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Plasma vitamin A and zinc levels in HIV-infected adults in Cape Town, South Africa

Published online by Cambridge University Press:  01 August 2008

M. E. Visser ,
G. Maartens ,
G. Kossew  and
G. D. Hussey
M. E. Visser*
Affiliation:
Nutrition and Dietetics Unit, University of Cape Town, South Africa
G. Maartens
Affiliation:
Infectious Disease Unit, Department of Medicine, University of Cape Town, South Africa
G. Kossew
Affiliation:
Child Health Unit, Department of Paediatrics and Child Health, University of Cape Town, South Africa
G. D. Hussey
Affiliation:
Child Health Unit, Department of Paediatrics and Child Health, University of Cape Town, South Africa
*
*Corresponding Author: Ms Marianne Visser, fax +27 21 4066534, email [email protected]
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Abstract

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A cross-sectional study of 132 adults attending an HIV clinic in Cape Town, South Africa, was conducted to determine predictors of low plasma vitamin A and Zn levels. No patients were on antiretroviral therapy. The possible confounding effect of the acute-phase response was controlled by including C-reactive protein levels in multivariate analysis and by excluding active opportunistic infections. Retinol levels were low (<1·05 μmol/l) in 39 % of patients with early disease (WHO clinical stages I and II) compared with 48 and 79 % of patients with WHO stage III and IV respectively (P<0·01). Plasma Zn levels were low (<10·7 μmol/l) in 20 % of patients with early disease v. 36 and 45 % with stage III and IV disease respectively (P<0·05). C-reactive protein levels were normal in 63 % of subjects. Weak, positive associations were found between CD4+ lymphocyte count and plasma levels of retinol (r 0·27; 95 % CI 0·1, 0·43) and Zn (r 0·31; 95 % CI 0·25, 0·46). Multivariate analysis showed the following independent predictors of low retinol levels: WHO stage IV (odds ratio 3·4; 95 % CI 2·1, 5·7) and body weight (odds ratio per 5 kg decrease 1·15; 95 % CI, 1·08, 1·25), while only body weight was significantly associated with low Zn levels (OR per 5 kg decrease 1·19; 95 % CI 1·09, 1·30). CD4+ lymphocyte count <200/μl was not significantly associated with either low retinol or Zn levels. In resource-poor settings, simple clinical features (advanced disease and/or weight loss) are associated with lowered blood concentrations of vitamin A and/or Zn. The clinical significance of low plasma retinol and/or Zn levels is unclear and more research is required to establish the role of multiple micronutrient intervention strategies in HIV disease.

Keywords

HIV infectionVitamin AZincC-Reactive ProteinAfrica
Type
Research Article
Information
British Journal of Nutrition , Volume 89 , Issue 4 , April 2003 , pp. 475 - 482
Copyright
Copyright © The Nutrition Society 2003

