Increased Mortality Associated With Vitamin A Deficiency During Human Immunodeficiency Virus Type 1 Infection

doi:10.1001/archinte.1993.00410180103012

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Vol. 153 No. 18, 27 SEP 1993

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Increased Mortality Associated With Vitamin A Deficiency During Human Immunodeficiency Virus Type 1 Infection

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 associatedwith immunologic status and clinical outcome during human immunodeficiencyvirus type 1 (HIV-1) infection.

Patients and Methods
Analysis of vitamin A levels, CD4 T cells, complete blood cellcount, and serologic markers for liver disease in a random subsampleof 179 subjects from a cohort of more than 2000 intravenousdrug 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 theHIV-l-seropositive individuals had plasma vitamin A levels lessthan 1.05 µmol/L, a level consistent with vitamin A deficiency.The HIV-l-seropositive individuals had lower mean plasma vitaminA levels than HIV-l-seronegative individuals (P<.001). VitaminA deficiency was associated with lower CD4 levels among bothseronegative individuals (P<.05) and seropositive individuals(P<.05). In the HIV-seropositive participants, vitamin Adeficiency was associated with increased mortality (relativerisk=6.3; 95% confidence interval, 2.1 to 18.6).

Conclusion
Vitamin A deficiency may be common during HIV-1 infection, andvitamin A deficiency is associated with decreased circulatingCD4 T cells and increased mortality. Vitamin A is an essentialmicronutrient for normal immune function, and vitamin A deficiencyseems to be an important risk factor for disease progressionduring 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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