Suppression of human immunodeficiency virus type 1 viral load with selenium supplementation: A randomized controlled trial

Barry Hurwitz, Johanna R. Klaus, Maria Llabre, Alex Gonzalez, Peter J. Lawrence, Kevin J. Maher, Jeffrey M. Greeson, Marianna K. Baum, Gail Shor-Posner, Jay S Skyler, Neil Schneiderman

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Abstract

Background: Despite findings that selenium supplementation may improve immune functioning, definitive evidence of its impact on human immunodeficiency virus (HIV) disease severity is lacking. Methods: High selenium yeast supplementation (200 μg/d) was evaluated in a double-blind, randomized, placebo-controlled trial. Intention-to-treat analyses assessed the effect on HIV-1 viral load and CD4 count after 9 months of treatment. Unless otherwise indicated, values are presented as mean±SD. Results: Of the 450 HIV-1-seropositive men and women who underwent screening, 262 initiated treatment and 174 completed the 9-month follow-up assessment. Mean adherence to study treatment was good (73.0%±24.7%) with no related adverse events. The intention-to-treat analyses indicated that the mean change (Δ) in serum selenium concentration increased significantly in the selenium-treated group and not the placebo-treated group (Δ = 32.2±24.5 vs 0.5±8.8 μg/L; P<.001), and greater levels predicted decreased HIV-1 viral load (P<.02), which predicted increased CD4 count (P<.04). Findings remained significant after covarying age, sex, ethnicity, income, education, current and past cocaine and other drug use, HIV symptom classification, antiretroviral medication regimen and adherence, time since HIV diagnosis, and hepatitis C virus coinfection. Follow-up analyses evaluating treatment effectiveness indicated that the non-responding selenium-treated subjects whose serum selenium change was less than or equal to 26.1 μg/L displayed poor treatment adherence (56.8%±29.8%), HIV-1 viral load elevation (Δ = +0.29±1.1 log10 units), and decreased CD4 count (Δ = -25.8±147.4 cells/μL). In contrast, selenium-treated subjects whose serum selenium increase was greater than 26.1 μg/L evidenced excellent treatment adherence (86.2%±13.0%), no change in HIV-1 viral load (Δ = -0.04±0.7 log10 units), and an increase in CD4 count (Δ = +27.9±150.2 cells/μL). Conclusions: Daily selenium supplementation can suppress the progression of HIV-1 viral burden and provide indirect improvement of CD4 count. The results support the use of selenium as a simple, inexpensive, and safe adjunct therapy in HIV spectrum disease. Trial Registration: isrctn.org Identifier: IS-RCTN22553118

Original languageEnglish
Pages (from-to)148-154
Number of pages7
JournalArchives of Internal Medicine
Volume167
Issue number2
DOIs
StatePublished - Jan 22 2007

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Selenium
Viral Load
HIV-1
Randomized Controlled Trials
CD4 Lymphocyte Count
HIV
Intention to Treat Analysis
Virus Diseases
Therapeutics
Serum
Placebos
Medication Adherence
Coinfection
Cocaine
Hepacivirus
Yeasts
Education

ASJC Scopus subject areas

  • Internal Medicine

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Suppression of human immunodeficiency virus type 1 viral load with selenium supplementation : A randomized controlled trial. / Hurwitz, Barry; Klaus, Johanna R.; Llabre, Maria; Gonzalez, Alex; Lawrence, Peter J.; Maher, Kevin J.; Greeson, Jeffrey M.; Baum, Marianna K.; Shor-Posner, Gail; Skyler, Jay S; Schneiderman, Neil.

In: Archives of Internal Medicine, Vol. 167, No. 2, 22.01.2007, p. 148-154.

