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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. doi:10.1001/archinte.1993.00410180103012.
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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)


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