Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy

Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy

In HIV-infected persons, low serum concentrations of vitamins and minerals, termed micronutrients, are associated with an increased risk of HIV disease progression and mortality. Micronutrient supplements can delay HIV disease progression and reduce mortality in HIV-positive persons not receiving highly active antiretroviral therapy (HAART). With the transition to more universal access to HAART, a better understanding of micronutrient deficiencies and the role of micronutrient supplements in HIV-positive persons receiving HAART has become a priority. The provision of simple, inexpensive micronutrient supplements as an adjunct to HAART may have several cellular and clinical benefits, such as a reduction in mitochondrial toxicity and oxidative stress and an improvement in immune reconstitution. We reviewed observational and trial evidence on micronutrients in HIV-positive persons receiving HAART to summarize the current literature and suggest future research priorities. A small number of observational studies have suggested that some, but not all, micronutrients may become replete after HAART initiation, and few intervention studies have found that certain micronutrients may be a beneficial adjunct to HAART. However, most of these studies had some major limitations, including a small sample size, a short duration of follow-up, a lack of adjustment for inflammatory markers, and an inadequate assessment of HIV-related outcomes. Therefore, few data are available to determine whether HAART ameliorates micronutrient deficiencies or to recommend or refute the benefit of providing micronutrient supplements to HIV-positive persons receiving HAART. Because micronutrient supplementation may cause harm, randomized placebo-controlled trials are needed. Future research should determine whether HAART initiation restores micronutrient concentrations, independent of inflammatory markers, and whether micronutrient supplements affect HIV-related outcomes in HIV-positive persons receiving HAART.

在艾滋病病毒（HIV）感染者中，维生素和矿物质（被称为微量营养素）的血清浓度较低与艾滋病病情进展和死亡风险增加有关。在未接受高效抗逆转录病毒治疗（HAART）的艾滋病病毒阳性者中，微量营养素补充剂可延缓艾滋病病情进展并降低死亡率。随着向更普遍获得高效抗逆转录病毒治疗的转变，更好地了解微量营养素缺乏情况以及微量营养素补充剂在接受高效抗逆转录病毒治疗的艾滋病病毒阳性者中所起的作用已成为当务之急。提供简单、廉价的微量营养素补充剂作为高效抗逆转录病毒治疗的辅助手段可能具有若干细胞和临床益处，例如减轻线粒体毒性和氧化应激以及改善免疫重建。我们回顾了关于接受高效抗逆转录病毒治疗的艾滋病病毒阳性者微量营养素的观察性和试验性证据，以总结当前文献并提出未来的研究重点。少数观察性研究表明，在开始高效抗逆转录病毒治疗后，部分（但不是全部）微量营养素可能会得到补充，且少数干预性研究发现某些微量营养素可能是高效抗逆转录病毒治疗的有益辅助手段。然而，这些研究大多存在一些主要局限性，包括样本量小、随访时间短、未对炎症标志物进行调整以及对艾滋病相关结局评估不充分。因此，几乎没有数据可用于确定高效抗逆转录病毒治疗是否改善微量营养素缺乏情况，或用于推荐或反驳向接受高效抗逆转录病毒治疗的艾滋病病毒阳性者提供微量营养素补充剂的益处。由于微量营养素补充可能有害，因此需要进行随机安慰剂对照试验。未来的研究应确定开始高效抗逆转录病毒治疗是否能恢复微量营养素浓度（不受炎症标志物影响），以及微量营养素补充剂是否会影响接受高效抗逆转录病毒治疗的艾滋病病毒阳性者的艾滋病相关结局。