Research output: Contribution to journalArticle

Hurwitz, Barry ; Klaus, Johanna R. ; Llabre, Maria ; Gonzalez, Alex ; Lawrence, Peter J. ; Maher, Kevin J. ; Greeson, Jeffrey M. ; Baum, Marianna K. ; Shor-Posner, Gail ; Skyler, Jay S ; Schneiderman, Neil. / Suppression of human immunodeficiency virus type 1 viral load with selenium supplementation : A randomized controlled trial. In: Archives of Internal Medicine. 2007 ; Vol. 167, No. 2. pp. 148-154.
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title = "Suppression of human immunodeficiency virus type 1 viral load with selenium supplementation: A randomized controlled trial",
abstract = "Background: Despite findings that selenium supplementation may improve immune functioning, definitive evidence of its impact on human immunodeficiency virus (HIV) disease severity is lacking. Methods: High selenium yeast supplementation (200 μg/d) was evaluated in a double-blind, randomized, placebo-controlled trial. Intention-to-treat analyses assessed the effect on HIV-1 viral load and CD4 count after 9 months of treatment. Unless otherwise indicated, values are presented as mean±SD. Results: Of the 450 HIV-1-seropositive men and women who underwent screening, 262 initiated treatment and 174 completed the 9-month follow-up assessment. Mean adherence to study treatment was good (73.0{\%}±24.7{\%}) with no related adverse events. The intention-to-treat analyses indicated that the mean change (Δ) in serum selenium concentration increased significantly in the selenium-treated group and not the placebo-treated group (Δ = 32.2±24.5 vs 0.5±8.8 μg/L; P<.001), and greater levels predicted decreased HIV-1 viral load (P<.02), which predicted increased CD4 count (P<.04). Findings remained significant after covarying age, sex, ethnicity, income, education, current and past cocaine and other drug use, HIV symptom classification, antiretroviral medication regimen and adherence, time since HIV diagnosis, and hepatitis C virus coinfection. Follow-up analyses evaluating treatment effectiveness indicated that the non-responding selenium-treated subjects whose serum selenium change was less than or equal to 26.1 μg/L displayed poor treatment adherence (56.8{\%}±29.8{\%}), HIV-1 viral load elevation (Δ = +0.29±1.1 log10 units), and decreased CD4 count (Δ = -25.8±147.4 cells/μL). In contrast, selenium-treated subjects whose serum selenium increase was greater than 26.1 μg/L evidenced excellent treatment adherence (86.2{\%}±13.0{\%}), no change in HIV-1 viral load (Δ = -0.04±0.7 log10 units), and an increase in CD4 count (Δ = +27.9±150.2 cells/μL). Conclusions: Daily selenium supplementation can suppress the progression of HIV-1 viral burden and provide indirect improvement of CD4 count. The results support the use of selenium as a simple, inexpensive, and safe adjunct therapy in HIV spectrum disease. Trial Registration: isrctn.org Identifier: IS-RCTN22553118",
author = "Barry Hurwitz and Klaus, {Johanna R.} and Maria Llabre and Alex Gonzalez and Lawrence, {Peter J.} and Maher, {Kevin J.} and Greeson, {Jeffrey M.} and Baum, {Marianna K.} and Gail Shor-Posner and Skyler, {Jay S} and Neil Schneiderman",
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T1 - Suppression of human immunodeficiency virus type 1 viral load with selenium supplementation

T2 - A randomized controlled trial

AU - Hurwitz, Barry

AU - Klaus, Johanna R.

AU - Llabre, Maria

AU - Gonzalez, Alex

AU - Lawrence, Peter J.

AU - Maher, Kevin J.

AU - Greeson, Jeffrey M.

AU - Baum, Marianna K.

