Running head: SELENIUM DEFICIENCY AND HIV MORTALITY

Selenium Deficiency and HIV Mortality: A Review of the Literature

Alvin L. Rozier

College Of Mt. St. Joseph


NUR 531-01 11/29/2013
SELENIUM DEFICIENCY AND HIV MORTALITY 2
Abstract

This paper explores several published articles that indicate that there is a very strong correlation
between Selenium deficiency and mortality from AIDS. In the article by Stone, et al., (2010)
they introduce that AIDS is a disease that affects the nutritionally disadvantaged. Baum (1997),
Schrauzer (1993), and Taylor (1997) indicate that Selenium deficiency leads to increased
mortality in patients with AIDS. Taylor (1997) also goes on to state the Stone (2010) has
indicated that HIV proliferates in the absence of Selenium, specifically the Selenium complex,
Glutathione Peroxidase. Taylor (1997) also indicates that there is a positive correlation between
Se levels and CD4+ T cells, the cells that are used to fight the AIDS virus, in that a deficiency
leads to a reduction in these cells and immune system compromise. Taylor (1997) also suggests
for the evidence presented, which is very strong, selenium deficiency is a risk factor for HIV.

Keywords: AIDS, Selenium deficiency, Glutathione Peroxidase,
SELENIUM DEFICIENCY AND HIV MORTALITY 3
Selenium Deficiency and HIV Mortality: A Review of the Literature

In the years since its discovery, a cure that could stop the spread of the virus that causes
AIDS has been very elusive. Researchers have been down several trails but all have been in vain.
The current and recommended treatment for a person infected with AIDS is retroviral therapy
with several toxic drugs. These drugs are designed to prevent the proliferation of the virus that
causes AIDS in the host thus curtailing or eventually stopping the spread of AIDS. Another
approach that is very promising is the nutritional avenue, specifically supplementation with
Selenium. It appears that the virus that causes AIDS codes for a specific selenoenzyme that
causes the host to be unable to mount a sufficient immune response to fight and eventually
render the virus ineffective. The presence of this enzyme enables the body of the host to
successfully deal with oxidative stress. The loss of this mechanism to appropriately deal with
oxidative stress is what causes the break down of the body, decreased immune response, which
results in disease that, if not reversed, eventually leads to death.
The main question that is under investigation has to deal with mortality and the
deficiency of Selenium. What role does it play in the immune system? How does it effect the
immune system? Does supplementation improve the efficiency of the immune system? Is this a
viable alternative to the highly toxic pharmaceutical agents already on the market?
In this review of the literature, I will be discussing several research articles that have
indicated that the supplementation of Selenium, Se, has positive implications on the proliferation
of the virus that causes AIDS, is a key element in the bodys arsenal in dealing with oxidative
stress, and the effect on mortality of Se supplementation.
There are positive implications that this could benefit nursing in relation to how AIDS
patients are cared for. Nurses give care to all kinds of patients in a variety of scenarios. The
SELENIUM DEFICIENCY AND HIV MORTALITY 4
patient suffering from AIDS is no exception. The nurse that can understand the mechanism of
AIDS and how it can be managed with the appropriate diet containing Selenium rich foods can
better care for the patient with AIDS with the knowledge that is gained from this research.
That can only be done when more concrete evidence, via research, proves that it can be done
with out a doubt.

Review of Literature

In the first article by Baum, et al. (Baum et al., 1997), the researchers wanted to
determine the effect on mortality of patients with HIV.
To determine the independent contribution of specific immunological nutritional
factors on survival in HIV-1 disease, CD4 cell count, antiretroviral treatment,
plasma levels of vitamins A, E, B
6
, and B
12
and minerals selenium and zinc were
considered in relation to relative risk for HIV-related mortality. (Baum et al,
1997, p. 370).

Baum et. al conducted their study on a population that fit certain characteristic. The population
of the study was as follows:
The HIV-1-seropositive participants in this study were drawn from a cohort of
230 persons who were recruited from a street drug-using population and engaged
in high-risk behaviors for HIV-1 transmission (Baum et al, 1997, p. 371).

Baum et al then selected a group of 125 seropositive participants. In this clinical trial, Baum et al
found that:
Despite the importance of other nutrients, including tocopherols, in immune f
unction and as protection against oxidative stress, only selenium deficiency was
significantly associated with HIV-related mortality. (Baum et al, 1997, p. 374).

