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Dr Barbaro (August 2001, JRSM, pp. 384-390) briefly mentions selenium deficiency as a contributing factor in the development of cardiomyopathy in patients infected with human immunodeficiency virus (HIV). Cardiomyopathy similar to Keshan disease has been well documented in HIV patients1 and those on total parenteral nutrition (TPN)2. TPN is deficient not only in selenium but also in other micronutrients including vitamin E3, and this may contribute to the development of cardiomyopathy. In animals, combined vitamin E and selenium deficiency can impair cardiac conduction4 and hence facilitate the development of disease.
Selenium is an essential component of glutathione peroxidase (GPX)5, and this enzyme together with catalase, superoxide dismutase, and vitamin E provides a line of defence against pro-oxidant molecules. In the absence of selenium, GPX is inactive and low GPX is found in HIV disease5. GPX activity increases after selenium supplementation5. Also the oxidative muscle damage produced by zidovudine treatment can be prevented with anti-oxidants6.
TPN is increasingly being used in HIV and other chronic illness. Adequate supplementation of selenium in TPN and in malnourished patients might protect against the development of cardiomyopathy in these patients. To date, there are no official guidelines regarding the use of selenium in TPN.