Nutritional Indices and Cardiovascular Risk Factors in HIV Infection in Southern Nigeria

Öz

Background: Viral load and specific drug related toxicities have been implicated in nutritional and metabolic disturbances in HIV infection. This study evaluated some micro, macro nutrients and cardiovascular risk factors in HIV infection with or without highly active antiretroviral therapy (HAART).

Material and Methods: Ninety subjects (18-65 years) comprising of 30 sero-positive HIV on HAART, 30 sero-positive HAART naïve and 30 HIV sero-negative subjects were recruited into the study. Fasting plasma glucose (FPG), total proteins (TP), albumin, vitamin C, total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) were estimated using colorimetric methods, zinc (Zn), copper (Cu) by atomic absorption spectrophotometry, CD4+ T cell count by flow cytometry while body mass index (BMI), globulin, atherogenic index of plasma (AIP), albumin/globulin ratio (A/G), very low density lipoprotein cholesterol (VLDL-C), low density lipoprotein cholesterol (LDL-C) were calculated. Data were analyzed using ANOVA, LSD post hoc at p< 0.05.

Results: HIV sero-negative subjects had higher BMI, CD4-T cell count, albumin, vitamin C, Zn, LDL-C, A/G ratio and lower FPG, globulin, Cu compared to HAART naïve; and higher BMI, CD4+T cell count, albumin, vitamin C, Zn with lower FPG, globulin, Cu, TG, and VLDLC compared to HIV on HAART respectively (p<0.05). HIV on HAART had increased albumin, A/G ratio, FPG, LDLC, VLDL, TG, TC and lower CD4 +T cell count, TP, globulin and Zn compared to HAART naive subjects (p<0.05).

Conclusion: Disturbances in homeostasis of total proteins, antioxidant micronutrients with dyslipidemia and increased risk of cardiovascular disorders in HIV infection may be aggravated by HAART.

Anahtar Kelimeler

• HAART,HIV,lipid profile,micronutrients,proteins

Kaynakça

1. 1. Martin A, EmeryS. Metabolic disorders and cardiovascular consequences of HIV infection and antiretroviral therapy. Epert Rev Clin Pharmacol 2009;2:381-390.
2. 2. Sellmeyer DE, Grunfeld C. Endocrine and metabolic disturbances in human immunodeficiency virus infection and the acquired immune deficiency syndrome. Endocr Rev 1996; 17:518-532.
3. 3. Serpa J, Haque D, Valayam J, Breaux K, Rodriguez-Barradas MC. Effect of combination antiretroviral treatment on total protein and calculated globulin levels among HIV-infected patients. International Journal of Infectious Diseases 2010; 14S:e41–e44.
4. 4. Drain PK, Kupka R, Mugusi F, Fawzi WW. Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy. American Journal of Clinical Nutrition 2007; 85(2):333-345.
5. 5. Cunningham-Rundles S, McNeeley DF, Moon A. Mechanism of nutrient modulation of the immune response. J Allergy Clin Immunol 2005; 115:1119-1128.
6. 6. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, 2013.
7. 7. Arai H, Petchclai B, Khupulsup K, Kurimura T, Takeda K. Evaluation of a rapid immunochromatographic test for detection of antibodies to human immunodeficiency virus. J Clin Microbiol 1999;37:367-370.
8. 8. Mandy FF, Bergeron M, Minkus T. Principles of flow cytometry. Transfus Sci 1995;16:303-314.

