Nutritional status and effect of highly active anti-retroviral therapy (HAART) on selected trace elements in people living with HIV in Ghana

Abstract

Background and objectivesEssential trace elements obtained from our diet are crucial for the initiation and development of host defence by the immune system. Trace elements such as selenium (Se), zinc (Zn) and copper (Cu) are important for immune competence, particularly in vulnerable population. Poor nutrition status including deficiencies of these vital elements is associated with immune abnormalities and increased susceptibility to infectious diseases. MethodsA comparative study involving a cohort of three hundred and twenty-five (325) participants comprising: 166 persons living with HIV (PLWH) (consisting of 100 on HAART and 66 HAART-treatment naive) and one hundred and fifty-nine (159) non-HIV controls were recruited. Waist to hip ratio and dietary habits were assessed to determine respondents’ nutritional status. Serum Zn, Se and Cu concentrations were estimated by neutron activation method. ResultsMean body mass index (BMI) of respondents was 24.7±4.8 kg/m2. Dietary recommended intakes (DRIs) of macronutrient [energy (69%), carbohydrates (86%) and fats (76%)] and micronutrient [(vitamin B2 (63%), vitamin D (15%), folate (47%) and calcium (63%)] were not adequately met by all groups. PLWH on HAART had a significantly higher total body fat (p=0.004) and visceral fat (p<0.001). Dietary intake of Se, Zn and Cu were highest among the controls (47.0±5.4 µg, 12.4±2.9 mg and 843±15.2 mg respectively) and least, among the HAART treatment naïve group (10.1±5.6 µg, 2.1±0.9mg and 438±16.3 mg respectively), although serum concentrations were significantly lower (0.63±0.21 µmol/L, 1.33±0.92 µmol/L and 1.12±0.14 µmol/L; p<0.001, respectively). Dietary intake of Se and Cu were not associated with their serum concentrations, but treatment status was significantly associated with their serum concentrations (p-value<0.001). Respondents on Zidovudine (AZT) + Lamivudine (3TC) + Nevirapine (NVP) had higher serum Se and Cu concentrations but lower Zn concentrations compared to those on other medications. ConclusionMultiple nutrient intakes among PLWH were not adequate; thus, dietary counseling and micronutrient supplementation are strongly recommended, as food security strategies by stakeholders involved in the nutrition management of PLWH in Ghana are also needed. Intake of AZT + 3TC + NVP may improve serum concentrations of Se, and Cu, but could negatively affect serum Zn concentration.