The researchers stated the following about the research conducted:

The results indicate that selenium deficiency is an independent predictor of
survival for those with HIV-1 infection. Baum et al, 1997, p.370)

SELENIUM DEFICIENCY AND HIV MORTALITY 5
The researchers of this study came to the following conclusion:

further studies to determine possible mechanisms and clinical trials to evaluate
the effect of selenium supplementation on HIV-1 disease progression are
essential. (Baum et al, 1997, p. 374).

In this article, the researchers used a single correlational/observational trial. The sample method
that was utilized was that of convenience sampling. The population that was studied was a group
of males and females that were street drug users that tested seropositive for HIV. The findings
were that there was a direct correlation to selenium deficiency and AIDS mortality. The
conclusion was that there needed to be more definitive research performed.
In the second article by Schrauzer and Sacher, the hypotheses put forth is that selenium
supplementation should be used as a supportive measure in patients with HIV.
Due to its antiviral effects and its importance for all immunological functions, the
administration of selenium is suggested as a supportive measure in early as well
as in advanced stages of HIV-induced disease. (Schrauzer and Sacher, 1994, p.
199).

The following also indicates states that this mineral selenium in sub optimal levels is detrimental
to the immune system.
Chronic suboptimal selenium intakes result in weakening of the immune
response (Schraauzer and Sacher, 1994, p. 200)

Schauzer and Sacher also stated that selenium supplementation should prove to be an alternative
retroviral if utilized. Also, the findings of this review indicate that
As selenium inhibits reverse transcriptase activity in RNA virus-infected animals,
supplemental selenium could also prevent the replication of HIV and retard the
development of AIDS in newly infected subjects. (Schauzer and Sacher, 1994, p.
199)

SELENIUM DEFICIENCY AND HIV MORTALITY 6
In their article, Schrauzer and Sacher, reviewed the literature of several other researchers. to put
forth there hypothesis for the advocacy of selenium. The review included some research
conducted by them. In this review, Schrauzer and Sacher go on to list 8 areas that they have
discussed. The conclusion of this literature review is the utilization of the mineral Selenium,
holds hope as a therapy.
simultaneous selenium supplementation holds promise as a means of
potentiating the efficacy of AIDS vaccines and other biologic therapeutic or
prophylactic agents. (Schrauzer and Sacher, 1994, p. 204).

This article by Schrauzer and Sacher (1994) was a systematic review of the physiologic
studies that was available for review. The population came from the various literature that was
reviewed by Schrauzer and Sacher (1994). Their findings/observations/conclusion was that there
was a strong correlation to the curtailment of the HIV virus in animals to what could possibly
happen in humans. The supplementation of selenium with the current ART has a promising
future but more definitive research needs to be done.
The next article Stone et al. found that researchers where able to corroborate the finding
that selenium deficiency in AIDS patients does exist although in the later stages of the disease.
Overall, serum selenium concentrations of persons in early stages of HIV disease
do not appear to differ significantly from those of the controls, but those in
advanced stages of the disease show low serum selenium concentrations. (Stone
et al. 2010, p. 673).

Stone et al., also found that researchers observed that low selenium concentrations were
linked to HIV mortality.
Studies have consistently found that low serum selenium levels are associated
with an increased risk of mortality among HIV-infected adults and children.
(Stone et al., 2010, p. 673).

SELENIUM DEFICIENCY AND HIV MORTALITY 7
Stone et al., have findings that corroborate what has already been found but goes on to
say that the place for selenium in the clinical setting is only that of adjunct to the already toxic
ART.
Selenium supplementation remains a possible adjunct therapy in HIV, but one
whose clinical role will be defined by future research that answers some of the
major reservations that remain (Stone et al, 2010, p. 678).

The next article by Stone et al., discusses some of the studies that were done to give
somewhat of a mixed ideation of what selenium as an adjunct to the already implemented
antiretroviral therapy. This article, a review of the literature, was a group of researchers that had
collaborated together giving results to the question if selenium could be utilized as a therapy to
affect the virus that causes AIDS. Stone et al. discusses the cross sectional studies, the cohort and
case control studies and prevention studies. The population ranged from 10-949 independent
subjects. These subjects were from several different countries.

In the final article to be reviewed, Taylor (1997) reviews much of the research already
done to come to the conclusions he puts forth in the article. The research speaks to the same
aspects as the research previous, that selenium supplementation is beneficial to those suffering
from the virus that cause AIDS. In the review of literature by (Taylor, 2010), the researchers, of
one he is himself, its found that selenium deficiency is linked to survival in HIV infected
patients.
A progressive decline in selenium levels, paralleling T cell loss, has been widely
documented in HIV patients, and selenium status is a significant predictor of
survival in HIV infections (Taylor, 1997, p.228).

