Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

76 Abstracts WePeB5987-WePeB5991

XIV International AIDS Conference

WePeB5987 Effect of multivitamin supplementation on genital
tract shedding of human immunodeficiency virus
type 1: results of a randomized trial
R.S. McClelland', J.M. Baeten', J. Overbaugh2, B.A. Richardson1,
K. Mandaliya3, S. Emery2, L. Lavreys', J.O. Ndinya-Achola4, J.J. Bwayo4,
J.K. Kreiss'. 'University of Washington, University of Washington, Box 359909,
325 9th Avenue, Seattle, wa 98104, United States; 2Fred Hutchinson Cancer
Research Center, Seattle, United States; 3Coast Provincial General Hospital,
Mombasa, Kenya; 4 University of Nairobi, Nairobi, Kenya
Background: Vitamin supplementation has been proposed as a means of modifying HIV-1 transmissibility Among pregnant women in Tanzania, multivitamins
reduced adverse pregnancy outcomes but were also associated with a trend toward increased HIV-1 infection among infants. The objective of this study was to
evaluate the effect of multivitamins on genital tract shedding of HIV-1.
Method: Between September 1998 and June 2000, a randomized trial of six
weeks of daily multivitamin supplementation (20 mg B1, 20 mg B2, 25 mg B6,
100 mg niacin, 50 ptg B12, 500 mg C, 30 mg E, 0.8 mg folic acid, and 200 tg
selenium) was conducted among 400 non-pregnant HIV-1 seropositive women
in Mombasa, Kenya. Vaginal and cervical swabs were collected for detection of
HIV-1 infected cells and RNA by PCR.
Results: The prevalence of HIV-1 infected cells in vaginal secretions was higher
among women who received multivitamins than among women who received
placebo (55/175, 31% vs. 30/176, 17%; p = 0.002). Likewise, the prevalence of
quantifiable vaginal HIV-1 RNA (>125 copies/swab) was higher among women
receiving multivitamins (133/175, 76% vs. 113/176, 64%; p = 0.02). The median
vaginal HIV-1 RNA level was 3.30 log1o copies/swab in women taking multivitamins versus 2.87 logo10 copies/swab in women taking placebo (p = 0.1). There
were no significant differences in cervical HIV-1 infected cells, cervical HIV-1
RNA, or plasma viral load. Multivitamin supplementation resulted in higher median CD4 (279 vs. 241 cells/ll; p = 0.09) and CD8 (807 vs. 650 cells/1l; p <0.001) lymphocyte counts.
Conclusions: Multivitmain supplementation increased vaginal shedding of HIV-1
infected cells and free virus. Multivitamins are unlikely to decrease HIV-1 infectivity among women. Moreover, increased genital tract shedding among women
receiving multivitamins could increase HIV-1 transmission.
Presenting author: R. Scott McClelland, University of Washington, Box 359909,
325 9th Avenue, Seattle, wa 98104, United States, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
WePeB5988I Zinc deficiency affects disease progression in
HIV+ drug users
M.K. Baum1, A. Campa1, S. Lai2, H. Lai2, S. Sales', Z. Yang', J. Scott1,
B. Page3. 'Florida International University, Florida International University,
University Park, CH 230, Miami, FL 33199, United States; 2John Hopkins
University, Baltimore, MD, United States; 3 University of Miami, Miam FL, United
States
Background: Zinc deficiency reduces the generation of T-cells, and depresses
humoral and cell-mediated immunity. The significance of zinc deficiency in HIV1 infection, however, has not been elucidated despite various HIV+ populations,
including those on HAART exhibiting plasma levels of zinc indicative of zinc deficiency. HIV + drug users are at a particularly high risk for developing zinc deficiency due to poor dietary intake that characterizes this population. The objective
of this study was to evaluate the relationship between zinc status and disease
progression in HIV+ drug users.
Method: Immunological and nutritional profiles of 118 HIV-1+ drug users were
assessed every 6 months in Miami, Florida, between 1994-1998. Fasting blood
was drawn at each visit for plasma zinc, CD4 cell count and other immunological parameters. The relationship between plasma zinc and immune function over
time was analyzed by the General Estimate Equation (GEE), controlling for antiretroviral therapy.
Results: Fifty-six percent of the subjects (n=67) had plasma zinc levels
<0.751g/ml, indicative of zinc deficiency. Plasma zinc was positively and significantly associated with CD4 cell count (13=0.679, p=0.005), and total lymphocyte
count (13=0.509, p=0.011), and inversely associated with 132 microglobulin (13 = -
0.509, p=0.027) after adjusting for age, gender, race and antiretroviral therapy.
Zinc deficiency was also significantly associated with advanced HIV-1 disease
(OR=1.72, p=0.002) over time, defined as CD4 count <200 cells/mm3.
Conclusions: Zinc deficiency defined by low plasma zinc levels over time enhances HIV-associated disease progression in HIV-1 infected drug users. A clinical trial is ongoing to determine whether supplementing dietary zinc will correct
zinc deficiency and slow disease progression.
Support: NIDA, NIHM, and Fogarty International Center.
Presenting author: Marianna Baum, Florida International University, University
Park, CH 230, Miami, FL 33199, United States, Tel.: [phone], Fax: [phone], E-mail: baumm @fiu.edu

