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dc.contributor.authorRupak Shivakotien_US
dc.contributor.authorErin R. Ewalden_US
dc.contributor.authorNikhil Gupteen_US
dc.contributor.authorWei Teng Yangen_US
dc.contributor.authorCecilia Kanyamaen_US
dc.contributor.authorSandra W. Cardosoen_US
dc.contributor.authorBreno Santosen_US
dc.contributor.authorKhuanchai Supparatpinyoen_US
dc.contributor.authorSharlaa Badal-Faesenen_US
dc.contributor.authorJavier R. Lamaen_US
dc.contributor.authorUmesh Lallooen_US
dc.contributor.authorFatima Zuluen_US
dc.contributor.authorJyoti S. Pawaren_US
dc.contributor.authorCynthia Riviereen_US
dc.contributor.authorNagalingeswaran Kumarasamyen_US
dc.contributor.authorJames Hakimen_US
dc.contributor.authorRichard Pollarden_US
dc.contributor.authorBarbara Detricken_US
dc.contributor.authorAshwin Balagopalen_US
dc.contributor.authorDavid M. Asmuthen_US
dc.contributor.authorRichard D. Sembaen_US
dc.contributor.authorThomas B. Campbellen_US
dc.contributor.authorJonathan Goluben_US
dc.contributor.authorAmita Guptaen_US
dc.description.abstract© 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism Background & aims: Nutritional deficiency and inflammation may impact CD4+ T cell recovery during combination antiretroviral therapy (cART), particularly in resource-limited settings where malnutrition is prevalent. The aim of this study was to investigate the relationship of micronutrient and inflammation biomarkers to CD4 recovery after cART initiation. Methods: We conducted a secondary analysis of a random sub-cohort sample (n = 270) from a multinational randomized trial of cART regimen efficacy among 1571 cART-naïve adults. We measured pre-cART serum levels of micronutrients (Vitamin A, B6, B12, D, total carotenoids, selenium, and iron) and inflammation (C-reactive protein, soluble CD14 (sCD14), IFNγ, TNFα, Interleukin-6, and C-X-C motif chemokine 10 (CXCL10/IP10), EndoCab (IgM)) biomarkers. Biomarker status (i.e. micronutrient deficiency vs. sufficiency and elevated vs. low inflammation) was defined using established cutoffs or quartiles. Mixed-effects linear regression models were used to determine the association of baseline (pre-cART) concentrations of individual biomarkers with CD4 recovery through 96 weeks post-cART initiation. Results: In models adjusting for time-dependent viral load and baseline CD4 count, age, sex, body mass index, country, treatment regimen, anemia and hypoalbuminemia status, pre-cART vitamin D deficiency was associated with lower CD4 recovery (−14.9 cells/mm3, 95% CI: −27.9, −1.8) compared to sufficiency. In contrast, baseline selenium deficiency (20.8 cells/mm3, 95% CI: 3.3, 38.3), vitamin A deficiency (35.9 cells/mm3, 95% CI: 17.6, 54.3) and high sCD14 (23.4 cells/mm3, 95% CI: 8.9, 37.8) were associated with higher CD4 recovery compared to sufficient/low inflammation status. Conclusions: In summary, baseline vitamin D deficiency was associated with diminished CD4 recovery after cART initiation; impaired CD4 recovery may contribute to the poor clinical outcomes recently observed in individuals with vitamin D deficiency. Vitamin A, selenium and sCD14 were associated with CD4 recovery but future studies are needed to further explore these relationships.en_US
dc.titleEffect of baseline micronutrient and inflammation status on CD4 recovery post-cART initiation in the multinational PEARLS trialen_US
article.title.sourcetitleClinical Nutritionen_US Johns Hopkins School of Medicineen_US Hopkins Bloomberg School of Public Healthen_US Oswaldo Cruzen_US Nossa Senhora de Conceiçãoen_US Mai Universityen_US of Witwatersranden_USón Civil Impacta Salud y Educaciónen_US Nelson R. Mandela Medical Schoolen_US of Malawi College of Medicineen_US AIDS Research Institute Indiaen_US Centres GHESKIOen_US Gaitonde Centre for AIDS Research and Educationen_US of Zimbabween_US of California, Davisen_US of Colorado School of Medicineen_US
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