Increased mortality associated with vitamin A deficiency during human immunodeficiency virus type 1 infection.
OBJECTIVE
To determine whether plasma vitamin A levels are associated with immunologic status and clinical outcome during human immunodeficiency virus type 1 (HIV-1) infection.


METHODS
Analysis of vitamin A levels, CD4 T cells, complete blood cell count, and serologic markers for liver disease in a random subsample of 179 subjects from a cohort of more than 2000 intravenous drug users with longitudinal follow-up to determine survival.


RESULTS
Mean (+/- SE) follow-up time was 22.8 +/- 1.1 months, and 15 subjects died during follow-up. More than 15% of the HIV-1-seropositive individuals had plasma vitamin A levels less than 1.05 mumol/L, a level consistent with vitamin A deficiency. The HIV-1-seropositive individuals had lower mean plasma vitamin A levels than HIV-1-seronegative individuals (P < .001). Vitamin A deficiency was associated with lower CD4 levels among both seronegative individuals (P < .05) and seropositive individuals (P < .05). In the HIV-seropositive participants, vitamin A deficiency was associated with increased mortality (relative risk = 6.3; 95% confidence interval, 2.1 to 18.6).


CONCLUSIONS
Vitamin A deficiency may be common during HIV-1 infection, and vitamin A deficiency is associated with decreased circulating CD4 T cells and increased mortality. Vitamin A is an essential micronutrient for normal immune function, and vitamin A deficiency seems to be an important risk factor for disease progression during HIV-1 infection.
Dana Center for Preventive Ophthalmology, Wilmer Institute, Johns Hopkins University, Baltimore, MD.
R D
RD
Semba
N M
NM
Graham
W T
WT
Caiaffa
J B
JB
Margolick
L
L
Clement
D
D
Vlahov
D000328:Adult; D015704:CD4 Antigens / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000503:physiopathology; D015497:HIV-1; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D014802:Vitamin A Deficiency / Q000150:complications* / Q000276:immunology / Q000503:physiopathology
D015704:CD4 Antigens