The role of antioxidant enzymes and micronutrients in mitigating HIV-associated oxidative stress in Sub-Saharan African populations

Abstract

HIV/AIDS poses a major public health burden in sub-Saharan Africa, a region disproportionately affected by both chronic infections and malnutrition. While antiretroviral therapy (ART) has markedly improved survival and viral suppression, emerging evidence highlights the persistent role of oxidative stress in immune dysfunction, disease progression, and comorbidity development in people living with HIV. This review examines the mechanisms of HIV-associated oxidative stress and evaluates the role of antioxidant enzymes and micronutrients in its modulation. It further explores the prevalence and causes of regional micronutrient deficiencies in sub-Saharan Africa and synthesizes findings from intervention studies to guide evidence-based nutrition and policy strategies in HIV care. The review reveals that HIV and ART disrupt antioxidant systems while also depleting essential micronutrients due to poor dietary diversity, soil nutrient depletion, and socioeconomic constraints. Evidence from multiple clinical trials in sub-Saharan Africa and beyond demonstrates that targeted micronutrient supplementation can enhance antioxidant capacity, improve CD4+ counts, reduce opportunistic infections, and support ART efficacy, particularly in nutrient-deficient individuals. Mitigating HIV-associated oxidative stress through antioxidant and micronutrient support offers a critical but underutilized strategy in HIV care. Integrating nutritional screening, targeted supplementation, and food fortification into HIV management frameworks could substantially improve immune recovery and long-term well-being among people living with HIV.