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Wobeser WL, McBane JE, Balfour L, Conway B, Gill MJ, Huff H, Kilby DLP, Fergusson DA, Mallick R, Mills EJ, Muldoon KA, Rachlis A, Ralph ED, Rosenes R, Singer J, Singhal N, Tan D, Tremblay N, Vo D, Walmsley SL, Cameron DW. A randomized control trial of high-dose micronutrient-antioxidant supplementation in healthy persons with untreated HIV infection. PLoS One 2022; 17:e0270590. [PMID: 35834528 PMCID: PMC9282469 DOI: 10.1371/journal.pone.0270590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Although micronutrient and antioxidant supplementation are widely used by persons with human immunodeficiency virus (HIV), a therapeutic role beyond recommended daily allowances (RDA) remains unproven. An oral high-dose micronutrient and antioxidant supplement (Treatment) was compared to an RDA supplement (Control) for time to progressive immunodeficiency or initiation of antiretroviral therapy (ART) in people living with HIV (PLWH). Methods This study was a randomized, double-blind, placebo-controlled multicenter clinical trial. PLWH were recruited from Canadian HIV Trials Network sites, and followed quarterly for two years. Eligible participants were asymptomatic, antiretroviral treatment (ART)-naïve, HIV-seropositive adults with a CD4 T lymphocyte count (CD4 count) between 375–750 cells/μL. Participants were randomly allocated 1:1 to receive Treatment or Control supplements. The primary outcome was a composite of time-to-first of confirmed CD4 count below 350 cells/μL, initiation of ART, AIDS-defining illness or death. Primary analysis was by intention-to-treat. Secondary outcomes included CD4 count trajectory from baseline to ART initiation or two years. A Data and Safety Monitoring Board reviewed the study for safety, recruitment and protocol adherence every six months. Results Of 171 enrolled participants: 66 (38.6%) experienced a primary outcome: 27 reached a CD4 count below 350 cells/μL, and 57 started ART. There was no significant difference in time-to-first outcome between groups (Hazard Ratio = 1.05; 95%CI: 0.65, 1.70), or in time to any component outcome. Using intent-to-treat censoring, mean annualized rates of CD4 count decline were -42.703 cells/μL and -79.763 cells/μL for Treatment and Control groups, with no statistical difference in the mean change between groups (-37.06 cells/μL/52 weeks, 95%CI: (-93.59, 19.47); p = 0.1993). Accrual was stopped at 171 of the 212 intended participants after an interim analysis for futility, although participant follow-up was completed. Conclusions In ART-naïve PLWH, high-dose antioxidant, micronutrient supplementation compared to RDA supplementation had no significant effect on disease progression or ART initiation. Clinical trial registration ClinicalTrials.gov Identifier: NCT00798772.
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Affiliation(s)
- Wendy L. Wobeser
- Department of Biomedical and Molecular Sciences and Public Health, Queen’s University, Kingston, Ontario, Canada
| | - Joanne E. McBane
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Louise Balfour
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Brian Conway
- Vancouver Infectious Disease Clinic, Vancouver, British Columbia, Canada
| | - M. John Gill
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Harold Huff
- Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Donald L. P. Kilby
- Faculty of Health Services, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A. Fergusson
- Clinical Epidemiology Program (CEP), University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Edward J. Mills
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Global Evaluative Sciences, Vancouver, British Columbia, Canada
| | - Katherine A. Muldoon
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Obstetrics and Maternal Investigations Research Group, The Ottawa Hospital, Ottawa, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anita Rachlis
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Edward D. Ralph
- Division of Infectious Diseases, Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Ron Rosenes
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
| | - Joel Singer
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neera Singhal
- Global Evaluative Sciences, Vancouver, British Columbia, Canada
| | - Darrell Tan
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- La Ka Shing Knowledge Institute, St. Michael’s, Toronto, Ontario, Canada
| | - Nancy Tremblay
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dong Vo
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sharon L. Walmsley
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - D. William Cameron
- CIHR Canadian HIV Trials Network (CIHR-CTN), Vancouver, British Columbia, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program (CEP), University of Ottawa at The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
- * E-mail:
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Batista KS, Cintra VM, Lucena PAF, Manhães-de-Castro R, Toscano AE, Costa LP, Queiroz MEBS, de Andrade SM, Guzman-Quevedo O, Aquino JDS. The role of vitamin B12 in viral infections: a comprehensive review of its relationship with the muscle-gut-brain axis and implications for SARS-CoV-2 infection. Nutr Rev 2022; 80:561-578. [PMID: 34791425 PMCID: PMC8689946 DOI: 10.1093/nutrit/nuab092] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This comprehensive review establishes the role of vitamin B12 as adjunct therapy for viral infections in the treatment and persistent symptoms of COVID-19, focusing on symptoms related to the muscle-gut-brain axis. Vitamin B12 can help balance immune responses to better fight viral infections. Furthermore, data from randomized clinical trials and meta-analysis indicate that vitamin B12 in the forms of methylcobalamin and cyanocobalamin may increase serum vitamin B12 levels, and resulted in decreased serum methylmalonic acid and homocysteine concentrations, and decreased pain intensity, memory loss, and impaired concentration. Among studies, there is much variation in vitamin B12 doses, chemical forms, supplementation time, and administration routes. Larger randomized clinical trials of vitamin B12 supplementation and analysis of markers such as total vitamin B12, holotranscobalamin, total homocysteine and methylmalonic acid, total folic acid, and, if possible, polymorphisms and methylation of genes need to be conducted with people with and without COVID-19 or who have had COVID-19 to facilitate the proper vitamin B12 form to be administered in individual treatment.
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Affiliation(s)
- Kamila S Batista
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Vanessa M Cintra
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Paulo A F Lucena
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Raul Manhães-de-Castro
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Ana E Toscano
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Larissa P Costa
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Maria E B S Queiroz
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Suellen M de Andrade
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Omar Guzman-Quevedo
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
| | - Jailane de S Aquino
- K.S. Batista and J.d.S. Aquino are with the Experimental Nutrition Laboratory, Department of Nutrition and Post Graduate Program in Nutrition Sciences, Federal University of Paraíba, Paraíba, Brazil. V.M. Cintra and P.A.F Lucena are with the Department of Medicine, Faculty of Medical Sciences of Paraíba, and the Department of Nutrition, Integrated Colleges of Patos, Paraíba, Brazil. V.M. Cintra is with the the Multiprofessional Residence in Child Health of Secretariat of Health of the State of Paraíba, Brazil. P.A.F Lucena is with Coordination of Neurology Services, Hospital Metropolitano Dom José Maria Pires, Santa Rita, Paraíba and Emergency, Trauma Hospital Senador Humberto Lucena, João Pessoa, Paraíba, Brazil. R. Manhães-de-Castro is with the Studies in Nutrition and Phenotypic Plasticity Unit, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil. R. Manhães-de-Castro and A.E. Toscano are with the Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil. A.E. Toscano is with the Department of Nursing, CAV, Federal University of Pernambuco, Pernambuco, Brazil. A.E. Toscano and O. Guzman-Quevedo are with the Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil. L.P. Costa, M.E.B.S. Queirozj, and S.M. de Andrade are with the Ageing and Neuroscience Laboratory, Health Sciences Center, Federal University of Paraíba, Paraíba, Brazil. O. Guzman-Quevedo is with the Higher Technological Institute of Tacámbaro, Tacámbaro, Michoacán, Mexico. O. Guzman-Quevedo is with the Center for Biomedical Research of Michoacán, Mexican Institute of Social Security, Morelia, Michoacán, Mexico
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Williams AA, Sitole LJ, Meyer D. HIV/HAART-associated oxidative stress is detectable by metabonomics. MOLECULAR BIOSYSTEMS 2018; 13:2202-2217. [PMID: 28920117 DOI: 10.1039/c7mb00336f] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Chronic human immunodeficiency virus (HIV) infection, separately and in combination with highly active antiretroviral therapy (HAART) is closely associated with oxidative stress (OS). Most studies demonstrating redox imbalances in HIV-infected individuals have done so using conventional biochemical methodologies. The limited simultaneous detection of multiple OS markers within one sample is a major drawback of these methodologies and can be addressed through the use of metabonomics. HIV-metabonomic studies utilizing biofluids from HAART cohorts as the investigative source, are on the increase. Data from many of these studies identified metabolic markers indicative of HIV-induced OS, usually as an outcome of an untargeted metabonomics study. Untargeted studies cast a wide net for any and all detectable metabolites in complex mixtures. Given the prevalence of OS during HIV infection and antiviral treatment, it is perhaps not surprising that indicators of this malady would become evident during metabolite identification. At times, targeted studies for specific (non-OS) metabolites would also yield OS markers as an outcome. This review examines the findings of these studies by first providing the necessary background information on OS and the main ways in which free radicals/reactive oxygen species (ROS) produced during OS, cause biomolecular damage. This is followed by information on the biomarkers which come about as a result of free radical damage and the techniques used for assaying these stress indicators. The established links between elevated ROS and lowered antioxidants during HIV infection and the subsequent use of HAART is then presented followed by a review of the OS markers detected in HIV metabonomic studies to date. We identify gaps in HIV/HAART-associated OS research and finally suggest how these research gaps can be addressed through metabonomic analysis, specifically targeting the multiple markers of HIV-induced OS.
