Effect of Multiple Micronutrient Supplementation on CD4 T Cell levels of Clinically Stable HIV Patients on Highly Active Antiretroviral Therapy; A Randomized Controlled Crossover Trial

Anthony C. Iwu¹, Chukwuma B. Duru^2, , Kenechi A. Uwakwe², Christopher N. Obionu³, Kevin C. Diwe², Abah O. Steve⁴, Prosper O. Adogu⁵, Irene A. Merenu², Nathan C. Nwaimo⁶, Uche R. Oluoha¹, Ikechi Ohanle¹ and Emmanuel U. Ndukwu¹

¹Department of Community Medicine, Imo State University Teaching Hospital, Orlu Imo State, Nigeria

²Department of Community Medicine, Imo State University, Owerri, Imo State, Nigeria

³College of Medicine, University of Nigeria Nsukka, EnuguState, Nigeria

⁴College of Medicine, Ambrose Ali University Ekpoma, Edo Nigeria

⁵Department of Community Medicine,NnamdiAzikiwe University, Anambra State, Nigeria

⁶Department of Chemical Pathology, Imo State University Teaching Hospital, Orlu Imo State, Nigeria

Cite this paper

Anthony C. Iwu, Chukwuma B. Duru, Kenechi A. Uwakwe, Christopher N. Obionu, Kevin C. Diwe, Abah O. Steve, Prosper O. Adogu, Irene A. Merenu, Nathan C. Nwaimo, Uche R. Oluoha, Ikechi Ohanle and Emmanuel U. Ndukwu. Effect of Multiple Micronutrient Supplementation on CD4 T Cell levels of Clinically Stable HIV Patients on Highly Active Antiretroviral Therapy; A Randomized Controlled Crossover Trial. American Journal of Clinical Medicine Research. 2016; 4(1):1-6. doi: 10.12691/AJCMR-4-1-1

Abstract

Background: Human Immunodeficiency Virus (HIV) infection produces a chronic and potentially fatal disease of the immune system. In the pre HAART (Highly Active Antiretroviral Therapy) era, micronutrient supplementation was associated with improvement in the immune status of HIV infected individuals but in the post HAART era, this association has been unclear with conflicting results. Objective: To determine the effect of multiple micronutrient supplementation on the CD4 T cell levels of clinically stable HIV patients on HAART for at least one year. Methods: A randomized cross over intervention trial was used to determine the CD4 T cell effect of a 12 week daily consumption of multiple micronutrient supplement on 50 clinically stable HIV infected participants receiving treatment from the Imo State University Teaching Hospital. The participants were purposively selected based on certain inclusion criteria and were randomized into two groups to receive the supplement at different periods after a washout period. CD4 T cell measurements were taken at baseline, 12, 20 and 32 weeks. Results: The mean age of the participants studied was 43.8±10.8 years with an average duration on HAART of 3.2±1.5 years. At baseline, 55.3% of the participants were severely immunodeficient, 51.1% were either overweight or obese and 45% were hypertensive. The intervention results, revealed that there was no statistically significant difference in CD4 T cell count levels with micronutrient supplementation compared to no supplementation [t=0.78, p=0.438]. Conclusion: Micronutrient supplementation in the post HAART era especially in patients on long term HAART appear not to have any significant effect on the CD4 T cell counts.

