THE IMPACT OF NUTRITIONAL AND INFLAMMATORY BIOMARKER LEVELS ON CD4 RECOVERY TO 96 WEEKS IN A TREATMENT-NAÏVE HIV-POSITIVE COHORT
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Background As antiretroviral therapy (ART) becomes more widespread globally, it is important to investigate factors which have an effect on HIV progression in order to determine the best intervention for individual patients. Nutritional and inflammatory factors have recently been at the forefront of this investigation; however, their effect on CD4 recovery is not well-studied. Objectives This study aims to determine nutritional and inflammatory markers that have an effect on CD4 recovery in a treatment-naïve HIV-positive cohort consisting of individuals in nine low-, medium-, and high-income countries. Methods 469 adults initiating ART in nine countries with CD4 count of <350 cells/mm3 were used for this analysis. Associations between baseline levels of nutritional and inflammatory biomarkers and longitudinal CD4 recovery were measured using a random-effects generalized least squares (GLS) linear model at 24 and 96 weeks. Logistic regression using generalized estimating equations (GEE) was used to examine the longitudinal relationship between CD4 recovery and specific nutritional deficiencies at 96 weeks. Results Multivariate GLS analysis at week 24 revealed statistically significant associations between longitudinal CD4 recovery and low baseline levels of β-carotene and lycopene, as well as 25(OH)-Vitamin D deficiency (decrease of 14.07 CD4 cells, p=0.027). At 96 weeks, we observed statistically significant associations between CD4 recovery and lower levels of α-carotene and lycopene, increased levels of sCD14, and selenium deficiency (decrease of 24.01 CD4 cells, p=0.012). 25(OH)-Vitamin D deficiency was also trending significant (decrease of 17.89 CD4 cells, p=0.059). Using an adjusted GEE logistic regression model at 96 weeks, we found that Vitamin B12 deficiency was associated with a higher odds of CD4 non-recovery (OR=2.00, p=0.031); selenium deficiency was also significantly associated with worse CD4 recovery, with a p-value of 0.024 (OR=1.54, p=0.024). Conclusions Our results show that baseline levels of nutritional biomarkers are associated with CD4 recovery over time after ART initiation, especially selenium and 25(OH)-vitamin D. Although achieving optimal CD4 recovery after ART initiation remains a challenge in many areas of the world, understanding the relationship between nutritional deficiencies and CD4 recovery can help us to identify and appropriately monitor high-risk populations.