补充硒对坦桑尼亚妇女母乳中HIV-1 RNA检测的影响。
Effect of selenium supplementation on HIV-1 RNA detection in breast milk of Tanzanian women.
作者信息
Sudfeld Christopher R, Aboud Said, Kupka Roland, Mugusi Ferdinand M, Fawzi Wafaie W
机构信息
Department of Global Health, Harvard School of Public Health, Boston, MA, USA.
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
出版信息
Nutrition. 2014 Sep;30(9):1081-4. doi: 10.1016/j.nut.2014.01.011. Epub 2014 Feb 15.
OBJECTIVE
Selenium supplementation for women infected with HIV may increase genital shedding of HIV-1, however, to our knowledge, no studies have examined the effect on viral shedding in breast milk. The aim of this study was to determine the effect of selenium supplementation on HIV-1 RNA detection in breast milk of HIV-infected women.
METHODS
HIV-infected pregnant women enrolled at 12 to 27 wk gestation in a randomized, double-blind, placebo-controlled trial of daily selenium (200 μg as selenomethionine) had cell-free HIV-1 RNA quantified in breast milk at 4 to 9 wk postpartum. All participants received high-dose multivitamins containing vitamin B complex, C, and E as standard of care.
RESULTS
The proportion of women with detectable (>50 copies/mL) HIV-1 RNA in breast milk appeared to be increased in the selenium group (36.4%) compared with those in the placebo group (27.5%) among the total cohort (N = 420), but results were borderline statistically significant (relative risk [RR], 1.32; 95% confidence interval [CI], 1.00-1.76; P = 0.05). In secondary analyses, the proportion of women with detectable HIV-1 RNA in breast milk was significantly greater in the selenium group (37.8%) compared with placebo group (27.5%) among women who did not receive highly active antiretroviral therapy (HAART; RR, 1.37; 95% CI, 1.03-1.82; P = 0.03). This relationship was primarily due to a significant effect of selenium among primiparous women (RR, 2.24; 95% CI, 1.30-3.86; P < 0.01), but not multiparous women (RR, 1.14; 95% CI, 0.81-1.59; P = 0.54) (P-value for interaction = 0.02). Too few women received HAART in this study (n = 12) to establish the effect of selenium supplementation.
CONCLUSIONS
Selenium supplementation appears to increase HIV-1 RNA detection in breast milk among primiparous women not receiving HAART. Safety studies among pregnant women on HAART need to be conducted before administering selenium-containing supplements.
目的
对感染HIV的女性补充硒可能会增加HIV-1的生殖器脱落，但据我们所知，尚无研究探讨其对母乳中病毒脱落的影响。本研究的目的是确定补充硒对HIV感染女性母乳中HIV-1 RNA检测的影响。
方法
在一项随机、双盲、安慰剂对照试验中，纳入妊娠12至27周的HIV感染孕妇，每日补充硒（200μg硒代蛋氨酸），产后4至9周对母乳中的游离HIV-1 RNA进行定量。所有参与者均接受含有复合维生素B、C和E的高剂量多种维生素作为标准治疗。
结果
在整个队列（N = 420）中，硒组母乳中可检测到（>50拷贝/mL）HIV-1 RNA的女性比例（36.4%）似乎高于安慰剂组（27.5%），但结果在统计学上接近显著（相对风险[RR]，1.32；95%置信区间[CI]，1.00 - 1.76；P = 0.05）。在二次分析中，未接受高效抗逆转录病毒治疗（HAART）的女性中，硒组母乳中可检测到HIV-1 RNA的女性比例（37.8%）显著高于安慰剂组（27.5%）（RR，1.37；95% CI，1.03 - 1.82；P = 0.03）。这种关系主要是由于硒对初产妇有显著影响（RR，2.24；95% CI，1.30 - 3.86；P < 0.01），而经产妇则无此影响（RR，1.14；95% CI，0.81 - 1.59；P = 0.54）（交互作用P值 = 0.02）。本研究中接受HAART的女性太少（n = 12），无法确定补充硒的效果。
结论
补充硒似乎会增加未接受HAART的初产妇母乳中HIV-1 RNA的检测。在给予含硒补充剂之前，需要对接受HAART的孕妇进行安全性研究。
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