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Affiliation(s)
- Aurelia A Williams
- Human Metabolomics, North-West University, Private Bag X6001, Box 269, Potchefstroom, 2531, South Africa
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Huff H, Merchant AT, Lonn E, Pullenayegum E, Smaill F, Smieja M. Vitamin D and progression of carotid intima-media thickness in HIV-positive Canadians. HIV Med 2017; 19:143-151. [PMID: 29110385 DOI: 10.1111/hiv.12563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Based on a growing body of evidence implicating low vitamin D status in the development of cardiovascular disease (CVD), we hypothesized that in Canadian HIV-positive adults, low 25-hydroxyvitamin D (25(OH)D) concentration would be associated with increased subclinical vascular disease progression. METHODS We prospectively studied the relationship between baseline 25(OH)D and subsequent progression of carotid intima-media thickness (CIMT) between 2002 and 2011, in the Canadian HIV Vascular Study using stored blood specimens. RESULTS Of the 128 participants, 89.1% were men, the mean age (standard deviation [SD]) was 46.5 (8.2) years, 93.8% were white, and 36.7% were current smokers. Mean (SD) annual CIMT follow-up was 5.9 (1.8) years (maximum 8.5 years), providing approximately 750 patient-years of follow-up. Mean (SD) CIMT progression was 0.027 (0.030) mm/year. Mean (SD) 25(OH)D was 95.0 (46.9) nmol/L. Only 13.3% of participants were vitamin D deficient (25(OH)D < 50 nmol/L), whereas 61.7% had a 25(OH)D exceeding the sufficiency threshold (75 nmol/L). Vitamin D quartiles were inversely associated with body mass index (BMI) (P = 0.034), total cholesterol to high-density lipoprotein (HDL) cholesterol ratio (P = 0.001) and parathyroid hormone concentration (P = 0.003), but not efavirenz exposure (P = 0.141). In linear regression analyses, baseline 25(OH)D as a continuous variable was inversely associated with CIMT progression in univariable (P < 0.001) and multivariable (P < 0.001) models. CONCLUSIONS Baseline 25(OH)D was associated with CIMT progression in this relatively vitamin D replete, predominately white and male, Canadian HIV-positive population. Future research needs to establish causality as this may warrant more targeted screening or supplementation.