Keywords

micronutrient supplementation, CD4 T cells, HIV patients, HAART

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	World Health Organization; HIV/AIDS factsheet 2013.Online at http://www.who.int/mediacentre/factsheets/fs360/en/index.html. Accessed; December 2013.
[2]	Egger M, May M, Chêne G, Phillips A N, Ledergerber B, Dabis F et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: A collaborative analysis of prospective studies.Lancet 2002; 360(9327):119-129.
[3]	Jourdain G, Le Cœur S, Ngo-Giang-Huong N, Traisathit P, Cressey T R, Fregonese F et al. Switching HIV Treatment in Adults Based on CD4 Count Versus Viral Load Monitoring: A Randomized, Non-Inferiority Trial in Thailand. PLoS Medicine. 2013;10(8):e1001494.
[4]	Beach R S, Mantero-Atienza E, Shor-Posner G, Javier J J, Szapocznik J, Morgan R et al. Specific nutrient abnormalities in asymptomatic HIV-1 infection.AIDS. 1992;6:701-708.
[5]	Fawzi W W, Msamanga G I, Spiegelman D, Wei R, Kapiga S, Villamor E et al. A Randomized Trial of Multivitamin Supplements and HIV Disease Progression and Mortality.N Engl J Med 2004; 351: 23-32.
[6]	World Health Organization; Nutrient requirements for people living with HIV/AIDS:Report of a technical consultation, World Health Organization, Geneva, 13-15 May. Online at http://www.who.int/nutrition/publications/Content_nutrient_requirements.pdfAccessed; December 2013.
[7]	Jiamton S, Pepin J, Suttent R, Filteau S, Mahakkanukrauh B, Hanshaoworakul W, Chaisilwattana P 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.
[8]	Isanaka S, Mugusi F, Hawkins C, Spiegelman D, Okuma J, Aboud S et al. Effect of High-Dose vs Standard-Dose Multivitamin Supplementation at the Initiation of HAART on HIV Disease Progression and Mortality in Tanzania. A Randomized Controlled Trial. JAMA. 2012;308(15):1535-1544.
[9]	Ndeezi G,Tylleskär T, Ndugwa C M, Tumwine J K. Effect of multiple micronutrient supplementation on survival of HIV-infected children in Uganda: a randomized, controlled trial. Journal of the International AIDS Society 2010; 13:18.
[10]	Villamor E, Mugusi F, Urassa W, Bosch R J, Saathoff E, Matsumoto K et al. A trial of the effect of micronutrient supplementation on treatment outcome, T cell counts, morbidity, and mortality in adults with pulmonary tuberculosis.J Infect Dis 2008;197:1499-505.
[11]	Kaiser J D, Campa A M, Ondercin J P, Leoung G S, Pless R F, Baum M K. Micronutrient supplementation increases CD4 count in HIV-infected individuals on highly active antiretroviral therapy: a prospective, double-blinded, placebo-controlled trial.J Acquir Immune DeficSyndr2006;42(5):523-8.
[12]	Fawzi W W, Msamanga G I, Spiegelman D, Wei R, Kapiga S, Villamor E et al. A Randomized Trial of Multivitamin Supplements and HIV Disease Progression and Mortality. N Engl J Med 2004;351:23-32.
[13]	Filteau S, PrayGod G, Kasonka L, Woodd S, Rehman A M, Chisenga M et al. Effects on mortality of a nutritional intervention for malnourished HIV-infected adults referred for antiretroviral therapy: a randomised controlled trial. BMC Medicine 2015; 13: 17.
[14]	Piconi S, Parisotto S, Rizzardini G, Passerini S, Terzi R, Argenteri B et al. Hydroxychloroquine drastically reduces immune activation in HIV infected ART-treated Immunological non responders. Blood 2011; 118(12):3263-3272.
[15]	Wilkin T J, Lalama C M, Mckinnon J, Gandhi R T, Lin N, Landay A et al. A pilot trial of adding maraviroc to suppressive antiretroviral therapy for suboptimal CD4 T cell recovery despite virologic suppression: ACTG A5256. J infect Dis 2012; 206(4): 534-542.
[16]	Wellek S, Blettner M. On the proper use of the crossover design in clinical trials. DtschArztebl Int. 2012; 109(15):276-281.
[17]	Sharma B. Drug Resistance in HIV-1: Genetic and Molecular Bases, Mechanisms and Strategies to Combat the Issue. Biochem Anal Biochem 2015; 4:e153.
[18]	Amorosa V, Synnestvedt M, Gross R, Friedman H, MacGregor R R, Gudonis D et al. A Tale of 2 Epidemics: The Intersection Between Obesity and HIV Infection in Philadelphia. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2005; 39(5):557-61.
[19]	Drain P K, Kupka R, Mugusi F, Fawzi W W. Micronutrients in HIV positive persons receiving highly active antiretroviral therapy. Am J ClinNutr. 2007; 85(2): 333-345.