JRSM > Volume 94, Number 11 > Pp. 609

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Cardiovascular manifestations of HIV infection

Syed Wamique Yusuf

Division of Cardiology, University of Texas, Houston, USA

Dr Barbaro (August 2001, JRSM, pp. 384-390) briefly mentions selenium deficiency as a contributing factor in the development of cardiomyopathy in patients infected with human immunodeficiency virus (HIV). Cardiomyopathy similar to Keshan disease has been well documented in HIV patients¹ and those on total parenteral nutrition (TPN)². TPN is deficient not only in selenium but also in other micronutrients including vitamin E³, and this may contribute to the development of cardiomyopathy. In animals, combined vitamin E and selenium deficiency can impair cardiac conduction⁴ and hence facilitate the development of disease.

Selenium is an essential component of glutathione peroxidase (GPX)⁵, and this enzyme together with catalase, superoxide dismutase, and vitamin E provides a line of defence against pro-oxidant molecules. In the absence of selenium, GPX is inactive and low GPX is found in HIV disease⁵. GPX activity increases after selenium supplementation⁵. Also the oxidative muscle damage produced by zidovudine treatment can be prevented with anti-oxidants⁶.

TPN is increasingly being used in HIV and other chronic illness. Adequate supplementation of selenium in TPN and in malnourished patients might protect against the development of cardiomyopathy in these patients. To date, there are no official guidelines regarding the use of selenium in TPN.

REFERENCES

1. Dworkin BM, Antonecchia PP, Smith F, et al. Reduced cardiac selenium contents in acquired immunodeficiency syndrome. J Parenter Enteral Nutr1989; 13:644 -7[Abstract]

2. Johnson RA, Baker SS, Fallon JT, et al. An occidental case of fatal cardiomyopathy and selenium deficiency. N Engl J Med 1981;304:1201 -2[Medline]

3. Forbes GM, Forbes A. Micronutrient status in patients receiving home parenteral nutrition. Nutrition1997; 13:941 -44[Medline]

4. Kennedy S, Rice BA. Selective morphological alteration of the cardiac conduction system in calves deficient in vitamin E and selenium. Am J Pathol1988; 130:315 -25[Abstract]

5. Delams-Beauneux MC, Peuchant E, Conchouran A, et al. The enzymatic anti-oxidant system in blood and glutathione status in human HIV infected patients: effect of supplementation with selenium and betacarotene. Am J Clin Nutr1996; 64:101 -7[Abstract/Free Full Text]

6. de La Asuncion JG, del Olmo ML, Sastre J, et al. AZT treatment induces molecular and ultrastructural oxidative damage to muscle mitochondria. Prevention by anti-oxidant vitamins. J Clin Invest 1998;102:4 -9[Medline]

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This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yusuf, S. W. Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?