title: Vitamin A deficiency and the acute phase response among HIV-1-infected and -uninfected women in Kenya.
abstract: 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 microg/dL) and HIV-1 status, HIV-1 disease stage, and the acute phase response (serum C-reactive protein >or=10 mg/L and/or alpha1-acid glycoprotein >or=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.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle 98104-2499, USA. jbaeten@u.washington.edu
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bankson
authors.forename: Ludo
authors.initials: L
authors.lastname: Lavreys
authors.forename: Mark H
authors.initials: MH
authors.lastname: Wener
authors.forename: Julie
authors.initials: J
authors.lastname: Overbaugh
authors.forename: Kishorchandra
authors.initials: K
authors.lastname: Mandaliya
authors.forename: Jeckoniah O
authors.initials: JO
authors.lastname: Ndinya-Achola
authors.forename: Job J
authors.initials: JJ
authors.lastname: Bwayo
authors.forename: Joan K
authors.initials: JK
authors.lastname: Kreiss
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D007630:Kenya; D008875:Middle Aged; D016017:Odds Ratio; D009961:Orosomucoid / Q000032:analysis; D019562:Viral Load; D014801:Vitamin A / Q000097:blood / Q000627:therapeutic use*; D014802:Vitamin A Deficiency / Q000150:complications* / Q000188:drug therapy*
chemical_list: D015415:Biomarkers; D009961:Orosomucoid; D014801:Vitamin A; D002097:C-Reactive Protein