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Presenters:Lauren NewmanKristen OldhamLauren Flowers
Punam Patel
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Intro to HIV/AIDS HIV (human Immunodeficiency virus)
Infection occurs by the transfer of blood, semen, vaginal fluid, or breastmilk. HIV present as both free virus particles and virus within infected
immune cells. Virus that affects T-cells: leads to a low level of CD4+ T cell counts and
in increase in viral load. CD4+ below a critical level, cell mediated immunity is lost and body
becomes progressively more susceptible to infections. Causing a damage to the immune system
Progression into AIDS The studies we focused on were infected pregnant mothers
transferring the virus off to their child, since that is the secondhighest form of transmission after blood transfusion.
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Prevalence of HIV .6O % adult prevalence rate in United States
An estimated 1.1 million Americans have HIV, and
about 20 percent of them don't know it. The number of infected people getting treatment rose
from 837 in 1996 to 5,413 in 2009.
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Micronutrients Micronutrients can be utilized as an inhibitor for
the progression, morbidity, and anemia of HIV
disease. Reason for choosing vitamin A and selenium
Both help with immune function
Currently no treatment, but anti-retroviral: longer
life expectancy
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HAART: highly active antiretroviral
therapy Improve immune status by
Selenium and Zinc
- Along with Selenium, Vitamin A helps with antioxidant
- Both studies used Tanzanian pregnant women.
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T lymphocytes
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Performed Vitamin A- backgroundVitamin A is a group of compounds that play an
important role in vision, bone growth, reproduction,cell division and cell differentiation
Vitamin A helps regulate the immune system, whichhelps prevent or fight off infections by making WBCsthat destroy harmful bacteria and viruses.
Studies: Performed Vitamin A= from animals Absorbed as retinol (active form)
Sources: liver, milk, fortified foods.
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Objective Vitamin AVitamin A along with micronutrients helps slow the
progression of HIV along with increasing CD4 cellcounts?
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Material and Methods- Vit A Daily dose of supplementations Monthly visits and every 6 months: blood work to check
T cell counts Viral Loads HIV related complications.
1,078 pregnant women infected with HIV tested Randomized study, 8 years, blood count once every 6 months,
1.vitamin A(30mg of Beta- Carotene + 5,000 IU of performed vitaminA)
2. Multivitamins (without vitamin A)- 20mg of B1 and B2, 25 mg ofB6, 100mg of naicin, 50 mg of B12, 500mg of vitamin C, 30mg of
Vitamin E, and .8 mg of Folic acid) 3. Multivitamin with vitamin A- dose combination of 1 and 2 4. placebo
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Results: Vitamin A Of the total analyzed, 299 women progressed to stage
4 or died or AIDS related causes.
67/271 died (multivitamin)- 25%
70/268 died (multivitamin + Vitamin A)- 26%
79/272 died (vitamin A)- 29%
83/267 died (placebo)- 31%
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Table 1: baseline characteristics of the
women.
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Discussion- Vitamin A Multivitamin alone had a greater impact in slowing the
progression of HIV/AIDS Due to increasing the CD4 counts and lowering the viral load.
Also lowered HIV-related complications. Vitamin A had a weaker response than Multivitamin
supplements in delaying the progression of disease Caused on significant effect on clinical outcomes, T-cell
counts or viral load.
Vitamin A supplements resulted in a significant increase inmother-to-child transmission of HIV.
Compared to no Vitamin A dose, Vitamin A supplementationincreased the risk of progression to stage 4 or death.
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Background of Selenium Functions: Plays catalytic role in antioxidant enzymes,
glutathione peroxidase and iodothyronine 5-deiodinases Participates in synthesis of leukotriene C4,
Selenium deficiency is common among HIV infected patients Glutathione peroxidase and Iodothyronine 5- deiodinases are
diminshed due to infected T cells. Viral cells use selenoproteins to replicate causing a decrease in selenium
concentrations.
Low plasma selenium concentrations are related to increased risk of
mortality and mycobacterial disease among HIV infected people Low hemoglobin concentrations are associated with selenium
among both HIV infected and un-infected populations.
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Sources of SeleniumAll dependent on soil content
Mostly plants, nuts, legumes
Meats Seafood
Supplement used
Selenomethionine
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Objective- Selenium Test effect of selenium supplements on hemoglobin
concentrations and morbidity amoung HIV-1 infectedTanzanian women.
Because the relationship between selenium, hemoglobinconcentrations, and infectious morbidity has not beenstudy adequately in sub-Saharan Africa.
To discover a low-cost immuno-modulatingsupplements.
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Materials and Methods- Selenium Daily dose of 200mg of selenomethionine
Until 6 months postpartum
915 infected pregnant women
Hemoglobin concentrations were measured at thebeginning, 6 weeks and 6 months postpartum Normal hemoglobin for pregnant women is between 11-
12 g/dL
Monthly visits Morbidity data
Diarrhea, cough, difficulty breathing, fatigue, fever, nausea orvomiting, ulcers in the mouth or throat, and oral thrush.
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Results- Selenium 467 had baseline measurement of hemoglobin at the
first follow up visit
Mean hemoglobin at baseline:
9.79 +/- 1.28 g/dL in selenium group
9.63 +/- 1.44 g/dL in placebo group.
15 progressed to >8.5 g/dL.
Overall, selenium did not affect progression of HIV Selenium supplements reduced diarrheal related
morbidity by 40%
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Kupka R et al. Clin Infect Dis. 2009;48:1475-1478
Effect of selenium supplements on hemoglobin concentrations in HIV-1-infected pregnant women.
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Kupka R et al. Clin Infect Dis. 2009;48:1475-1478
Effect of selenium supplements on hemoglobin concentrations in HIV-1-infected pregnant women.
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Discussion- Selenium No effect on hemoglobin concentrations.
Decreased diarrheal morbidity and no effect on othermorbidities .
Selenium as part of glutathione peroxidase, protectsagainst hemolysis of erythrocytes and thus may berelevant to hemoglobin levels. However, the results of
the study did not support this claim. One limitation to the study was that researchers relied
only on patients recollection on morbidities whichmay lead to misclassification on morbidity data.
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Future Research Test the beneficial effects of selenium on different
stages of the disease, because it is believedsupplementation can increase the replication of the
virus in early stages.
More thorough assessment of morbidity data.
Conduct future research on why selenium reduced
diarrheal morbidities. Vitamin A: what about vitamin A increased
transmission from mother to child.
Does the virus use vitamin A as a source of replication.
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References http://www.avert.org/aids/htm
http://www.nejm.org.doi/full/10.1056/NEJmoa040541
http://www.ncbi.nlm.nih.gov/pmc/articles/PMc2777617/?tool=pubmed
http://ods.od.nih.gov/factsheets/vitamina/
http://www.avert.org/aids/htmhttp://www.nejm.org.doi/full/10.1056/NEJmoa040541http://www.ncbi.nlm.nih.gov/pmc/articles/PMc2777617/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMc2777617/?tool=pubmedhttp://ods.od.nih.gov/factsheets/vitamina/http://ods.od.nih.gov/factsheets/vitamina/http://www.ncbi.nlm.nih.gov/pmc/articles/PMc2777617/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMc2777617/?tool=pubmedhttp://www.nejm.org.doi/full/10.1056/NEJmoa040541http://www.avert.org/aids/htm8/3/2019 HIV- Development of AIDS
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