Predictive factors of hyperhomocysteinemia in HIV-positive patients

The impact of homocysteine, B12, and D vitamins levels on functional neurocognitive performance in HIV-positive subjects

Background

The correlation among high levels of total homocysteine, low levels of B₁₂vitamin, and neurocognitive impairment in HIV negative patients has been the main research topic in some of the latest reviews. The aim of this study was to examine if the alteration of homocysteine, B₁₂ vitamin, and D vitamins plasma levels was present in HIV-positive, and their relationship with cognitive function.

Methods

57 HIV infected were enrolled and underwent the serum measurement of homocysteine, B₁₂, and D vitamins. The neurocognitive evaluation investigated 5 cognitive domains, through a neuropsychological battery test

Results

Homocysteine was found to be elevated in 70.2% of cases, B₁₂ vitamin mean levels were low in 8 participants (14.0%), and 8 patients had D hypovitaminosis (14.0%). Abnormal homocysteine levels were associated with worse performance of verbal fluency (p = 0.003) and worse executive function (Stroop E test p = 0.040). The 25-OH D hypovitaminosis was associated with worse performances in executive functions in three different tests: Stroop E (p = 0.049), Trail B (p = 0.035), and Wais Digit Span (p = 0.042). Pathological levels of B₁₂ Vitamin were also associated to worse performances in executive functions (Trail B Test and Wais Digit Span respectively p = 0.002 and 0.029) and with a lower speed in psychomotor processing (Peg Board Test on dominant hand, p = 0.014).

Conclusions

In this study serum homocysteine, B₁₂, and D vitamin levels are associated with neurocognitive performances; in fact low performance neurocognitive was correlated with hyperhomocysteine and low B₁₂vitamin, and D vitamin levels. Evidence of the alteration of these parameters could facilitate the early identification of a neurocognitive impairment.

Dietary B Vitamins and Depression in Persons with Human Immunodeficiency Virus Infection: The Positive Living with HIV (POLH) Study

B vitamins have beneficial roles in mental health functional impairments; however, research on the role of B vitamins in depression among HIV-infected persons is limited. This study assessed the association between dietary B vitamin intake and depressive symptoms in a cohort of HIV-infected persons. A cross-sectional survey was conducted among 314 HIV-infected persons (180 men and 134 women) aged 18 to 60 y residing in the Kathmandu, Nepal. The Beck Depression Inventory-I was used to measure depression, with a cutoff score of 20 or higher. Dietary intake was assessed using two nonconsecutive 24-h dietary recalls. The relationships between B vitamins and depressive symptoms were assessed using multiple logistic regression analysis. Twenty-six percent participants (men: 23%; women: 29%) were depressed. More than two thirds of participants' B vitamins intake were below the estimated average requirements (EAR) level. Low intake of riboflavin was associated with an increased risk of depression in women but not in men. Multivariate OR (95% CI) for depression in the first, second, and third tertiles of riboflavin in total participants were 1 (reference), 0.87 (0.46-1.64), and 0.49 (0.24-0.98), respectively (p for trend=0.048) and in women were 1 (reference), 0.94 (0.36-2.40), and 0.23 (0.07-0.77), respectively (p for trend=0.020). No clear associations were seen between other B vitamins and depressive symptoms in either sex. Low intake of riboflavin was independently associated with an increased risk of depressive symptoms in all participants and in HIV-infected women. Further prospective studies are warranted to confirm the role of vitamin B vitamins in depressive symptoms among HIV-infected persons.

Increased homocysteine plasma level is associated with shortened prothrombin time in HIV-infected patients

OBJECTIVE

To find factors associated with increased homocysteine plasma level in HIV-infected patients.

METHODS

Cross-sectional study, carried out as a supplementary task to the standard care of HIV-infected patients. The possible association of increased homocysteine plasma level with blood analyses results was assessed with a multiple linear regression analysis, using the automatic linear modeling available in SPSS version 22.

RESULTS

A total of 145 patients were included. Creatinine was higher than normal in 7 patients (5%), prothrombin time was shortened in 36 patients (25%), and a monoclonal gammopathy was detected in 2 patients (1%). In the regression analysis, an association was found between high homocysteine plasma level and the following variables: low prothrombin time (β coefficient -0.286, confidence interval -1.1854 to -0.754, p < 0.001), high creatinine (coefficient 9.926, confidence interval 6.351-15.246, p < 0.001), low folic acid (coefficient -0.331, confidence interval -0-483 to -0.187, p < 0.001), and low vitamin B12 (coefficient -0.007, confidence interval -0.01 to -0.001, p = 0.005).

CONCLUSION

An association was found between increased homocysteine plasma level and shortened prothrombin time.

Association between Plasma Homocysteine Levels and Neuronal Injury in HIV Infection

Objective

To investigate the role of homocysteine in neuronal injury in HIV infection.

