Selenium may help lower HIV levels

Selenium supplements can slow the rise in virus levels in HIV-positive patients, which allows the number of beneficial CD4 immune cell to increase, according to results of a clinical trial supported by grants from the National Institutes of Health.

Low blood levels of selenium have been linked to high HIV virulence and more opportunistic infections, Dr. Barry E. Hurwitz and associates at the University of Miami in Florida report in the Archives of Internal Medicine. In lab experiments, the element suppresses HIV-1 replication.

Even when antiretroviral therapy (ART) is widely available, failure to keep the virus suppressed "is relatively common, due to the complexity and toxicity of the drugs," Hurwitz told Reuters Health. "Something like selenium is stable in the blood stream and may prevent 'viral escape'."

In their study, Hurwitz's team randomly assigned some 260 HIV-infected adults with no other major diagnosis to take 200-milligram capsules of inactive yeast (placebo) daily or 200-milligram capsules of high-selenium yeast. The researchers used selenium-enriched yeast (Selenomax, Nutrition 21 Inc.) because it contains high concentrations of organic, bioavailable forms of selenium.

After 9 months, viral load had increased by 10,000 to 20,000 copies/milliliter in the placebo group. Viral load was unchanged in the group on selenium supplementation, Hurwitz said, and CD4 cell counts increased.

The researchers identified 50 "selenium responders," whose blood levels of selenium rose significantly more than the average.

These responders tended to have greater adherence as determined by computerized electronic medication-monitoring caps compared with nonresponders, although some subjects with excellent compliance failed to absorb selenium.

Considering just the 50 selenium responders, their viral load actually decreased on average by 10,000 copies/milliliters, Hurwitz noted. Levels among nonresponders did not differ significantly from those in the plain yeast group.

The investigators conclude that selenium supplementation may represent "a simple, inexpensive, and safe adjunct therapy" to antiretroviral medications for HIV.

Hurwitz added that some stores sell the selenium-enriched yeast, with a 2-month supply costing about $15. However, consumers must be careful, he added, because many forms of selenium that are sold are not absorbed into the blood stream.

He also remarked on the potential impact that selenium supplementation could have in parts of world where soil is deficient in selenium, and people generally can't get enough from their food. "Selenium supplements could have very rapid and beneficial effects on HIV-infected individuals in those circumstances," he said.

Not much in the medical literature on selenium, but good news on vitamin D (and this is just the latest):

Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis.Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A.
Department of Nutrition, Harvard School of Public Health, and Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass 02115, USA.

CONTEXT: Epidemiological and experimental evidence suggests that high levels of vitamin D, a potent immunomodulator, may decrease the risk of multiple sclerosis. There are no prospective studies addressing this hypothesis. OBJECTIVE: To examine whether levels of 25-hydroxyvitamin D are associated with risk of multiple sclerosis. DESIGN, SETTING, AND PARTICIPANTS: Prospective, nested case-control study among more than 7 million US military personnel who have serum samples stored in the Department of Defense Serum Repository. Multiple sclerosis cases were identified through Army and Navy physical disability databases for 1992 through 2004, and diagnoses were confirmed by medical record review. Each case (n = 257) was matched to 2 controls by age, sex, race/ethnicity, and dates of blood collection. Vitamin D status was estimated by averaging 25-hydroxyvitamin D levels of 2 or more serum samples collected before the date of initial multiple sclerosis symptoms. MAIN OUTCOME MEASURES: Odds ratios of multiple sclerosis associated with continuous or categorical levels (quantiles or a priori-defined categories) of serum 25-hydroxyvitamin D within each racial/ethnic group. RESULTS: Among whites (148 cases, 296 controls), the risk of multiple sclerosis significantly decreased with increasing levels of 25-hydroxyvitamin D (odds ratio [OR] for a 50-nmol/L increase in 25-hydroxyvitamin D, 0.59; 95% confidence interval, 0.36-0.97). In categorical analyses using the lowest quintile (<63.3 nmol/L) as the reference, the ORs for each subsequent quintile were 0.57, 0.57, 0.74, and 0.38 (P = .02 for trend across quintiles). Only the OR for the highest quintile, corresponding to 25-hydroxyvitamin D levels higher than 99.1 nmol/L, was significantly different from 1.00 (OR, 0.38; 95% confidence interval, 0.19-0.75; P = .006). The inverse relation with multiple sclerosis risk was particularly strong for 25-hydroxyvitamin D levels measured before age 20 years. Among blacks and Hispanics (109 cases, 218 controls), who had lower 25-hydroxyvitamin D levels than whites, no significant associations between vitamin D and multiple sclerosis risk were found. CONCLUSION: The results of our study suggest that high circulating levels of vitamin D are associated with a lower risk of multiple sclerosis.