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Affiliation(s)
- H Huff
- Department of Clinical Education, Canadian College of Naturopathic Medicine, Toronto, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, Health Research Methods, McMaster University, Hamilton, ON, Canada
| | - A T Merchant
- Department of Clinical Epidemiology and Biostatistics, Health Research Methods, McMaster University, Hamilton, ON, Canada.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - E Lonn
- Department of Clinical Epidemiology and Biostatistics, Health Research Methods, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Cardiology, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - E Pullenayegum
- Department of Clinical Epidemiology and Biostatistics, Health Research Methods, McMaster University, Hamilton, ON, Canada.,Sick Kids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - F Smaill
- Department of Pathology and Molecular Medicine, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - M Smieja
- Department of Clinical Epidemiology and Biostatistics, Health Research Methods, McMaster University, Hamilton, ON, Canada.,Department of Pathology and Molecular Medicine, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
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5
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Welch V, Doull M, Yoganathan M, Jull J, Boscoe M, Coen SE, Marshall Z, Pardo JP, Pederson A, Petkovic J, Puil L, Quinlan L, Shea B, Rader T, Runnels V, Tudiver S. Reporting of sex and gender in randomized controlled trials in Canada: a cross-sectional methods study. Res Integr Peer Rev 2017; 2:15. [PMID: 29451565 PMCID: PMC5803639 DOI: 10.1186/s41073-017-0039-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/26/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Accurate reporting on sex and gender in health research is integral to ensuring that health interventions are safe and effective. In Canada and internationally, governments, research organizations, journal editors, and health agencies have called for more inclusive research, provision of sex-disaggregated data, and the integration of sex and gender analysis throughout the research process. Sex and gender analysis is generally defined as an approach for considering how and why different subpopulations (e.g., of diverse genders, ages, and social locations) may experience health conditions and interventions in different or similar ways.The objective of this study was to assess the extent and nature of reporting about sex and/or gender, including whether sex and gender analysis (SGA) was carried out in a sample of Canadian randomized controlled trials (RCTs) with human participants. METHODS We searched MEDLINE from 01 January 2013 to 23 July 2014 using a validated filter for identification of RCTs, combined with terms related to Canada. Two reviewers screened the search results to identify the first 100 RCTs that were either identified in the trial publication as funded by a Canadian organization or which had a first or last author based in Canada. Data were independently extracted by two people from 10% of the RCTs during an initial training period; once agreement was reached on this sample, the remainder of the data extraction was completed by one person and verified by a second. RESULTS The search yielded 1433 records. We screened 256 records to identify 100 RCTs which met our eligibility criteria. The median sample size of the RCTs was 107 participants (range 12-6085). While 98% of studies described the demographic composition of their participants by sex, only 6% conducted a subgroup analysis across sex and 4% reported sex-disaggregated data. No article defined "sex" and/or "gender." No publication carried out a comprehensive sex and gender analysis. CONCLUSIONS Findings highlight poor uptake of sex and gender considerations in the Canadian RCT context and underscore the need for better articulated guidance on sex and gender analysis to improve reporting of evidence, inform policy development, and guide future research.
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Affiliation(s)
- V. Welch
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
- University of Ottawa, Ontario, Canada
| | - M. Doull
- School of Nursing, University of British Columbia, T223-2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5 Canada
| | - M. Yoganathan
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
| | - J. Jull
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario Canada
| | - M. Boscoe
- Research Sex/gender, Health Equity, Primary Care Consultant, 906 Bowron Court, North Vancouver, BC V7H 2S7 Canada
| | - S. E. Coen
- Department of Geography and Planning, Queen’s University, Mackintosh-Corry Hall, Kingston, Ontario K7L 3 N6 Canada
| | - Z. Marshall
- Renison University College, University of Waterloo, 240 Westmount Road North, Waterloo, Ontario N2L 3G4 Canada
| | - J. Pardo Pardo
- Cochrane Musculoskeletal, University of Ottawa, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - A. Pederson
- B.C. Women’s Hospital + Health Centre, E305, 4500 Oak Street, Vancouver, BC V6H 3E1 Canada
| | - J. Petkovic
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
- University of Ottawa, Ontario, Canada
| | - L. Puil
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - L. Quinlan
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
| | - B. Shea
- Bruyère Research Institute, Bruyère Continuing Care, 304b-85 Primrose Avenue, Ottawa, Ontario K1R 6 M1 Canada
- University of Ottawa, Ontario, Canada
| | - T. Rader
- Canadian Agency for Drugs and Technology in Health, 865 Carling Ave, Ottawa, Ontario Canada
| | - V. Runnels
- Globalization and Health Equity Research Unit, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3 Canada
| | - S. Tudiver
- Gender and Health Consultant, 161 Northwestern Avenue, Ottawa, Ontario K1Y 0 M1 Canada
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6
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Joyce VR, Sun H, Barnett PG, Bansback N, Griffin SC, Bayoumi AM, Anis AH, Sculpher M, Cameron W, Brown ST, Holodniy M, Owens DK. Mapping MOS-HIV to HUI3 and EQ-5D-3L in Patients With HIV. MDM Policy Pract 2017; 2:2381468317716440. [PMID: 30288427 PMCID: PMC6125043 DOI: 10.1177/2381468317716440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 05/10/2017] [Indexed: 12/25/2022] Open
Abstract
Objectives: The Medical Outcomes Study HIV Health Survey (MOS-HIV)
is frequently used in HIV clinical trials; however, scores generated from the
MOS-HIV are not suited for cost-effectiveness analyses as they do not assign
utility values to health states. Our objective was to estimate and externally
validate several mapping algorithms to predict Health Utilities Index Mark 3
(HUI3) and EQ-5D-3L utility values from the MOS-HIV. Methods: We
developed and validated mapping algorithms using data from two HIV clinical
trials. Data from the first trial (n = 367) formed the estimation data set for
the HUI3 (4,610 observations) and EQ-5D-3L (4,662 observations) mapping
algorithms; data from the second trial (n = 168) formed the HUI3 (1,135
observations) and EQ-5D-3L (1,152 observations) external validation data set. We
compared ordinary least squares (OLS) models of increasing complexity with the
more flexible two-part, beta regression, and finite mixture models. We assessed
model performance using mean absolute error (MAE) and mean squared error (MSE).
