Humans with low blood selenium concentrations are more likely to have impaired immune function and rapid mutation of benign variants of RNA viruses to virulent forms. Low blood selenium concentrations are concentrations less than 1 micromol of selenium per liter of blood = less than 78 micrograms of selenium per liter of blood [Harthill].
If a virus-infected, selenium-deficient human host is supplemented with selenium, the mutation rate of the virus tends to decrease, and the immune function tends to improve [Harthill].
Thus, the selenium status of the human host can have a profound effect on the development of a virus infection. In cases of selenium deficiency, a normally non-virulent virus can become virulent. A virus can become pathogenic by replicating in a nutritionally deficient human host [Beck].
Selenium Deficiency and HIV Disease Progression
In HIV-infected patients, deficiencies of various micronutrients, including selenium deficiency, have been associated with an increased risk of the HIV disease progression and with increased mortality.
Supplementation with micronutrients, again including selenium, has been associated with delayed HIV disease progression and reduced mortality in HIV-positive patients who were not receiving antiretroviral therapy [Drain; Stone].
Selenium Supplementation and Antiretroviral Therapy
Antiretroviral therapy consists of the daily taking of a combination of HIV medicines that do not cure the virus but do prevent its growth. The purpose of the antiretroviral therapy is the reduction of the concentration of the HIV virus in the blood to undetectable levels.
Patients on antiretroviral therapy who attain undetectable viral loads can live longer and healthier lives and can have practically no risk of transmitting the virus to a sex partner.
An important question to be decided is whether selenium supplementation can be a useful adjunctive treatment for patients on antiretroviral therapy. After all, adequate concentrations of selenium are needed for the formation of the antioxidant selenoproteins, the glutathione peroxidases and the thioredoxine reductases, that are associated with reduced oxidative stress [Stone].
Specifically, it is thought that the selenoproteins’ antioxidant activity may disrupt viral replication in HIV-infected immune cells [Baum].
Randomized Controlled Trials of Selenium Supplementation and HIV Infection
Burbano Study 2002
Daily supplementation of 186 HIV-positive adults with 200 micrograms of selenium or placebo for two years showed significant selenium-associated reductions in total hospital admission rates, in the percentage of hospitalizations due to infection, and in the cost of patient care.
Hurwitz Study 2007
Daily supplementation of 174 HIV-positive individuals with 200 micrograms of high-selenium yeast or placebo for nine months showed that the selenium supplementation can suppress the progression of the HIV viral load and improve the CD4 lymphocyte T-cell count.
Kupka Study 2008
Daily supplementation of 913 HIV-positive pregnant women from enrollment between week 12 and week 27 of gestation until six months following birth with 200 micrograms of selenomethionine or placebo did not have an effect on the mothers’ HIV viral load or CD4 leukocyte counts but did significantly decrease the risk of acute or persistent diarrhea and did significantly reduce the risk of mortality after six weeks for the infants of the mothers supplemented with selenium.
Baum Study 2013
In this four-armed clinical trial, 878 HIV-positive adults not yet on antiretroviral therapy were randomly assigned to one of four daily treatment modalities for 24 months:
- treatment with multivitamins (vitamins B, C, and E)
- treatment with 200 micrograms of selenium
- treatment with both multivitamins and selenium
- treatment with placebo
The combined supplementation with multivitamins plus selenium significantly reduced the participants’ risk of dropping below a CD4 cell count of 250 CD4 cells per microliter of blood. The multivitamins plus selenium supplementation also reduced the risk of pre-specified secondary outcomes for disease progression. Multivitamins alone and selenium supplementation alone were not statistically different from placebo for any end point.
However, none of the supplementation modalities — multivitamins alone, selenium alone, multivitamins + selenium, placebo — had a significant effect on the level of HIV viral load. That is to say, they did not significantly reduce the count of copies of HIV RNA in the blood.
In sum, it was good that the multivitamins + selenium kept the HIV patients’ CD4 cell counts up, considering that the HIV viral load was not decreasing appreciably.
Kamwesiga Study 2015
Daily supplementation of 300 HIV-infected adults not yet on antiretroviral therapy with 200 micrograms of selenium or placebo for 24 months demonstrated that selenium supplementation significantly slows down the rate of CD4 cell count decline in patients not on antiretroviral therapy.
Sources
Baum, M. K., Miguez-Burbano, M.J., Campa, A. & Shor-Posner, G. (2000). Selenium and interleukins in persons infected with human immunodeficiency virus type 1. J Infect Dis, 182 Suppl 1:S69-73.
Baum, M.K., Campa, A., Lai, S., et al. (2013). Effect of micronutrient supplementation on disease progression in asymptomatic, antiretroviral-naive, HIV-infected adults in Botswana: a randomized clinical trial. JAMA, 310(20):2154-2163.
Beck, M.A. (2000). Nutritionally induced oxidative stress: effect on viral disease. Am J Clin Nutr. 71(6 Suppl):1676S-81S.
Burbano, X., Miguez-Burbano, M. J., McCollister, K., Zhang, G., Rodriguez, A., Ruiz, P. & Shor-Posner, G. (2002). Impact of a selenium chemoprevention clinical trial on hospital admissions of HIV-infected participants. HIV Clinical Trials, 3(6), 483–491.
Drain, P.K., Kupka, R., Mugusi, F. & Fawzi, W.W. Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy. Am J Clin Nutr, 85(2):333-345.
Harthill, M. (2011). Review: micronutrient selenium deficiency influences evolution of some viral infectious diseases. Biol Trace Elem Res. 143(3):1325-36.
Kamwesiga, J., Mutabazi, V., Kayumba, J., Tayari, J.-C. K., Uwimbabazi, J. C., Batanage, G., … Mukazayire, E. (2015). Effect of selenium supplementation on CD4+ T-cell recovery, viral suppression and morbidity of HIV-infected patients in Rwanda: a randomized controlled trial. AIDS (London, England), 29(9), 1045–1052.
Kupka, R., Mugusi, F., Aboud, S., Msamanga, G. I., Finkelstein, J. L., Spiegelman, D., & Fawzi, W. W. (2008). Randomized, double-blind, placebo-controlled trial of selenium supplements among HIV-infected pregnant women in Tanzania: effects on maternal and child outcomes. The American Journal of Clinical Nutrition, 87(6), 1802–1808.
Stone, C.A., Kawai, K., Kupka, R. & Fawzi, W.W. (2010). Role of selenium in HIV infection. Nutr Rev, 68(11):671-681.
The information presented in this review article is not intended as medical advice and should not be construed as such.