Iron intake is positively associated with viral load in antiretroviral naïve Brazilian men living with HIV

Gonçalves, Juliana Lauar; Silva, Maria Clara Amorim; Roma, Eric Henrique; Grinsztejn, Beatriz; Lemos, Alberto dos Santos de; Gorni, Nathalia; Cruz, Adele Moura; Almeida, Cristiane Fonseca de; Quintana, Marcel de Souza Borges; Bonecini-Almeida, Maria da Gloria; Brito, Patrícia Dias de

doi:10.1590/0074-02760190350

BACKGROUND

Iron homeostasis contribute for the human immunodeficiency virus (HIV) pathogenesis.

OBJECTIVES

We assessed the iron intake pattern in antiretroviral naïve Brazilian men living with HIV correlating with clinical and nutritional parameters.

METHODS

The iron consumption mean was estimated according to a food frequency questionnaire (FFQ), and a 3-day food record (3dFR) submitted to the patients. HIV viral load, CD4⁺ T cell counts, serum iron, haematological and anthropometrics parameters were recorded.

FINDINGS

Fifty-one HIV-infected adult men naïve for antiretroviral therapy (ART) were enrolled. The mean age of participants was 35 (SEM ± 1.28) years old, with mean time of HIV-1 infection of 1.78 (0-16.36, min-max) years. Majority (41.18%) had complete secondary, and 21.57% had tertiary educational level. The income was around 1x (54.90%) to 2x (41.18%) minimum wage. Fifty-four percent showed normal weight, while 40% were overweight. The patients showed normal mean values of haematological parameters, and mean serum iron was 14.40 µM (SEM ± 0.83). The FFQ showed moderate correlation with the 3dFR (ρ = 0.5436, p = 0.0009), and the mean values of iron intake were 10.55(± 0.92) mg/day, recorded by FFQ, and 15.75(± 1.51) mg/day, recorded by 3dFR. The iron intake, recorded by FFQ, negatively correlated with serum iron (ρ = -0.3448, p = 0.0132), and did not have influence in the CD4⁺ T cell counts [e.B 0.99 (0.97-1.01, 95% confidence interval (CI), p = 0.2]. However, the iron intake showed a positive effect in HIV viral load [e.B 1.12 (1.02-1.25, 95%CI), p < 0.01].

MAIN CONCLUSIONS

This study draws attention for the importance of iron intake nutritional counseling in people living with HIV. However, more studies are required to clarify the association between high iron intake and HIV infection and outcome.

Key words:
HIV; iron intake; nutrition; ART naïve

[1] + Corresponding author: eric.roma@ini.fiocruz.br

Variables	Findings
Demographics
Age (years), n = 51^a	35 (± 1.28)
Income (minimum wage), n = 51^b
1x	28 (54.90%)
2x	21 (41.18%)
3x	0 (0%)
4x	2 (3.92%)
Education level (categories), n = 51^b,c
0-early childhood	0 (0%)
1-primary	0 (0%)
2-lower secondary	1 (1.96%)
3-upper secondary	9 (17.65%)
4-post-secondary non-tertiary	21 (41.18%)
5-short-cycle tertiary	6 (11.76%)
6-bachelor’s or equivalent	11 (21.57%)
7-master’s or equivalent	3 (5.88%)
Diagnosis of HIV-1 infection (years), n = 51^d	1.78 (0.00-16.36)
Anthropometrics parameters, n = 50^b
BMI (kg/m²)
Normal weight	27 (54%)
Overweight	20 (40%)
Obesity
Haematological and iron parameters, n = 45^a,d
RBC (1 x 10⁶ cells/mm3)	4.90 (3.71-6.89)
MCV (μm3)	86.30 (69.7-98.4)
MCH (pg)	29.2 (21.0-34.3)
MCHC (g/dL)	33.8 (30.2-35.9)
Haemoglobin (g/dL)	14.49 (± 0.17)
Hematocrit (%)	43.08 (± 0.49)
Transferrin (mg/dL)	209.0 (108.2-350.6)
Serum iron (µM), n = 51^a	14.40 (± 0.83)
Iron intake (mg/day)^a
FFQ, n = 51	10.55 (± 0.92)
3dFR, n = 34	15.75 (± 1.51)

Variables	CD4 cells				Viral load (HIV RNA copy/mL)
	Univariate		Multivariate		Univariate		Multivariate
	eB (CI-95%)	p value	eB (CI-95%)	p value	eB (CI-95%)	p value	eB (CI-95%)	p value
Iron intake (FFQ) (n = 51)	0.98 (0.96-1)	0.11	0.99 (0.97-1.01)	0.2	1.15 (1.04-1.31)	< 0.01	1.12 (1.02-1.25)	< 0.01
Iron intake (3dFR) (n = 34)	0.99 (0.97-1.01)	0.22	0.99 (0.97-1.01)	0.29	1.1 (1.02-1.2)	0.01	1.09 (1-1.2)	0.02
Serum iron (n = 51)	1.01 (1-1.01)	< 0.01	1.01 (1-1.01)	<0.01	0.98 (0.97-1)	0.01	0.98 (0.97-1)	0.01