Title: SERUM TRACE ELEMENTS DISTURBANCES IN HIV INFECTED CHILDREN
1SERUM TRACE ELEMENTS DISTURBANCES IN HIV
INFECTED CHILDREN
- Bharti B, Singh S, Sonia, Attri S, Bhalla AK
- Advanced Pediatric Center, PGIMER, Chandigarh
2Introduction Rationale
- Trace element disturbances frequently underpin
HIV infection in children and they can escalate - immune dysfunction,
- morbidity and
- HIV disease progression.
3Trace elements (Micronutrients) and HIV
4Rationale
- This study offers insight into alterations of
trace elements (Zinc, Copper and Iron ) milieu
and may prompt better nutritional intervention.
5Objectives
- To measure the serum levels of three trace
elements (zinc, iron and copper) in stable HIV
infected children.
6Design Setting
- Prospective
- Cross-sectional
- Setting
- Pediatric Immunology Clinic at the Advanced
Pediatric Center, PGIMER Chandigarh
7Materials Methods
- Serum zinc (Zn), iron (Fe) and copper(Cu) levels
in HIV children(cases) were assessed using
Perkin Elmer Atomic Absorption Spectrophotomer - ( Zn Cu) and Dimension AR Autoanalyser (Fe).
8Methods (contd)
- Inclusion criteria
- Children beyond the age of 18 months
presenting to the Pediatric Immunology clinic of
Advanced Pediatric Center at PGIMER - Exclusion criteria
- Lack of consent
9Results
- 69 stable HIV infected children were enrolled
during the year 2008 to 2009 hospital. - Mean Age(years) 7.9 years (SD 3.6)
- Range 2 to 18 years
- Male Female ratio 41
-
10Results
- Route of transmission
- Perinatally acquired 98
- Transfusion acquired 2
- Common clinical manifestations
- Recurrent or Persistent fever (31)
- Lymphadenopathy(30)
- Hepatosplenomegaly (21)
- Ear infection/pyoderma/skin rash/
- Oral Thrush/Parotid enlargement (lt10)
-
11HIV childrens parent status
- 20 of the children orphan
- 30 had a single parent living
- Out of those with single parent
- 62 childrens father had expired
12Nutritional status of the HIV children
- 14 severely malnourished (lt3 zscore)
- 25 moderate (-2 to -3z score)
- 17 mild (-1 to -2 z score)
- 11 normal
13Immune status of the children with HIV
- 11 of the children had CD4 counts lt200
- suggesting severe immunodeficiency
- These children were on
- HAART as per
- NACO guidelines
14Levels of the Trace elements
- Mean Serum Zinc (SD) 114.4 µg/dl (52.0)
- Normal Serum Zn levels (64-118 µg/dl)
- Mean Serum Copper (SD) 147.20 µg/dl(51.5)
- Normal Serum Cu levels(80-150 µg/dl)
- Serum Iron 92.44 µg/dl(49.9)
- Normal Serum Fe levels(22-184 µg/dl)
15age of Patients having low values
- Serum Zinc -6 of the patients had low values
- Serum Copper -20 had low values
- Serum Iron- 17 had low values
16Serum Copper levels an interesting observation
High values An acute phase reactant
17Correlation between Trace elements Malnutrition
18Correlation between Trace elements CD4 counts
19Correlations between Ser Cu Zn and CD4 counts
20Scatter Plot Serum Iron CD4 counts
21Serum Copper CD4 counts
22Correlations between Serum Cu, Zn and Fe level
23Conclusions
-
- 14 of the children were severely malnourished
- Zn deficiency was observed in 6 children
whereas Copper and Iron deficiencies were
reported in 20 and 17 respectively - Interestingly 44 of patients had high
copper levels possibly due to its role as an
acute phase reactant.
24Conclusions
- There was no significant correlation between the
serum Zinc and copper levels with malnutrition
and CD4 counts - Only significant correlation was with Serum iron
and severe malnutrition