Again in Taylor (1997) it is found that selenium levels could indicate HIV mortality.
In most recent studies, there is compelling evidence that selenium status is
actually a significant predictor of outcome in HIV infection, and that the relative
SELENIUM DEFICIENCY AND HIV MORTALITY 8
risk for mortality is much higher in selenium deficient patients (Taylor, 1997, p.
228).


In this article by Taylor (1997) the research was previously conducted and a systematic
review of physiologic studies. The populations were not clearly defined. Although, the question
of selenium supplementation being of benefit to patients suffering from HIV and from other
viruses, specifically Hepatitis B and C, and Coxsackie virus. the findings were in accord with the
other research or review of the literature that was done. Namely, that supplementation of
selenium affected the sufferers in a positive manner that cannot be over looked. Taylor also
indicated that more definitive research needs to be done.

Ethical Review

In the research and the literature reviews discussed that involved human subjects, an
Institutional Review Board and or similar ethics committee approved all of the research. In the
research trial that included human subject none of the subjects were harmed inadvertently. The
outcome tests the relationship of selenium deficiency to mortality rate. Some test subject did die
in the trial but were not affected excessively due to physical, mental or emotional distress. The
benefits to the participants did outweigh the any risk suffered by any of the participants. The
benefit was to show a link between selenium deficiency and mortality. The goal of the research
was reached with out any undo risks to participants.
Conclusion

From reading the literature, there seems to be some mixed views about the role that
selenium plays in the progression and halting the virus that causes AIDS. Some researchers say
that there is promise (Schrauzer and Sacher, 1994) while others have come to the conclusion that
SELENIUM DEFICIENCY AND HIV MORTALITY 9
its only a possibility (Stone et al, 2010). Clearly there needs to be more clinical research done to
support the findings made by all of the researchers.
In two of articles the research does answer the question that selenium supplementation
does positively affect the mortality of patients with AIDS (Baum et al, 1997) but there has not
been sufficient definitiveness to implement the course of treatment with patients that are
suffering from AIDS. Clearly, selenium supplementation affects the glutathione peroxidase
complex that enables the body to clearly deal with oxidative stress much better than with out it
(Taylor 1997). It is evident by all of the most recent views and research that the body, in order to
increase longevity, needs to be able to deal with oxidative stress in a positive manner. Without
this ability, which also can weaken the immune system (Schauzer and Sacher, 1994), the body
falls prey to oxidative damage and infection, which eventually may cause death. In practice,
there has not been much change to the standard protocol for care. Antiretroviral therapy is still
the therapy of choice. This may because of the ambiguity with which the research indicates and
the fact that no additional research as to the definitiveness of the benefit of selenium has been
carried out. Although, there is more than enough research to warrant that there is a positive
correlation with selenium supplementation and the curtailment of not only HIV but the other
viruses listed previously as well.
The articles that held the most validity was the literature reviews conducted by Stone et al
(2010) and Taylor (1997) because it was a systematic review of correlational/observational
studies.
What I learned from reviewing this research s that there is still some bias apparent in the
scientific community when it comes to embracing a new theory or a way of doing things. It
seems appropriate to not only change the ART protocol but to suspend it indefinitely. The
SELENIUM DEFICIENCY AND HIV MORTALITY 10
selenium supplementation is a more effective and cheaper way of treating patients suffering from
HIV, Hepatitis B and C and Coxsackie 8 virus. From the research it not only halt the viruses it
stops the shedding of the viruses which curtails transmission of the viruses. Selenium
supplementation needs to be evaluated further to see what other viruses could be affected by this
line of treatment.
I would inform the reader to make their own decision about the research. The findings
and the results are there in plain text. From the research it is apparent that selenium
supplementation needs to be utilized along with further studies.






























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References


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2. Baum, M., Shor-Posner, G., Lai, S., Zhang, G., Lai, H., Fletcher, M., & ... Page, J.
(1997). High risk of HIV-related mortality is associated with selenium deficiency.
Journal Of Acquired Immune Deficiency Syndromes And Human Retrovirology:
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3. Schrauzer, G., & Sacher, J. (1994). Selenium in the maintenance and therapy of HIV-
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