HIV- Development of AIDS

8/3/2019 HIV- Development of AIDS

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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/htm


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HIV- Development of AIDS

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