However, even this should only have been done after reporting the results of the overall comparison of HIV progression in all those randomly allocated to selenium treatment vs those allocated to placebo.Nowhere do the authors present this primary trial result.The potential for bias in subgroup analyses is substantial and well recognized. The selenium nonresponders were less likely to have taken their capsules than the responders, raising concerns that they differed from responders in others ways and that they may have been at increased risk of a poor <a href="http://www.targetmol.com/compound/Chlorpheniramine-maleate">buy
Chlorpheniramine maleate</a> outcome irrespective of their adherence, perhaps because they had more advanced HIV disease at baseline, which might well have also reduced their ability to absorb the selenium or were less likely to adhere to other HIV treatments including, for example, ART.The authors also present a structural equation analysis model, in which the results are compatible with a beneficial effect of selenium supplementation but, although this is not entirely clear from the text, it appears that this follows the same analytical plan as the main analysis and does not present a comparison of the overall impact of randomized allocation to the selenium vs the placebo group.We believe that several issues need to be considered before reaching this conclusion.First, human CD cell counts are not distributed normally in the population; thus, a better measurement of treatment response is to examine the change in either CD cell percentage or the square root of the CD cell count.Third, the nonresponders demonstrated increased serum selenium levels compared with the placebo group, yet there was no selenium dose effect on either CD cell count or HIV RNA concentration. Finally, these subjects were heavily experienced with ART and did not receive standardized ART regimens.Consistent with extensive ART use, the median baseline HIV RNA levels were only and copiesmL among selenium recipients and placebo, respectively.Although several methods were used to try and assess whether or not ART regimen, receipt of ART, and change in HIV RNA levels among those receiving ART with detectable viral load altered the overall results, these efforts do not remove these important confounding variables.Thus, it is very difficult to interpret the small differences in CD cell count or HIV RNA level among the selenium treatment groups in these individuals receiving ART, and poor adherence in only a few subjects in either group could greatly alter the results.In conclusion, while it is possible that selenium may influence HIV disease progression, HIV RNA concentration, and CD cell count, the differences observed in this study are of questionable relevance.Future studies of selenium in subjects who are either not receiving ART or receiving a standardized ART regimen are needed be, JULY, WWW.All rights reserved. View publication stats View publication stats Papers are published here unedited, as submitted by their authors.The conference does not necessarily endorse their contents.No part of this publication may be reproduced in any form or by any means, electronically, mechanically, by photocopying, recording or other wish without the prior permission of the copying owners.It is achieved through management strategies which help the producer select hybrids and varieties, soil conserving cultural practices, soil fertility programs, crop rotations, weed, pest and disease biological management programs, and strategic use of animal and green manures and use of natural or synthetic inputs in a way that poses no significant hazard to man, animals, or the environment.