Selenium deficiency is associated with shedding of HIV-1-infected cells inthe female genital tract

Objective: To assess the relation between selenium deficiency and vaginal o r cervical shedding of HIV-1-infected cells. Design: Cross-sectional study of 318 HIV-1 seropositive women in Mombasa, Kenya. Methods: Vaginal and cervical swab specimens were tested for the presence o f HIV-1 DNA by polymerase chain reaction. Multivariate logistic regression models, adjusting for CD4 count and vitamin A deficiency, were used. Results: Selenium deficiency (defined as levels < 85 mug/L) was observed in 11% of the study population. In unstratified multivariate analyses, there was no significant association between selenium deficiency and vaginal or c ervical shedding. In stratified analyses, however, significant associations became apparent after excluding women with predictors of shedding with str ong local effects on the genital tract mucosa. Among women who did not use oral contraceptives and who did not have vaginal candidiasis, selenium defi ciency was significantly associated with vaginal shedding (adjusted odds ra tio [AOR] 2.9, 95% confidence interval [CI] 1.0-8.8, p = .05). Effect modif ication was also observed in the relation between selenium deficiency and c ervical shedding, with a significant association seen among those women who were not using oral contraceptive pills or depot medroxyprogesterone aceta te and who did not have Neisseria gonorrhoeae infection (AOR 2.8, 95% CI 1. 1-7.0, p = .02). Conclusions: We found selenium deficiency to be associated with a nearly th reefold higher likelihood of genital mucosal shedding of HIV-1-infected cel ls, suggesting that deficiency may increase the infectiousness of women wit h HIV-1. Nutritional interventions to prevent HIV-1 transmission warrant in vestigation.