Methods

Using a cross-sectional design and archived samples, we compared concentrations of plasma homocysteine and cerebrospinal fluid (CSF) neurofilament light protein (NFL), a sensitive marker of neuronal injury, in 83 HIV-1-infected subjects without antiretroviral treatment. We also analyzed plasma vitamin B₁₂, serum folate, CSF, and plasma HIV RNA, the immune activation marker neopterin in CSF and serum, and albumin ratio as a marker of blood-brain barrier integrity. Twenty-two subjects provided a second sample median of 12.5 months after antiretroviral treatment initiation.

Results

A significant correlation was found between plasma homocysteine and CSF NFL concentrations in untreated individuals (r = 0.52, p < 0.0001). As expected, there was a significant inverse correlation between homocysteine and B₁₂ (r = –0.41, p < 0.001) and folate (r = –0.40, p = < 0.001) levels. In a multiple linear regression analysis homocysteine stood out as an independent predictor of CSF NFL in HIV-1-infected individuals. The correlation of plasma homocysteine and CSF NFL was also present in the group receiving antiretroviral therapy (r = 0.51, p = 0.016).

Conclusion

A correlation between plasma homocysteine and axonal injury, as measured by CSF NFL, was found in both untreated and treated HIV. While this study is not able to prove a causal link, homocysteine and functional B₁₂/folate deficiency appear to play a role in neural injury in HIV-infected individuals.

Dietary B Vitamins and Serum C-Reactive Protein in Persons With Human Immunodeficiency Virus Infection: The Positive Living With HIV (POLH) Study

BACKGROUND

B vitamins may have beneficial roles in reducing inflammation; however, research on the role of B vitamins in inflammation among HIV-infected persons is lacking.

OBJECTIVE

This study assessed the association between B vitamins and serum C-reactive protein (CRP) concentrations in HIV-infected persons.

METHODS

A cross-sectional survey was conducted among 314 HIV-infected persons (180 men and 134 women) aged 18 to 60 years residing in the Kathmandu, Nepal. High-sensitive and regular serum CRP concentrations were measured by the latex agglutination nephelometry and latex agglutination turbidimetric method, respectively. Dietary intake was assessed using 2 nonconsecutive 24-hour dietary recalls. The relationships between B vitamins and serum CRP concentrations were assessed using multiple regression analysis.

RESULTS

The multivariate-adjusted geometric mean of serum CRP concentrations was significantly decreased with an increasing B vitamins intake across quartiles of niacin (P for trend = .007), pyridoxine (P for trend = .042), and cobalamin (P for trend = .037) in men. In men, the mean serum CRP concentrations in the highest quartiles of niacin, pyridoxine, and cobalamin were 63%, 38%, and 58%, respectively, lower than that in the lowest quartile. In women, the mean serum CRP concentrations in the highest quartiles of riboflavin (P for trend = .084) and pyridoxine (P for trend = .093) were 37% and 47%, respectively, lower than that in the lowest quartile.

CONCLUSION

High intake of niacin, pyridoxine, or cobalamin was independently associated with decreased serum CRP concentrations among HIV-infected men. Further prospective studies are warranted to confirm the role of B vitamins in inflammation among HIV-infected persons.

Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women

BACKGROUND

Little is known about the influence of antiretroviral therapy with or without micronutrient supplementation on the micronutrient concentrations of HIV-infected lactating women in resource-constrained settings.

OBJECTIVE

We examined associations of highly active antiretroviral therapy (HAART) and lipid-based nutrient supplements (LNS) with concentrations of selected micronutrients in HIV-infected Malawian women at 24 wk postpartum.

METHODS

Plasma micronutrient concentrations were measured in a subsample (n = 690) of Breastfeeding, Antiretrovirals, and Nutrition (BAN) study participants who were randomly assigned at delivery to receive HAART, LNS, HAART+LNS, or no HAART/no LNS (control). HAART consisted of protease inhibitor-based triple therapy. LNS (140 g/d) met energy and micronutrient requirements of lactation. Multivariable linear regression tested the association of HAART and LNS, plus their interaction, with micronutrient concentrations, controlling for season, baseline viral load, and baseline CD4 count.

RESULTS

We found significant HAART by LNS interactions for folate (P = 0.051), vitamin B-12 (P < 0.001), and transferrin receptors (TfRs) (P = 0.085). HAART was associated with lower folate (with LNS: -27%, P < 0.001; without LNS: -12%, P = 0.040) and higher TfR concentrations (with LNS: +14%, P = 0.004; without LNS: +28%, P < 0.001), indicating iron deficiency. LNS increased folate (with HAART: +17%, P = 0.037; without HAART: +39%, P < 0.001) and decreased TfR concentrations (with HAART only: -12%, P = 0.023). HAART was associated with lower vitamin B-12 concentrations only when LNS was present (-18%, P = 0.001), whereas LNS increased vitamin B-12 only when no HAART was present (+27%, P < 0.001). HAART, but not LNS, was associated with higher retinol-binding protein (RBP; +10%, P = 0.007). We detected no association of HAART or LNS with selenium, ferritin, or hemoglobin.

