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Published on: July 24, 2013
Mortality risk in selenium-deficient HIV-positive children
A Campa1, G Shor-Posner, F Indacochea
1Center for Disease Prevention, Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Florida 33136, USA.
Insights
Low plasma selenium levels independently predict mortality and faster disease progression in children with HIV-1 infection. This highlights selenium
Area of Science:
- Pediatric Immunology
- Nutritional Science
- Epidemiology
Background:
- Human Immunodeficiency Virus type 1 (HIV-1) infection in children presents significant challenges to immune status and overall survival.
- Nutritional factors are increasingly recognized for their potential impact on disease progression in pediatric HIV-1.
- Understanding specific nutritional contributions is crucial for improving outcomes in affected children.
Purpose of the Study:
- To investigate the independent role of specific nutritional factors in the progression of HIV-1 disease and survival among infected children.
- To identify key nutritional markers associated with mortality and disease advancement in pediatric HIV-1.
Main Methods:
- A cohort of 24 symptomatic, perinatally HIV-1-exposed children was followed for 5 years.
- Immune status (CD4 cell count) and nutritional status (serum albumin, plasma trace elements like selenium) were assessed.
- Cox proportional hazards regression models analyzed the relationship between nutritional factors, immune status, and survival, considering antiretroviral treatment.
Main Results:
- Twelve children died from HIV-1 related causes during the study period.
- Low plasma selenium levels (RR = 5.96) and CD4 cell counts below 200 (RR = 7.05) were independently significant predictors of mortality.
- Children with low selenium levels died at a younger age, indicating accelerated disease progression.
Conclusions:
- Low plasma selenium levels are an independent predictor of mortality in pediatric HIV-1 infection.
- Reduced selenium levels are associated with more rapid HIV-1 disease progression in children.
- Monitoring and potentially supplementing selenium may be important for improving survival and managing disease progression in pediatric HIV-1.
Objective:
To determine the independent contribution of specific nutritional factors on disease progression and survival in HIV-1-infected children.
Population:
HIV-infected children (N = 24), who were perinatally exposed to the virus and symptomatic, were recruited between October and December of 1990 from the Jackson Memorial Pediatric Immunology Clinic, Miami, Florida, and observed for 5 years.
Methods:
Immune status was measured by CD4 cell count; nutritional status was determined using serum albumin and plasma trace elements including iron, zinc, and selenium. Cox proportional hazards regression models were used to evaluate the relationship of these parameters to survival. Use of antiretroviral treatment was considered in the statistical model, and age at death was considered a parameter of disease progression.
Results:
Over the course of the study, 12 children died of HIV-related causes. The final Cox multivariate analysis indicated that, of the variables evaluated, only CD4 cell count below 200 (risk ratio [RR] = 7.05; 95% confidence interval [CI], 1.87-26.5); p = .004], and low levels of plasma selenium (RR = 5.96; 95% CI, 1.32-26.81; p = .02) were significantly and independently related to mortality. Among the children who died, those with low selenium levels (< or =85 microg/L), died at a younger age, suggesting more rapid disease progression.
Conclusions:
In pediatric HIV-infection, low plasma level of selenium is an independent predictor of mortality, and appears to be associated with faster disease progression.
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