Increased mortality associated with vitamin A deficiency during human immunodeficiency virus type 1 infection.
Archives of Internal Medicine 1993 Sep 27;153(18):2149-54 (ISSN: 0003-9926)
Semba RD; Graham NM; Caiaffa WT; Margolick JB; Clement L; Vlahov D Dana Center for Preventive Ophthalmology, Wilmer Institute, Johns Hopkins University, Baltimore, MD.
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. PATIENTS AND 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). CONCLUSION: 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.
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