Vitamin A deficiency and the acute phase response among HIV-1-infected and -uninfected women in Kenya.
J Acquir Immune Defic Syndr 2002 Oct 1;31(2):243-9 (ISSN: 1525-4135)
Baeten JM; McClelland RS; Richardson BA; Bankson DD; Lavreys L; Wener MH; Overbaugh J; Mandaliya K; Ndinya-Achola JO; Bwayo JJ; Kreiss JK Department of Epidemiology, University of Washington, Seattle 98104-2499, USA. email@example.com.
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
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