Results: The OLS model that used MOS-HIV dimension scores along
with squared terms gave the best HUI3 predictions (mean observed 0.84; mean
predicted 0.80; MAE 0.0961); the finite mixture model gave the best EQ-5D-3L
predictions (mean observed 0.90; mean predicted 0.88; MAE 0.0567). All models
produced higher prediction errors at the lower end of the HUI3 and EQ-5D-3L
score ranges (<0.40). Conclusions: The proposed mapping
algorithms can be used to predict HUI3 and EQ-5D-3L utility values from the
MOS-HIV, although greater error may pose a problem in samples where a
substantial proportion of patients are in poor health. These algorithms may be
useful for estimating utility values from the MOS-HIV for cost-effectiveness
studies when HUI3 or EQ-5D-3L data are not available.
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Affiliation(s)
- Vilija R Joyce
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Huiying Sun
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Paul G Barnett
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Nick Bansback
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Susan C Griffin
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Ahmed M Bayoumi
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Aslam H Anis
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Mark Sculpher
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - William Cameron
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Sheldon T Brown
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Mark Holodniy
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Douglas K Owens
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
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Abstract
BACKGROUND Micronutrient deficiencies are common among adults living with HIV disease, particularly in low-income settings where the diet may be low in essential vitamins and minerals. Some micronutrients play critical roles in maintenance of the immune system, and routine supplementation could therefore be beneficial. This is an update of a Cochrane Review previously published in 2010. OBJECTIVES To assess whether micronutrient supplements are effective and safe in reducing mortality and HIV-related morbidity of HIV-positive adults (excluding pregnant women). SEARCH METHODS We performed literature searches from January 2010 to 18 November 2016 for new randomized controlled trials (RCTs) of micronutrient supplements since the previous review included all trials identified from searches prior to 2010. We searched the CENTRAL (the Cochrane Library), Embase, and PubMed databases. Also we checked the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and the ClinicalTrials.gov trials registers. We also checked the reference lists of all new included trials. SELECTION CRITERIA We included RCTs that compared supplements that contained either single, dual, or multiple micronutrients with placebo, no treatment, or other supplements. We excluded studies that were primarily designed to investigate the role of micronutrients for the treatment of HIV-positive participants with metabolic morbidity related to highly active antiretroviral therapy (HAART). Primary outcomes included all-cause mortality, morbidity, and disease progression. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, and appraised trial quality for risk of bias. Where possible, we presented results as risk ratios (RR) for dichotomous variables, as hazard ratios (HRs) for time-to-event data, and as mean differences (MD) for continuous variables, each with 95% confidence intervals (CIs). Since we were often unable to pool the outcome data, we tabulated it for each comparison. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 33 trials with 10,325 participants, of which 17 trials were new trials. Ten trials compared a daily multiple micronutrient supplement to placebo in doses up to 20 times the dietary reference intake, and one trial compared a daily standard dose with a high daily dose of multivitamins. Nineteen trials compared supplementation with single or dual micronutrients (such as vitamins A and D, zinc, and selenium) to placebo, and three trials compared different dosages or combinations of micronutrients. Multiple micronutrientsWe conducted analyses across antiretroviral therapy (ART)-naive adults (3 trials, 1448 participants), adults on antiretroviral therapy (ART) (1 trial, 400 participants), and ART-naive adults with concurrent active tuberculosis (3 trials, 1429 participants). Routine multiple micronutrient supplementation may have little or no effect on mortality in adults living with HIV (RR 0.91, 95% CI 0.72 to 1.15; 7 trials, 2897 participants, low certainty evidence).Routine supplementation for up to two years may have little or no effect on the average of mean CD4+ cell count (MD 26.40 cells/mm³, 95% CI -22.91 to 75.70; 6 trials, 1581 participants, low certainty evidence), or the average of mean viral load (MD -0.1 log10viral copies, 95% CI -0.26 to 0.06; 4 trials, 840 participants, moderate certainty evidence). One additional trial in ART-naïve adults did report an increase in the time to reach a CD4+ cell