influence of highly active antiretroviral therapy on micronutrient profiles in HIV-infected patients. Ann Nutr Metab 2000; 44: 212-216.
25.
Jones CY, Tang AM, Forrester JE, et al. Micronutrient levels and HIV disease status in HIV-infected patients on highly active antiretroviral therapy in the Nutrition for Healthy Living cohort. J Acquir Immune Defic Syndr 2006; 43: 475-482.
26.
Wellinghausen N, Kern WV, Jochle W, Kern P. Zinc serum level in human immunodeficiency virus-infected patients in relation to immunological status. Biol Trace Elem Res 2000; 73: 139-149.
27.
Siberry GK, Ruff AJ, Black R. Zinc and human immunodeficiency virus infection. Nutr Res 2002; 22: 527-538.
28.
Mocchegiani E, Muzzioli M, Gaetti R, Veccia S, Viticchi C, Scalise G. Contribution of zinc to reduce CD4+ risk factor for ‘severe’ infection relapse in aging: parallelism with HIV. Int J Immunopharmacol 1999; 21: 271-281.
29.
Graham NM, Sorensen D, Odaka N, et al. Relationship of serum copper and zinc levels to HIV seropositivity and progression to AIDS. J Acquir Immune Defic Syndr 1991; 4: 976-980.
30.
Eley BS, Sive AA, Abelse L, Kossew G, Cooper M, Hussey GD. Growth and micronutrient disturbances in stable, HIV-infected children in Cape Town. Ann Trop Paediatr 2002; 22: 19-23.