AU - Shor-Posner, Gail

AU - Skyler, Jay S

AU - Schneiderman, Neil

PY - 2007/1/22

Y1 - 2007/1/22

N2 - Background: Despite findings that selenium supplementation may improve immune functioning, definitive evidence of its impact on human immunodeficiency virus (HIV) disease severity is lacking. Methods: High selenium yeast supplementation (200 μg/d) was evaluated in a double-blind, randomized, placebo-controlled trial. Intention-to-treat analyses assessed the effect on HIV-1 viral load and CD4 count after 9 months of treatment. Unless otherwise indicated, values are presented as mean±SD. Results: Of the 450 HIV-1-seropositive men and women who underwent screening, 262 initiated treatment and 174 completed the 9-month follow-up assessment. Mean adherence to study treatment was good (73.0%±24.7%) with no related adverse events. The intention-to-treat analyses indicated that the mean change (Δ) in serum selenium concentration increased significantly in the selenium-treated group and not the placebo-treated group (Δ = 32.2±24.5 vs 0.5±8.8 μg/L; P<.001), and greater levels predicted decreased HIV-1 viral load (P<.02), which predicted increased CD4 count (P<.04). Findings remained significant after covarying age, sex, ethnicity, income, education, current and past cocaine and other drug use, HIV symptom classification, antiretroviral medication regimen and adherence, time since HIV diagnosis, and hepatitis C virus coinfection. Follow-up analyses evaluating treatment effectiveness indicated that the non-responding selenium-treated subjects whose serum selenium change was less than or equal to 26.1 μg/L displayed poor treatment adherence (56.8%±29.8%), HIV-1 viral load elevation (Δ = +0.29±1.1 log10 units), and decreased CD4 count (Δ = -25.8±147.4 cells/μL). In contrast, selenium-treated subjects whose serum selenium increase was greater than 26.1 μg/L evidenced excellent treatment adherence (86.2%±13.0%), no change in HIV-1 viral load (Δ = -0.04±0.7 log10 units), and an increase in CD4 count (Δ = +27.9±150.2 cells/μL). Conclusions: Daily selenium supplementation can suppress the progression of HIV-1 viral burden and provide indirect improvement of CD4 count. The results support the use of selenium as a simple, inexpensive, and safe adjunct therapy in HIV spectrum disease. Trial Registration: isrctn.org Identifier: IS-RCTN22553118

AB - Background: Despite findings that selenium supplementation may improve immune functioning, definitive evidence of its impact on human immunodeficiency virus (HIV) disease severity is lacking. Methods: High selenium yeast supplementation (200 μg/d) was evaluated in a double-blind, randomized, placebo-controlled trial. Intention-to-treat analyses assessed the effect on HIV-1 viral load and CD4 count after 9 months of treatment. Unless otherwise indicated, values are presented as mean±SD. Results: Of the 450 HIV-1-seropositive men and women who underwent screening, 262 initiated treatment and 174 completed the 9-month follow-up assessment. Mean adherence to study treatment was good (73.0%±24.7%) with no related adverse events. The intention-to-treat analyses indicated that the mean change (Δ) in serum selenium concentration increased significantly in the selenium-treated group and not the placebo-treated group (Δ = 32.2±24.5 vs 0.5±8.8 μg/L; P<.001), and greater levels predicted decreased HIV-1 viral load (P<.02), which predicted increased CD4 count (P<.04). Findings remained significant after covarying age, sex, ethnicity, income, education, current and past cocaine and other drug use, HIV symptom classification, antiretroviral medication regimen and adherence, time since HIV diagnosis, and hepatitis C virus coinfection. Follow-up analyses evaluating treatment effectiveness indicated that the non-responding selenium-treated subjects whose serum selenium change was less than or equal to 26.1 μg/L displayed poor treatment adherence (56.8%±29.8%), HIV-1 viral load elevation (Δ = +0.29±1.1 log10 units), and decreased CD4 count (Δ = -25.8±147.4 cells/μL). In contrast, selenium-treated subjects whose serum selenium increase was greater than 26.1 μg/L evidenced excellent treatment adherence (86.2%±13.0%), no change in HIV-1 viral load (Δ = -0.04±0.7 log10 units), and an increase in CD4 count (Δ = +27.9±150.2 cells/μL). Conclusions: Daily selenium supplementation can suppress the progression of HIV-1 viral burden and provide indirect improvement of CD4 count. The results support the use of selenium as a simple, inexpensive, and safe adjunct therapy in HIV spectrum disease. Trial Registration: isrctn.org Identifier: IS-RCTN22553118

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