INCREASED MORTALITY ASSOCIATED WITH VITAMIN-A-DEFICIENCY DURING HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 INFECTION

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.