count < 250 cells/mm³ after two years of high dose supplementation in Botswana (HR 0.48, 95% CI 0.26 to 0.88; 1 trial, 439 participants). However, the trial authors reported this effect only in the trial arm that received multiple micronutrients plus selenium (not either supplementation alone), which is inconsistent with the findings of other trials that used similar combinations of micronutrients and selenium.In one additional trial that compared high-dose multiple micronutrient supplementation with standard doses in people on ART, peripheral neuropathy was lower with high dose supplements compared to standard dose (incidence rate ratio (IRR) 0.81, 95% CI 0.7 to 0.94; 1 trial, 3418 participants), but the trial was stopped early due to increased adverse events (elevated alanine transaminase (ALT) levels) in the high dose group. Single or dual micronutrientsNone of the trials of single or dual micronutrient supplements were adequately powered to assess for effects on mortality or morbidity outcomes. No clinically significant changes in CD4 cell count (data not pooled, 14 trials, 2370 participants, very low or low certainty evidence) or viral load (data not pooled, seven studies, 1334 participants, very low or low certainty evidence), were reported. Supplementation probably does increase blood concentrations of vitamin D and zinc (data not pooled, vitamin D: 4 trials, 299 participants, zinc: 4 trials, 484 participants, moderate certainty evidence) and may also increase blood concentrations of vitamin A (data not pooled, 3 trials, 495 participants, low certainty evidence), especially in those who are deficient. AUTHORS' CONCLUSIONS The analyses of the available trials have not revealed consistent clinically important benefits with routine multiple micronutrient supplementation in people living with HIV. Larger trials might reveal small but important effects.These findings should not be interpreted as a reason to deny micronutrient supplements for people living with HIV where specific deficiencies are found or where the person's diet is insufficient to meet the recommended daily allowance of vitamins and minerals.
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Affiliation(s)
| | - Solange Durao
- South African Medical Research CouncilCochrane South AfricaPO Box 19070TygerbergCape TownSouth Africa7505
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
| | - James H Irlam
- University of Cape TownPrimary Health Care DirectorateE47 OMBGroote Schuur HospitalCape TownWestern CapeSouth Africa7925
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8
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Steenkamp L, Goosen A, Venter D, Beeforth M. Food insecurity among students living with HIV: Strengthening safety nets at the Nelson Mandela Metropolitan University, South Africa. SAHARA J 2016; 13:106-112. [PMID: 27687153 PMCID: PMC5642430 DOI: 10.1080/17290376.2016.1218791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The HIV prevalence in South Africa among students at higher education institutions (HEIs) in 2008 was reported to be 3.4%, with the highest HIV prevalence found in the Eastern Cape Province. Students at these facilities are also increasingly affected by socio-economic constraints that may impact on food security. Little is known about the impact of food insecurity on HIV-infected students in HEIs in South Africa. The purpose of this paper is to describe food insecurity and the nutritional status among HIV-infected students on the Nelson Mandela Metropolitan University campuses in South Africa, as well as current initiatives to strengthen the safety nets for food-insecure students. This descriptive, cross-sectional survey was conducted among a convenience sample of known HIV-infected, registered students (n = 63), older than 18 years of age and managed as part of the Campus Health Service antiretroviral therapy (ART) programme. Ethical approval for the study was obtained from the Research Ethics Committee (NMMU) and participants were included in the sample after providing written, informed consent. Findings indicate that food insecurity was common with more than 60% of the sample reporting food insecurity at the household level during the previous month. Of the sample, 51% were classified as being either overweight or obese. Although food insecurity did not contribute to weight loss in our sample, food-insecure students were more likely to consume inadequate amounts of vitamins and minerals, especially antioxidants that are important in supporting the immune system. Food insecurity has been identified as affecting the majority of HIV-infected students in this study, especially regarding their difficulty in accessing nutritious foods. As overweight and obesity also seem to threaten the health and future well-being of the students, appropriate management of the overweight individuals and those with obesity should be instituted in order to prevent the development of chronic diseases of lifestyle, thus allowing for a healthier more productive life. Current intervention strategies to strengthen food security have made inroads to improve access to healthier food options.
