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Community and International Nutrition

Selenium Status Is Associated with Accelerated HIV Disease Progression among HIV-1–Infected Pregnant Women in Tanzania¹

Roland Kupka^*,,2, Gernard I. Msamanga^**, Donna Spiegelman^,, Steve Morris, Ferdinand Mugusi^**, David J. Hunter^*, and Wafaie W. Fawzi^*,

Departments of ^* Nutrition, Epidemiology, and Biostatistics, Harvard School of Public Health, Boston MA; ^** Department of Community Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; and University of Missouri Research Facility, Columbia, MO

²To whom correspondence should be addressed. E-mail: rkupka{at}post.harvard.edu.

Selenium deficiency has been implicated in accelerated disease progression and poorer survival among populations infected with HIV in developed countries, yet these associations remain unexamined in developing countries. Among 949 HIV-1–infected Tanzanian women who were pregnant, we prospectively examined the association between plasma selenium levels and survival and CD4 counts over time. Over the 5.7-y median follow-up time, 306 of 949 women died. In a Cox multivariate model, lower plasma selenium levels were significantly associated with an increased risk of mortality (P-value, test for trend = 0.01). Each 0.1 µmol/L increase in plasma selenium levels was related to a 5% (95% CI = 0%–9%) decreased risk of mortality. Plasma selenium levels were not associated with time to progression to CD4 cell count < 200 cells/mm³ but were weakly and positively related to CD4 cell count in the first years of follow up. Selenium status may be important for clinical outcomes related to HIV disease in sub-Saharan Africa.

KEY WORDS: • HIV/AIDS • selenium • mortality • CD4⁺ • Tanzania

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