Summary:Among HIV-1-infected individuals, vitamin A deficiency has been associated with faster disease progression and greater infectivity in observational studies, but randomized clinical trials have shown no effect of vitamin A supplementation. We conducted a cross-sectional study of 400 HIV-1-infected and 200 HIV-1-uninfected women in Mombasa, Kenya to examine the relations between vitamin A deficiency (serum retinol <30 μg/dL) and HIV-1 status, HIV-1 disease stage, and the acute phase response (serum C-reactive protein ≥10 mg/L and/or α1-acid glycoprotein ≥1.2 g/L). Among the HIV-1-infected women, the effect of vitamin A supplementation was examined in a randomized trial. Vitamin A deficiency was independently associated with HIV-1 infection (OR = 2.7, 95% CI: 1.9-4.0) and the acute phase response (OR = 2.8, 95% CI: 1.9-4.1). Among HIV-1-infected women, vitamin A deficiency and the acute phase response were associated with each other and were both independently associated with higher HIV-1 plasma viral load and lower CD4 count. HIV-1-infected women having an acute phase response had no increase in serum vitamin A levels after supplementation. Serum levels increased significantly among women without an acute phase response, although not to normal levels among women who were deficient at baseline. Among HIV-1-infected individuals, it is likely that low serum vitamin A concentrations reflect more active infection and the acute phase response. These results provide possible explanations for the disparity between observational studies and randomized trials of vitamin A for HIV-1 infection.
This study was supported in part by the U.S. National Institutes of Health through research grants AI43844 and AI39996 and through a center grant to the University of Washington Clinical Nutrition Research Unit (DK35816). J.M. Baeten and R.S. McClelland were scholars in the International AIDS Research and Training Program supported by the Fogarty International Center, National Institutes of Health (D43-TW00007). J. Overbaugh is an Elizabeth Glaser Scientist.
Address correspondence and reprint requests to Jared M. Baeten, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104-2499, U.S.A.; e-mail: email@example.com
Manuscript received November 7, 2001; accepted May 30, 2002.
© 2002 Lippincott Williams & Wilkins, Inc.