The point is that the CDC suggests below that the drugs probably lead to risky behavior and that the drugs to not prevent infectiousness. (See underlined.) http://www.cdc.gov/hiv/resources/factsheets/msm.htm

The success of highly active antiretroviral therapy (HAART) may have had the unintended consequence of increasing some MSM’s risk behaviors. Some research suggests that the negative aspects of HIV infection have been minimized since the introduction of HAART, which has led to a false understanding of what living with HIV means and thus can lead to an increase in risky sexual behaviors [16, 17]. For example, some MSM may mistakenly believe that they or their partners are not infectious when they take medication or when they have low or undetectable viral loads [18]. Even though surveys suggest that optimism about HIV treatments is associated with a greater willingness to have unprotected anal intercourse [19, 20], a recent review found that the prevalence of unprotected sexual intercourse was not significantly higher among HIV-positive persons who were receiving HAART or who had an undetectable viral load. However, this review did find that unprotected sex was associated with beliefs about HAART and viral load [21].

This is their effort to prevent risky behavior since there is evidence that not ALL people on HAART are protected, for instance see here:

Acquir Immune Defic Syndr. 2007 Jan 1;44(1):38-42.

Cervical shedding of HIV-1 RNA among women with low levels of viremia while receiving highly active antiretroviral therapy.

Neely MN, Benning L, Xu J, Strickler HD, Greenblatt RM, Minkoff H, Young M, Bremer J, Levine AM, Kovacs A.

Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. mneely@usc.edu

BACKGROUND: Among women with low or undetectable quantities of HIV-1 RNA in plasma, factors associated with genital HIV-1 RNA shedding, including choice of treatment regimen, are poorly characterized. METHODS: We measured HIV-1 RNA in cervical swab specimens obtained from participants in the Women's Interagency HIV Study who had concurrent plasma viral RNA levels <500 copies/mL, and we assessed factors associated with genital HIV shedding. The study was powered to determine the relative effects of antiretroviral protease inhibitors (PIs) versus nonnucleoside reverse transcriptase inhibitors (NNRTIs) on viral RNA shedding. RESULTS: Overall, 44 (15%) of 290 women had detectable HIV-1 RNA in cervical specimens. In the final multivariate model, shedding was independently associated with NNRTI (vs. PI) use (odds ratio [OR], 95% confidence interval [CI]: 2.24, 1.13 to 4.45) and illicit drug use (OR, 95% CI: 2.41, 0.96 to 5.69). CONCLUSIONS: This is the largest study to define risks for genital HIV-1 RNA shedding in women with low/undetectable plasma virus. Shedding in this population was common, and NNRTI-based highly active antiretroviral therapy (HAART) (vs. PI-based HAART) was associated with genital HIV shedding. Further study is required to determine the impact of these findings on transmission of HIV from mother to child or to sexual partners.

So, if 15% have cervical virus, how are we to know? Therefore, we must tell everyone that they are infectious. As I said, it reduces the risk, it does not eliminate it. And the drugs prolong life, but AIDS is still no picnic.

Here's another abstract about antivirals and mother/child transmission:

: Curr Opin Infect Dis. 2006 Feb;19(1):33-8.

Strategies to prevent mother-to-child transmission of HIV.

McIntyre J. University of the Witwatersrand, Diepkloof, Johannesburg, South Africa. mcintyre@pixie.co.za

PURPOSE OF REVIEW: This review describes recent advances in the prevention of mother-to-child transmission, focusing on the use of antiretroviral treatment strategies in pregnancy, and discusses the emergence of viral resistance following the use of nevirapine to prevent mother-to-child transmission. RECENT FINDINGS: Mother-to-child transmission has been dramatically reduced in developed countries by the use of antiretroviral treatment and avoidance of breastfeeding. Highly active antiretroviral therapy use in pregnancy is recommended for women who require ongoing treatment, and, where available, is also very effective in reducing mother-to-child transmission in women with higher CD4 counts. The addition of a maternal and infant nevirapine dose to antenatal zidovudine can reduce transmission to below 5%, approximately half the transmission rate that can be achieved by single-dose nevirapine alone. The emergence of resistant virus following nevirapine use is a concern, occurring in up to 60% of mothers and 50% of infants following a single dose. Addition of zidovudine and lamivudine for 4-7 days postpartum can reduce the risk of resistance to 10%. SUMMARY: There is broad consensus on an approach to preventing mother-to-child transmission, which provides antiretroviral treatment in pregnancy and beyond to those women who need it, and an effective prophylactic regimen for those who do not yet need treatment, These regimens include highly active antiretroviral therapy, where available, a zidovudine-plus-nevirapine regimen in other settings, or nevirapine alone where this is all that is possible. More work is needed on the impact of nevirapine resistance and on reducing breast-milk transmission.

So you see, you must know the data and the context of CDC pronouncement about an infectious disease, especially AIDS.

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