Vitamin B12 Malabsorption in Patients With Acquired Immunodeficiency Syndrome

doi:10.1001/archinte.1989.00390090091018

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Vol. 149 No. 9, September 1989

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Vitamin B12 Malabsorption in Patients With Acquired Immunodeficiency Syndrome

Gregory R. Harriman, MD; Phillip D. Smith, MD; McDonald K. Home, MD; Cecil H. Fox, PhD; Scott Koenig, MD; Ernest E. Lack, MD; H. Clifford Lane, MD; Anthony S. Fauci, MD

Arch Intern Med. 1989;149(9):2039-2041.

Abstract

• We have examined 11 patients with the acquired immunodeficiencysyndrome (AIDS) for evidence of subclinical vitamin B₁₂ malabsorption.Three subjects (27%) had low levels of vitamin B₁₂. Eight subjects(73%), including these 3 subjects plus 5 others with normalvitamin B₁₂ levels, had abnormal Schilling test results. Inaddition, 15% of an unselected population of 121 patients withAIDS and 7% of 27 patients without AIDS who were seropositivefor human immunodeficiency virus type 1 (HIV-1) had low serumvitamin B₁₂ levels. Stool cultures from the 8 subjects withabnormal Schilling test results revealed no pathogens. Intestinalinvolvement by Kaposi's sarcoma was found in only 1 patient.Biopsy specimens from 5 of 6 patients with vitamin B₁₂ malabsorption,however, contained mononuclear cells harboring HIV-1, as indicatedby in situ hybridization studies. Our observations suggest thatvitamin B₁₂ malabsorption is common in patients with AIDS andmay be a very early manifestation of infection with HIV-1.

(Arch Intern Med. 1989;149:2039-2041)

Author Affiliations

From the Laboratories of Clinical Investigation (Dr Harriman) and Immunoregulation (Drs Koenig, Lane, and Faci), National Institute of Allergy and Infectious Diseases; the Laboratory of Microbiology and Immunology, National Institute of Dental Research (Dr Smith); the Department of Clinical Pathology, Warren Grant Magnuson Clinical Center (Dr Horne); and the Laboratory of Pathology, Division of Cancer Biology and Diagnosis (Drs Fox and Lack), National Cancer Institute, National Institutes of Health, Bethesda, Md.

Footnotes

Accepted for publication June 19, 1989.

Reprint requests to Room 11N250, Bldg 10, National Institutesof Health, Bethesda, MD 20892 (Dr Harriman).

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