The proposed research, to be done in HIV-infected drug abusers, is in response to a research program on the medical and health consequences of drug abuse and a program at NIDA on metabolic and endocrine complications of drug substance abuse and HIV infection. Poor serum/plasma micronutrient status is common in drug abusers with and without HIV. Low micronutrient levels have been associated with adverse outcomes in HIV infection. Previous studies suggest that poor nutritional status among drug abusers cannot be attributed entirely to dietary intake. Little research has been published on non-dietary mechanisms by which drug abusers, with and without HIV, may develop low blood levels of micronutrients. Non-dietary factors affecting micronutrient status may include malabsorption, abnormal metabolism, increased excretion, and increased requirements. Malabsorption, liver, and renal dysfunction are all common among drug abusers. Furthermore, drug abusers often smoke cigarettes and abuse alcohol, which are known to affect the metabolism of some micronutrients. Here, we propose to examine some aspects of micronutrient metabolism to identify mechanisms contributing to low blood levels. We will focus on the antioxidant micronutrients vitamins A and E, the carotenoids, selenium and zinc, which are metabolically related to one another. Specifically we will: 1) Determine the prevalence of low to marginal serum levels of the micronutrients vitamin A, beta-carotene, vitamin E, selenium and zinc among three groups: drug abusers with HIV, drug abusers without HIV and non-drug abusers with HIV. 2) Determine the association between malabsorption and serum icronutrient levels (listed in specific aim 1). 3) Determine the association between levels of transportation factors and serum micronutrient levels. 4) Determine the role of liver or renal dysfunction in the association between micronutrient transport factors and low to marginal serum micronutrient levels. The proposed study will build on the existing BIENESTAR study (NIDA DA11598), and complement the ongoing TANG study (NIDA DA10252). The long term goal of this research is to develop effective interventions to improve the nutritional status and health outcomes of drug abusers with and without infectious diseases, including HIV.
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