WePeB5989I Vitamin A supplementation and HIV-1 shedding in
women: results of a randomized clinical trial
J.M. Baeten', R.S. McClelland', J. Overbaugh2, B.A. Richardson', S. Emery2,
L. Lavreys', K. Mandaliya3, D.D. Bankson', J.O. Ndinya-Achola4, J.J. Bwayo4,
J.K. Kreiss'. 'University of Washington, IARTR Box 359909, 325 Ninth Ave,
Seattle, WA 98104, United States; 2Fred Hutchinson Cancer Research Center,
Seattle, United States; 3Coast Provincial General Hospital, Mombasa, Kenya;
4 University of Nairobi, Nairobi, Kenya
Background: Observational studies have associated vitamin A deficiency with
vaginal shedding of human immunodeficiency virus type 1 (HIV-1) infected cells
and mother-to-child HIV-1 transmission.
Methods: To assess the effect of vitamin A supplementation on vaginal shedding of HIV-1, a randomized, double-blind, placebo-controlled trial of 6 weeks of
daily oral vitamin A (10,000 IU retinyl palmitate) was conducted among 400 HIV-1
infected women in Mombasa, Kenya.
Results: At follow-up, there was no statistically significant difference in the prevalence of HIV-1 DNA (18% vs. 21%, p=0.4) or the quantity of HIV-1 RNA (3.12 vs.
3.00 log10 copies/swab, p=1.0) in vaginal secretions of women receiving vitamin
A compared to women receiving placebo. No significant effect of supplementation
on plasma HIV-1 viral load or CD4 or CD8 counts was observed, and no effect
was seen among women who were vitamin A deficient at baseline (serum retinol
<30 ig/dl, 59% of the study sample).
Conclusions: Vitamin A supplementation is unlikely to decrease the infectivity of
women infected with HIV-1.
Presenting author: Jared Baeten, IARTP, Box 359909, 325 Ninth Ave, Seattle,
WA 98104, United States, Tel.: [phone], Fax: [phone], E-mail:
jbaeten@ u.washington.edu
WePeB5990 The effect of nutrition and exercise advice on lipid
profiles of HIV+ patients with hyperlipidemia
M. Liss', C. Vaamonde2, B. Boyle2. 1Center For Special Studies,
NewYork-Presbyterian Hospital, New York Presbyterian Hospital, 525 e. 68th
street, f-24, New York, 10021, United States; 2Weill Medical College, Cornell
University, New York, New York, United States
Background: Nutrition and exercise interventions have favorable effects on abnormal lipid profiles in the general population. Little data exists on the impact of
these interventions on HAART-associated hyperlipidemia (HAH).
Methods: Retrospective medical record review of patients (Pts) with documented
hyperlipidemia, on stable HAART for at least 3 months, who were referred to a
registered dietitian (RD) for nutrition/exercise advice (NEA). Pts with at least 6
months or more of lipid profile follow-up while not taking lipid-lowering drugs were
included. Mean change in pre- and post-NEA CHOL, HDL, LDL, CHOL/HDL ratio, and triglyceride (TG) levels were compared using a paired T-test. National
Cholesterol Education Program (NCEP) guidelines were applied to lipid profiles
and compared pre- and post-NEA. In Pts > 120% of their ideal body weight (IBW),
weight loss (at least 5% of baseline) was a concomitant goal of the NEA. Attainment of weight loss goal was assessed as a marker of adherence to the NEA.
Results: Twenty five Pts (mean age: 47; 10 females; 12 Pts > 120% IBW) met inclusion criteria. TG levels showed significant improvement as a result of the NEA,
with a mean change in TG of 83.9 mg/dl (P<0.05). Changes in all other components of the lipid profile were not significant. Of Pts who failed to meet their
baseline NCEP goals, 0%, 4%, 16%, 8%, and 12% were able to meet their postNEA CHOL, HDL, LDL, CHOL/HDL ratio, and TG NCEP goals, respectively. Only
2 of 12 overweight Pts met their weight loss goal.
Conclusion: HIV+ Pts with HAH referred to a RD for NEA were found to have
significant decreases in their TG levels, but little improvement in meeting NCEP
guidelines. The majority of overweight Pts did not meet their weight loss goal,
suggesting that NEA non-adherence may be the reason for failure of the intervention.
Presenting author: Meredith Liss, New York Presbyterian Hospital, 525 e. 68th
street, f-24, New York, 10021, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB5991 Potential benefit of selenium as an adjuvant
therapy in the HAART era
G. Shor-Posner', M.J. Miguez', X. Burbano', A. Rodriguez', P. Ruiz',
G. Zhang', M.K. Baum2. 1University of Miami School of Medicine, University of
Miami School of Medicine, Dept. of Psychiatry (D21), 1400 N. W 10th ave., 6th
floor, United States; 2Florida International University, Miami, United States
Background: Deficiency of the trace element selenium has been shown to dramatically increase the risk of HIV-1 related mortality. The present findings are
based on recently completed studies to determine the impact of selenium chemoprevention on HIV disease progression.

Methods: 259 HIV+ drug users (147 men, 112 women) were enrolled in a randomized, double-blind, placebo-controlled trial and followed over two years (1998 -2000). Monthly pills of selenium (2001ig/day) or placebo were dispensed and patients evaluated every 6 months for both clinical and laboratory variables. At the
12-month evaluation, data from 46 selenium and 63 placebo-treated participants
were available for analysis using Chi square or Fischer exact tests.
Results: Selenium-administered compliant participants, defined as those who