VITAMIN-A STATUS IN HIV-INFECTION

HIV+ individuals may be at particular risk for deficiency of vitamin A, a critical micronutrient in the maintenance of epithelial barriers and normal immune function. We studied 25 HIV+ outpatients with CD4+ T cell counts less than 800 : 5 had AIDS, 2 had diarrhea and weight loss and 18 were asymptomatic. Vitamin A status was assessed with a battery of tests; conjunctival impression cytology (CIC), relative dose responses (RDR) and serum retinol and retinol binding protein (RBP) levels. We also measured mitogen-induced lymphoproliferation and in vitro cytokine production (soluble IL-2 receptor (sIL-2R) and interferon-gamma (IFN-gamma)) with and without supplemental retinol. Eight subjects (32%) had one or more tests suggestive of vitamin A deficiency: serum retinol levels < 1.05 muM/L (4), abnormal CIC (6), abnormal RDR (1), RBP < 7 (1). Correspondence between the various measures of vitamin status was limited but subjects with abnormal CIC tended to have lower serum retinol levels than those with normal CIC (1.54 +/- 0.30 vs 2.20 +/- 0.21 muM/L; P=.15). 60% of subjects with AIDS had abnormal CIC (vs 17% in non-AIDS subjects; P<.04). Retinol levels in subjects with CD4+ counts less-than-or-equal-to 300 tended to be lower than in those with CD4+ counts > 300 (1.80 +/- 0.24 vs 2.20 +/- 0.24 muM/L; P=.15). Subjects taking a daily multivitamin containing modest amounts of vitamin A had higher serum retinol levels than those taking no supplements (2.50 +/- 0.24 vs 1.47 +/- 0.21 muM/L; P<.009), an association which remained after stratification by CD4+ cell counts. In vitro proliferation and cytokine production were not correlated with measures of vitamin A status. Retinol supplementation in cultures with the lowest baseline cytokine levels increased production of sIL-2R (>27-fold; P<.03) and IFN-gamma (>3.1-fold; P<.02) regardless of apparent vitamin A status. These preliminary observations suggest that vitamin A status may deteriorate with advancing HIV and that even modest doses of vitamin A can have significant impact on serum retinol levels. Increased cytokine production with supplemental retinol in vitro demonstrates that lymphocytes can be retinoid responsive despite apparently normal vitamin A status.