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Richard D. Semba, MD, MPH; Neil M. H. Graham, MD; Waleska T. Caiaffa, MD, PhD; Joseph B. Margolick, MD, PhD; Liliana Clement; David Vlahov, PhD

Arch Intern Med. 1993;153(18):2149-2154.

Abstract
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-l-seropositive individuals had plasma vitamin A levels less than 1.05 µmol/L, a level consistent with vitamin A deficiency. The HIV-l-seropositive individuals had lower mean plasma vitamin A levels than HIV-l-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-l infection.

(Arch Intern Med. 1993;153:2149-2154)

Author Affiliations
From the Dana Center for Preventive Ophthalmology, Wilmer Institute (Dr Semba and Ms Clement), and the Program of Infectious Diseases, Departments of Epidemiology (Drs Graham, Caiaffa, and Vlahov), Immunology and Infectious Diseases (Drs Semba and Margolick), Environmental Health Sciences (Dr Margolick), and Medicine (Drs Graham and Vlahov), the School of Medicine and the School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Md.

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