Age and gender dependent response in levels of CD4 T cell levels, viral load, and some trace elements in HIV sero positive subjects on ART and ART naive subjects in Rivers State, Nigeria

Received: 25-Mar-2022, Manuscript No. pulijhar-22-4579; Editor assigned: 29-Mar-2022, Pre QC No. pulijhar-22-4579(PQ); Accepted Date: Apr 25, 2022; Reviewed: 12-Apr-2022 QC No. pulijhar-22-4579(Q); Revised: 21-Apr-2022, Manuscript No. pulijhar-22-4579(R); Published: 27-Apr-2022, DOI: DOI No. 10.37532/ pulijhar.2022.5(2).06-09

Citation: Onwuli, Waribo Helen, Eberechukwu Okwuchi A, et al. Age and gender-dependent response in levels of CD4+ T-cell levels, viral load, and some trace elements in HIV sero-positive subjects on ART and ART naïve subjects in Rivers State, Nigeria. J HIV AIDS Res. 2022;5(2): 06-09

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Abstract

Background: Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) infection results in depletion of immune cells and micronutrients. Recently, HIV patients are treated with Antiretroviral Therapy (ART) with remarkable progress. This study was aimed at evaluating Cluster of Differentiation (CD4⁺ ) T-cells levels, viral load, serum Copper, Zinc and Selenium levels in HIV sero-positive subjects on ART and ART naïve subjects in Southern Nigeria with respect to age and gender.

Methods: 150 subjects aged 20 to 79 years were recruited after informed consent 70 subjects were HIV-positive on ART, 30 subjects were HIV-positive ART naïve, while 50 were apparently healthy subjects. Ten (10) milliliters of blood was collected from each subject for the analysis of CD4 T-cells using fluorescent activated cell sorter, serum Copper and Zinc were analyzed colorimetrically using semi auto-analyzer WP 21E, while selenium was analyzed using atomic absorption spectrophotometer. Data generated were analyzed using Graph-Pad Prism version 8.0.2 and p < 0.05 was considered significant.

Results: CD4+ T-cells was significantly lower in HIV subjects, and administration of ART improved the count significantly (546.9 ± 277.7 cells/ml) when compared with HIV ART naïve (297.5±244.6 cells/ml) [p<0.001]. The viral load 2.93 ± 1.39 was significantly higher in the ART naïve when compared to the HIV positive on ART 0.33 ± 0.19 (p<0.0001.). Serum selenium levels in control subjects (0.47 ± 0.40 µmol/l) was significantly higher than in HIV positive subjects on ART (0.058 ± 0.07 µmol/l) which is also significantly higher than ART naïve subjects (0.006 ± 0.004 µmol/l).[p<0.001]. Serum copper was significantly higher (285.5 ± 85.70 µg/dl) in ART naïve subjects than the HIV positive subjects on ART (258.5 ± 65.68 µg/dl) and the control subjects (198.3 ±40.23 µg/dl) [p<0.001]. Female subjects on ART (577.5 ± 27.0cells/ml) has a significantly higher CD4 T-cell count than male subjects on ART (451.2 ± 28.4 cells/ml) (p,0.001) and age interval of ART medication did not significantly differ.

Conclusion: There is significant reduction in CD4⁺ T-cell count, with elevated viral load and alteration in serum trace elements levels in HIV infection, while ART treatment improves the condition.

Key Words

CD4 T-cells; ART; Viral load; HIV; Micronutrients

Introduction

Human Immunodeficiency Virus (HIV) infection has become a global health problem and HIV positive individuals are susceptible to malnutrition [1] due to several factors, such as poor nutritional intake (gastrointestinal complications such as nausea and vomiting, oral and esophageal sores), loss of nutrient (diarrhea and/or malabsorption), alteration in the metabolic process (changes in fatty acid metabolism and increased protein turnover), and interaction between drug and nutrient [2]. HIV infects mainly the cells of the immune system particularly CD4⁺ Thelper cells, macrophages, and dendritic cells. The progressive depletion of the CD4⁺T-cells plays a critical role in the pathogenesis of HIV [3]. Trace elements (zinc (Zn), iron (Fe), copper (Cu), selenium (Se), chromium (Cr), cobalt (Co), iodine (I), manganese (Mn), and magnesium (Mg)) are dietary mineral that are present in very minute quantities (less than 0.01%) of the mass of the organism [4] and are involved in the regulation of vital functions of the body at all stages of development [5]. Zinc and Selenium are essential trace elements required for maintaining a healthy immune system. The deficiency of Zinc can result in decreased T-cells generation, suppression of humoral and cell-mediated immunity [6,7], progression to AIDS, and mortality in HIV-infected adults [8-9]. Deficiency of Selenium is associated with the increased mortality rate in HIV-positive individuals [10-15]. Hurwitz et al., in a randomized trial, reported improvement in CD4 T-cell count following Selenium supplementation in HIV-positive adults receiving Antiretroviral Therapy (ART) [16]. According to the National HIV/AIDS plan report in 2019, Rivers State is among the first three states with the highest incidence of HIV cases in Nigeria [17], with Port Harcourt having the largest number of cases in the state. There are limited data on the levels of plasma Zinc, Selenium, viral load, and CD4+ cells in HIV-seropositive subjects in this locality. This study is therefore aimed at evaluating the plasma levels of CD4⁺ T-cells, viral load, Zinc, and Selenium levels in HIVSero-positive individuals on ART and ART naïve subjects resident in Port Harcourt with respect to age and gender.