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Affiliation(s)
- L. Steenkamp
- PhD (Dietetics), is a Research Associate at the HIV&AIDS Research Unit, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - A. Goosen
- MCur (Advanced Primary Health Care), is a Head of Department at the Campus Health Service, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - D. Venter
- PhD, is a Statistical Consultant at the Unit for Statistical Consultation at the Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - M. Beeforth
- BSc Dietetics, is a Postgraduate Student at the Department of Dietetics, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
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Masiá M, Padilla S, Fernández M, Rodríguez C, Moreno A, Oteo JA, Antela A, Moreno S, del Amo J, Gutiérrez F. Oxidative Stress Predicts All-Cause Mortality in HIV-Infected Patients. PLoS One 2016; 11:e0153456. [PMID: 27111769 PMCID: PMC4844170 DOI: 10.1371/journal.pone.0153456] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/30/2016] [Indexed: 01/07/2023] Open
Abstract
Objective We aimed to assess whether oxidative stress is a predictor of mortality in HIV-infected patients. Methods We conducted a nested case-control study in CoRIS, a contemporary, multicentre cohort of HIV-infected patients, antiretroviral-naïve at entry, launched in 2004. Cases were patients who died with available stored plasma samples collected. Two age and sex-matched controls for each case were selected. We measured F2-isoprostanes (F2-IsoPs) and malondialdehyde (MDA) plasma levels in the first blood sample obtained after cohort engagement. Results 54 cases and 93 controls were included. Median F2-IsoPs and MDA levels were significantly higher in cases than in controls. When adjustment was performed for age, HIV-transmission category, CD4 cell count and HIV viral load at cohort entry, and subclinical inflammation measured with highly-sensitive C-reactive protein (hsCRP), the association of F2-IsoPs with mortality remained significant (adjusted OR per 1 log10 increase, 2.34 [1.23–4.47], P = 0.009). The association of MDA with mortality was attenuated after adjustment: adjusted OR (95% CI) per 1 log10 increase, 2.05 [0.91–4.59], P = 0.080. Median hsCRP was also higher in cases, and it also proved to be an independent predictor of mortality in the adjusted analysis: OR (95% CI) per 1 log10 increase, 1.39 (1.01–1.91), P = 0.043; and OR (95% CI) per 1 log10 increase, 1.46 (1.07–1.99), P = 0.014, respectively, when adjustment included F2-IsoPs and MDA. Conclusion Oxidative stress is a predictor of all-cause mortality in HIV-infected patients. For plasma F2-IsoPs, this association is independent of HIV-related factors and subclinical inflammation.
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Affiliation(s)
- Mar Masiá
- Infectious Diseases Unit, Hospital General de Elche, Universidad Miguel Hernández, Alicante, Spain
| | - Sergio Padilla
- Infectious Diseases Unit, Hospital General de Elche, Universidad Miguel Hernández, Alicante, Spain
| | - Marta Fernández
- Infectious Diseases Research Laboratory, Hospital General de Elche, Alicante, Spain
| | - Carmen Rodríguez
- HIV/AIDS and Sexually Transmitted Diseases Clinic, Centro Sanitario Sandoval, Madrid, Spain
| | - Ana Moreno
- Infectious Diseases Service, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Jose A. Oteo
- Infectious Diseases Service, Hospital San Pedro de La Rioja, Logroño, Spain
| | - Antonio Antela
- Infectious Diseases Unit, Hospital Clínico de Santiago, La Coruña, Spain
| | - Santiago Moreno
- Infectious Diseases Service, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Julia del Amo
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Félix Gutiérrez
- Infectious Diseases Unit, Hospital General de Elche, Universidad Miguel Hernández, Alicante, Spain
- * E-mail:
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