Selenium (Se) is required for the activity of the enzyme glutathione peroxidase, and selenium deficiency may be associated with myopathy, cardiomyopathy and immune dysfunction including oral candidiasis, impaired phagocytic function and decreased CD4 T-cell counts. When a host is malnourished, the immune system is compromised and there is an increased susceptibility to viral infections. Research published points about the importance ofhost nutrition during a viral disease, not only from the perspective of the host, but from the perspective of the viral pathogen as well. When a benign strain of coxsackievirus B3 is injected into Selenium (Se)-deficient or vitamin E-deficient mice, it evolves to become virulent. Studies have shown that in addition to immunosuppression due to micronutrient deficiency, the virus itselfbecomes altered [43], Beck et al. have shown in a mouse model of coxsackievirus-induced myocarditis, that host deficiency in either selenium or vitamin E leads to a change in viral phenotype such that an avirulent strain of the virus becomes virulent and a virulent strain becomes more virulent. The change in phenotype was shown to be due to point mutations in the viral genome. Once the mutations occur, the phenotype change is stable and can now be expressed even in well nourished mice. These results suggest that nutrition can affect not only the host, but the pathogen as well, and show a new model of relating host nutritional effects to viral pathogenesis [44],

In a study done with AIDS patients, plasma and red blood cell levels of Se were found to be less than half of those in healthy individuals [45], A correlation between Se and glutathione perioxidase and the total lymphocyte count was also established. This occurred in both homosexuals and drug users with AIDS and was irrespective of the presence or absence of diarrhea or GI malabsorption. Interestingly, cardiac tissue Se levels in AIDS patients was also found to be low [45],

One reason for the decreased selenium levels in HIV infected patients may have to do with the virus itself. The virus uses selenoproteins to regulate its replication, which deplete the Se levels of the host. Supplementation trials with individual antioxidants have shown improvement in immunological parameters and decreased evidence of lipid peroxidation when selenium is added [46], Recent investigations indicate that supplementation with Se may help to increase the enzymatic defense systems in HIV-infected patients [47,48], These studies help support the assertion that increased Se levels help to decrease morbidity and prolong survival in HIV infected hosts.

Micronutrient deficiency is common in HIV positive patients as documented by low plasma and red blood cell levels of Se, diminished activity of glutathione peroxidase, and low cardiac Se levels in AIDS infected hearts. This worsens with time since AIDS patients tend to have more severe vitamin deficits than those with earlier stages ofHIV infection. The Se deficit in blood correlates with serum albumin levels and total lymphocyte counts, which in turn accetuates the conditions to predispose the AIDS patients to secondary infections.

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