CONCLUSION

The association of HAART with lower folate, iron deficiency, and higher RBP plus the attenuation of LNS effects on folate and vitamin B-12 when combined with HAART has implications for the health of lactating HIV-infected women taking HAART in prevention of mother-to-child transmission programs. This trial was registered at clinicaltrials.gov as NCT00164736.

Plasma homocysteine levels in HIV-infected men with and without lipodystrophy

OBJECTIVE

Lipodystrophy syndrome is an unexpected clinical manifestation in patients infected with HIV and might be a clinical marker of increased risk for cardiovascular diseases (CVDs). Because hyperhomocysteinemia has been associated with CVD, the goal of the present study was to investigate homocysteine (Hcy) levels and their association with the factors of lipodystrophy syndrome in men with HIV.

METHODS

Hcy metabolism-related molecules were determined in 13 men infected with HIV with lipodystrophy (HIV+LIP), 10 men with HIV without lipodystrophy (HIV), and 10 healthy controls (C).

RESULTS

Significant (P < 0.05) increased Hcy plasma levels were found in HIV (20.5%) and in HIV+LIP (35.2%) compared with the control group. Plasma levels of vitamin B12 (HIV, 26.5%; HIV+LIP, 28.8%) and folate (HIV, 39.1% and HIV+LIP, 49.4%) were significantly (P < 0.05) lower in the two groups of HIV patients compared with control. HIV+LIP men presented raised plasma total sulfur-containing amino acids (20.1%) and lower total plasma thiol (11.3%) than controls. The same was not observed in the HIV group. Spearman's correlation test revealed significant (P < 0.05) association between plasma Hcy and duration of highly active antiretroviral therapy (HAART) and plasma insulin, as well as plasma adiponectin levels.

CONCLUSION

Our results demonstrated that HIV+LIP men were more susceptible to disturbances in Hcy metabolism compared with men infected with HIV without lipodystrophy characteristics. Duration of HAART treatment, elevated plasma insulin, and low levels of adiponectin seem to be relevant for the appearance of these Hcy metabolic disorders.

Effect of highly active antiretroviral therapy on homocysteine plasma concentrations in HIV-1-infected patients

OBJECTIVE

To analyze the effect of antiretroviral therapy on homocysteine levels in HIV-1-infected patients.

DESIGN

Observational, prospective study of patients with AIDS.

METHODS

We included patients with HIV-1 infection naive for antiretroviral drugs. Before and after 6 months of treatment, we evaluated fasting and postoral methionine load plasma homocysteine, serum vitamins B6 and B12, and intraerythrocyte folate levels.

RESULTS

We studied 69 patients who began therapy for a 6-month period. Fasting and postoral methionine load plasma homocysteine levels increased significantly after 6 months of antiretroviral therapy with respect to basal values (P < 0.001). Fasting hyperhomocysteinemia was present in 7.3% of patients before treatment and in 89.9% after 6 months of therapy (P = 0.0001). Postoral methionine load hyperhomocysteinemia was found in 4.5% of subjects before therapy vs. 98.5% at the end of study period (P = 0.001). These results were not associated with folate or vitamins B6 or B12 levels.

CONCLUSIONS

In patients with HIV-1 infection, fasting and postoral methionine load plasma homocysteine levels increased after 6 months of antiretroviral treatment. Nutritional abnormalities were not responsible for hyperhomocysteinemia, suggesting that enzymatic disturbances in the metabolic pathways of homocysteine may occur.

Plasma homocysteine is not associated with HIV serostatus or antiretroviral therapy in women

BACKGROUND

The effects of HIV serostatus and combination antiretroviral therapy (cART) on plasma homocysteine (HCY) are uncertain.

METHODS

Plasma HCY was assayed in a cross-sectional study of 249 HIV-infected and 127 HIV-uninfected women at the Bronx Women's Interagency HIV Study site.

RESULTS

Mean plasma HCY was 7.42 +/- 2.68 in HIV-infected women and 7.18 +/- 2.66 mumol/L in HIV-uninfected women (P = 0.40). Hyperhomocysteinemia (defined as HCY >10 mumol/L) was seen in 16.9% and 13.4% of HIV-infected and HIV-uninfected women, respectively (P = 0.45). Among HIV-infected women, cART use was not associated with HCY level. Compared with the lowest quartile, women with HCY in the highest quartile had lower mean serum vitamin B12 and RBC folate levels. In multivariate analysis that did not include micronutrient levels, age, serum creatinine, and lower CD4% were significantly associated with plasma HCY level in HIV-infected women.

CONCLUSIONS

Plasma HCY was not associated with HIV serostatus or use of cART in this cross-sectional study. Reduced availability of folate cofactors for HCY remethylation in HIV-infected women with lower folate intake and decreased health status may influence HCY levels.