9. 9. Laboratory Methods Committee of the Lipid Research Clinics Program: Cholesterol and triglyceride concentrations in serum/plasma pairs. Clin Chem 1977;23:60-63
10. 10. Fossati P, Prencipe L. Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide. Clinical chemistry 1982; 28(10):2077-2080.
11. 11. Natio HK. High-density lipoprotein (HDL) cholesterol. In: Kaplan L A, Pesce AJ, Kazmierczak SC. editors, Clinical Chemistry, theory, analysis and correlations.4th ed, Mosby Inc, St Louis USA, 1984, p.437,1207-1213.
12. 12. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical Chemistry 1972; 18: 499-502.
13. 13. Dobiasova M, Frohlich J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clinical Biochemistry 2001; 34:583-588.
14. 14. Roe JH, Kuether CA. Determination of ascorbic acid in whole blood and urine through the 2:4- dinitrophenylhydrazine derivateof dehydroascorbic acid. J. biol. Chem 1943; 147:399-406.
15. 15. Fenk CJ, Kaufman N, Gerbig D.G. Protein detection and measurement. J Chem Educ 2007; 84:1676-1678.
16. 16. Doumas BT, Biggs HG. Determination of serum albumin,– Standard methods of clinical chemistry , Acad. Press. N.Y. 1972; 7: p.175-188.
17. 17. Everson ME. Spectrophotometric techniques. In: Burtis CA, Ashwood ER, editors, Tietz Textbook of Clinical Chemistry, W. B. Saunders, Philadelphia, Pa, USA, 3rd ed, 1999, p. 75–93.
18. 18. Cunha J, Maselli LMF, Stern ACB, Spada C, Bydlowski SP. Impact of antiretroviral therapy on lipid metabolism of human immunodeficiency virus-infected patients: Old and new drugs World J Virol 2015;4:56-77.
19. 19. Cerrato E, Calcagno A, D'Ascenzo F, Biondi-Zoccai G. Cardiovascular disease in HIV patients: from bench to bedside and backwards. Open heart 2015;2:e000174.
20. 20. Mulligan K, Grunfeld C, Tai VW, Algren H. Hyperlipidemia and insulin resistance are induced by protease inhibitors independent of changes in body composition in patients with HIV infection. J Acquir Immune Defic Syndr 2000; 23:35-43.
21. 21. Agu CE, Usoro CAO, Inaku KO, Nsonwu AC, Offor SJ. Cross-sectional analysis of cardiovascular risk markers among obese males and females in Southern Nigeria. Scholars Journal of Applied Medical Sciences 2016; 4(5A):1471-1478.
22. 22. Ngatchou W, Lemogoum D, Ndobo P, Yagnigni E. Increased burden and severity of metabolic syndrome and arterial stiffness in treatment-naive HIV + patients from Cameroon. Vasc Health Risk Manag 2013;9:509–516.
23. 23. Hima BA, Naga AP. Adverse effects of highly active anti-retroviral therapy (HAART). J Antivir Antiretrovir 2011; 3:060-64.
24. 24. Grinspoon S. Diabetes mellitus, cardiovascular risk, and HIV disease. Circulation 2009; 119:770-772.
25. 25. Limone P, Biglino A, Valle M, Degioanni M. Insulin resistance in HIV-infected patients: relationship with pro-inflammatory cytokines released by peripheral leukocytes. Journal of Infection 2003;47(1):52-58.
26. 26. Brown TT, Tassiopoulos K, Bosch RJ, Shikuma C, McComsey GA. Association between systemic inflammation and incident diabetes in HIV-infected patients after initiation of antiretroviral therapy. Diabetes Care 2010; 33:2244–2249.
27. 27. Schreck R, Rieber P, Baeuerle PA. Reactive oxygen intermediates as apparently widely used messengers in the activation of the NF-κB transcription factor and HIV-1. The EMBO Journal 1991;10:2247-2258.
28. 28. Halliwell B. Albumin an important extracellular antioxidant? Biochem. Pharmacol. 1988; 37:569-571.
29. 29. Hu ML, Louie S, Cross, CE, Motchnik, P, Halliwell B. Antioxidant protection against hypochlorous acid in human plasma. J Lab Clin Med 1993; 121: 257-262.
30. 30. Pasupathi P, Ramchandran T, Sindhu PJ, Saranavan G, Bakthavathsalam G. Enhanced oxidative stress markers and antioxidant imbalance in HIV infection and AIDS patients. Journal of Scientific Research 2009; 1:370-380.
31. 31. Cote HC, Brumme ZL, Craib KJ. Changes in mitochondrial DNA as a marker of nucleoside toxicity in HIV patients. N Engl J Med 2002; 346:811-820.
32. 32. Visser ME, Maartens G, Kossew G, Hussey GD. Plasma vitamin and zinc concentrations in HIV-infected adults in Cape Town, South Africa. Br J Nutr 2003; 89:475-482.
33. 33. Egbe ER, Nsonwu-Anyanwu AC, Offor SJ, Usoro CAO, Etukudo MH, Egbe DI. Cement dust exposure and perturbations in some elements and lung and liver functions of cement factory workers. Journal of Toxicology 2016:1-7.
34. 34. Biron A, Bobin-Dubigeon C, Volteau C, Piroth L. Metabolic syndrome in French HIV-infected patients: prevalence and predictive factors after 3 years of antiretroviral therapy. AIDS research and human retroviruses 2012; 28:1672-1678.
35. 35. Toma E, Devost D, Chow LN, Bhat PV. HIV-protease inhibitors alter retinoic acid synthesis. AIDS 2001;5:1979-1984.