Results

TABLE 1 ANOVA Result of Control, ART Naïve, and HIV Subjects on ART

TABLE 2 ANOVA Result of Female Control, Female ART Naïve, and Female HIV Subjects on ART

TABLE 3 ANOVA result of male control, male art naïve, and male HIV subjects on art

TABLE 4 Comparative Analysis (ANOVA) of Male and Female Subjects on ART and ART Naïve

TABLE 5 Comparative Analysis (ANOVA) of Female Subjects on ART Based on Age Interval (years)

Table 6 Comparative Analysis (ANOVA) of Male Subjects on ART Based on Age Interval (years)

Discussion

The key feature of untreated HIV/AIDS infection is the progressive depletion of CD4⁺ cell lymphocytes and resultant severe immunosuppression. Initiation of ART gives better clinical improvement and leads to an increase in CD4⁺ cell count, dramatically decreases the incidence of opportunistic infections, and leads to immune restoration (partial or complete), that is, reversal of HIV-associated immunological alterations [18, 19]. This leads to a better quality of life for the patients [18-20]. The present study reveals that there is a higher level of CD4 T-cells in patients on ART compared to the level in ART naïve patients. This corresponds with the findings of Otieno et al., [21]. The improvement in CD4 T-cell count in patients on ART was age-related as subjects within the age range of 20-29 years had the highest number of CD4 T-cell count compared to the older subjects. This study also revealed gender-based differences in CD4 T-lymphocyte count. CD4 T-cells were higher in females than in males on ART and ART naïve subjects. This finding could be explained by the fact that women are likely tested for HIV earlier than men and had earlier access to treatment and clinical care compared to men, because of the increasing availability of antenatal testing as part of ongoing expansion in voluntary counseling and testing [22-23]. Early access to treatment and clinical care in female improve their health condition compared to their male counterparts at enrollment into care. Patients on ART showed greater improvement in CD4 lymphocyte count compared to ART naïve patients of both sexes, which confirmed the earlier report by Kumarasamy et al., [24] that both men and women showed consistent improvement in the HIV patients on initiating ART.

Micronutrients play a critical role in the proper functioning of the immune system. Thus in HIV where there is profound immune suppression, there occurs a deficiency of many micronutrients such as Zinc and Selenium. In HIV-positive cases, there is zinc deficiency, an essential element for the functioning of CD4 T-cell counts as seen in Tables 1-3, where zinc levels in control subjects (healthy individuals) were significantly higher when compared to HIV-infected subjects (ART naïve and subjects on ART). Zinc level was not affected by sex and age as there was no significant difference across the various age ranges and sex in the ART naïve and subjects on ART (Tables 4-6). Decreased Zinc levels have been reported in HIV infection at different stages [25]. Hence, low levels of Zinc may contribute to susceptibility to HIV or clinical features of HIV; also, HIV infection does suppress Zinc levels [26].

The deficiency of Selenium is associated with the early progression of HIV disease and mortality [27]. Deficiency of Selenium has been reported in HIV/ AIDS patients. This study reports decreased levels of Selenium in HIV seropositive subjects, this was independent of age and sex. This agrees with the reports of other researchers [28-32].

Conclusion

Low levels of CD4 lymphocytes, Zinc, and Selenium in HIV-infected subjects have been established. This scenario can enhance disease progression, complications, and mortality. Plasma Zn and Se deficiency are common in Port Harcourt HIV-infected patients and early evaluation of the nutritional status of these HIV positive subjects as well as provision of appropriate nutritional support and mineral supplementation along with antiretroviral therapy are recommended.

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