Effect of baseline micronutrient and inflammation status on CD4 recovery post-cART initiation in the multinational PEARLS trial. Issue 3 (June 2019)

• Record Type: Journal Article
• Authors: Shivakoti, Rupak; Ewald, Erin R.; Gupte, Nikhil; Yang, Wei-Teng; Kanyama, Cecilia; Cardoso, Sandra W.; Santos, Breno; Supparatpinyo, Khuanchai; Badal-Faesen, Sharlaa; Lama, Javier R.; Lalloo, Umesh; Zulu, Fatima; Pawar, Jyoti S.; Riviere, Cynthia; Kumarasamy, Nagalingeswaran; Hakim, James; Pollard, Richard; Detrick, Barbara; Balagopal, Ashwin; Asmuth, David M.; Semba, Richard D.; Campbell, Thomas B.; Golub, Jonathan; Gupta, Amita
• Is Part Of: Clinical nutrition. Volume 38:Issue 3(2019)
• Page Start: 1303
• Page End: 1309
• Publication Date: 2019-06
• Subjects: CD4 reconstitution -- CD4 recovery -- Micronutrients -- Inflammation -- HIV -- Nutrition; cART Combination antiretroviral therapy -- HIV Human immunodeficiency virus -- CD4 CD4+ T cells -- sCD14 soluble CD14 -- CXCL10/IP10 C-X-C motif chemokine 10 -- CRP C-reactive protein -- IgM EndoCab -- IL6 Interleukin-6 -- IFNg Interferon gamma -- TNFa Tumor necrosis factor alpha -- 25-hydroxyvitamin D vitamin D -- BMI body mass index; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2018.05.014
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Nutritional deficiency and inflammation may impact CD4+ T cell recovery during combination antiretroviral therapy (cART), particularly in resource-limited settings where malnutrition is prevalent. The aim of this study was to investigate the relationship of micronutrient and inflammation biomarkers to CD4 recovery after cART initiation. Methods: We conducted a secondary analysis of a random sub-cohort sample (n = 270) from a multinational randomized trial of cART regimen efficacy among 1571 cART-naïve adults. We measured pre-cART serum levels of micronutrients (Vitamin A, B6, B12, D, total carotenoids, selenium, and iron) and inflammation (C-reactive protein, soluble CD14 (sCD14), IFNγ, TNFα, Interleukin-6, and C-X-C motif chemokine 10 (CXCL10/IP10), EndoCab (IgM)) biomarkers. Biomarker status (i.e. micronutrient deficiency vs. sufficiency and elevated vs. low inflammation) was defined using established cutoffs or quartiles. Mixed-effects linear regression models were used to determine the association of baseline (pre-cART) concentrations of individual biomarkers with CD4 recovery through 96 weeks post-cART initiation. Results: In models adjusting for time-dependent viral load and baseline CD4 count, age, sex, body mass index, country, treatment regimen, anemia and hypoalbuminemia status, pre-cART vitamin D deficiency was associated with lower CD4 recovery (−14.9 cells/mm 3, 95% CI: −27.9, −1.8) compared to sufficiency. In contrast, baseline selenium deficiency (20.8 cells/mm 3, 95% CI: 3.3, 38.3), vitamin A deficiency (35.9 cells/mm 3, 95% CI: 17.6, 54.3) and high sCD14 (23.4 cells/mm 3, 95% CI: 8.9, 37.8) were associated with higher CD4 recovery compared to sufficient/low inflammation status. Conclusions: In summary, baseline vitamin D deficiency was associated with diminished CD4 recovery after cART initiation; impaired CD4 recovery may contribute to the poor clinical outcomes recently observed in individuals with vitamin D deficiency. Vitamin A, selenium and sCD14 were associated with CD4 recovery but future studies are needed to further explore these relationships.