References

Baum, MK, Shor-Posner, G, Lu, Y, Rosner, B, Sauberlich, HE, Fletcher, MA, Szapocznik, J, Eisdorfer, C, Buring, JE & Hennekens, CH (1995) Micronutrients and HIV-1 disease progression. AIDS 9, 1051–1056.CrossRefGoogle ScholarPubMed
Baum, MK, Shor-Posner, G, Lai, S, Zhang, G, Lai, H, Zhang, G, Lai, H, Fletcher, M, Sauberlich, H & Page, JB (1997) High risk of HIV-related mortality is associated with selenium deficiency. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 15, 370–374.CrossRefGoogle ScholarPubMed
Beach, RS, Mantero-Atienza, E, Shor-Posner, G, Javier, JJ, Szapocznik, J, Morgan, R, Sauberlich, HE, Cornwell, PE, Eisdorfer, C & Baum, MK (1992) Specific nutrient abnormalities in asymptomatic HIV-1 infection. AIDS 6, 701–708.CrossRefGoogle ScholarPubMed
Breen, EC, Rezai, AR, Nakajima, K, Beall, GN, Mitsuyasu, RT, Hirano, T, Kishimoto, T & Matinez-Maza, O (1990) Infection with HIV is associated with elevated IL-6 levels and production. Journal of Immunology 144, 480–484.CrossRefGoogle ScholarPubMed
Campos, FACS, Flores, H & Underwood, B (1987) Effect of an infection on vitamin A status of children as measured by the relative dose response (RDR). American Journal of Clinical Nutrition 46, 91–94.CrossRefGoogle ScholarPubMed
Castell, JV, Goméz-Lechón, MJ, David, M, Fabra, R, Trullenque, R & Heinrich, PC (1990) Acute-phase response of human hepatocytes: regulation of acute-phase protein synthesis by interleukin-6. Hepatology 12, 1179–1186.CrossRefGoogle ScholarPubMed
Castillo-Duran, C, Heresi, G, Fisberg, M & Uauy, R (1987) Controlled trial of zinc supplementation during recovery from malnutrition: effects on growth and immune function. American Journal of Clinical Nutrition 45, 602–608.CrossRefGoogle ScholarPubMed
Coutsoudis, A (1997) Effects of vitamin A supplementation on viral load in HIV-1 infected pregnant women. Journal of the Acquired Immune Deficiency Syndromes and Human Retrovirology 15, 86.Google ScholarPubMed
Coutsoudis, A, Bobat, R, Coovadia, H, Huhn, L, Tsai, W & Stein, Z (1995) The effects of vitamin A supplementation on the morbidity of children born to HIV-infected women. American Journal of Public Health 85, 1076–1081.CrossRefGoogle ScholarPubMed
Coutsoudis, A, Pillay, K, Spooner, E, Kuhn, L & Coovadia, HM (1999) Randomized trial testing the effect of vitamin A supplementation on pregnancy outcomes and early mother-to-child transmission in Durban, South Africa. AIDS 13, 1517–1524.CrossRefGoogle ScholarPubMed
Fawzi, WW & Hunter, DJ (1998) Vitamins in HIV disease progression and vertical transmission. Epidemiology 9, 457–466.CrossRefGoogle ScholarPubMed
Fawzi, W, Mbise, R, Hertzmark, E, Fataki, M, Herrera, M, Ndossi, G & Spiegelman, D (1999) A randomized trial of vitamin A suppplements in relation to mortality among HIV-infected and uninfected children in Tanzania. Pediatric Infectious Diseases Journal 18, 127–133.CrossRefGoogle ScholarPubMed
Fawzi, WW, Msamanga, G, Hunter, D, Urassa, E, Renjifo, B, Mwakagile, D, Hertzmark, E, Coley, J, Garland, M, Kapiga, S, Antelman, G, Essex, M & Spiegelman, D (2000) Randomized trial of vitamin supplements in relation to vertical transmission of HIV-1 in Tanzania. Journal of Acquired Immune Deficiency Syndromes 23, 246–254.CrossRefGoogle ScholarPubMed
Ferre, F, Moss, RB, Daigle, A, Richieri, SP, Jensen, F & Carlo, DJ (1995) Viral load in peripheral blood mononuclear cells as surrogate for clinical progression. Journal of Acquired Immune Deficiency Syndromes 10, Suppl., 51–56.Google ScholarPubMed
Fleck, A (1989) Clinical and nutritional aspects of changes in acute-phase proteins during inflammation. Proceedings of the Nutrition Society 48, 347–354.CrossRefGoogle ScholarPubMed
Friis, H, Ndhlovu, P, Kaondera, K, Sandstrom, B, Michaelsen, KF & Vennervald, BJ (1996) Serum concentration of micronutrients in relation to schistosomiasis and indicators of infection: a cross-sectional study amongst rural Zimbabwean school-children. European Journal of Clinical Nutrition 50, 386–391.Google Scholar
Golden, MH & Golden, BE (1981) Effect of zinc supplementation on the dietary intake, rate of weight gain, and energy cost of tissue deposition in children recovering from severe malnutrition. American Journal of Clinical Nutrition 34, 900–908.CrossRefGoogle ScholarPubMed
Graham, N, Sorenson, D, Odaka, N, Brookmeyer, R, Chan, D, Willett, W, Morris, JS & Saah, AJ (1991) Relationship of serum copper and zinc levels to HIV-1 seropositivity and progression to AIDS. Journal of Acquired Immune Deficiency Syndromes 4, 976–980.Google ScholarPubMed
Greenberg, BL, Semba, RD, Vink, PE, Farley, J, Sivapalasingam, M, Steketee, RW, Thea, DM & Schoenbaum, EE (1997) Vitamin A deficiency and maternal–infant transmission of HIV in two metropolitan areas in the United States. AIDS 11, 325–332.CrossRefGoogle ScholarPubMed
Honda, M, Kitamura, K, Mizutani, Y, Oishi, M, Arai, N & Okura, T (1990) Quantitative analysis of serum IL-6 and its correlation with increased levels of serum IL-2R in HIV-induced diseases. Journal of Immunology 145, 4059–4064.CrossRefGoogle ScholarPubMed
Humphrey, JH, Quinn, T, Fine, D, Lederman, H, Yamini-Roodsari, S, Wu, LSF, Moeller, S & Ruff, AJ (1999) Short-term effects of large-dose Vitamin A Supplementation on viral load and immune response in HIV-infected women. Journal of the Acquired Immune Deficiency Syndromes and Human Retrovirology 20, 44–51.CrossRefGoogle ScholarPubMed
Hussey, GD, Hughes, J, Potgieter, S, Kessow, G, Burgess, J, Beatty, D, Keraan, M & Carelse, E (1996) Vitamin A Status and Supplementation and its Effects on Immunity in Children with AIDS. Abstracts of the XVII IVACG Meeting (Guatemala City), pp. 6. Washington, DC: International Life Science Institute, Human Nutrition Institute.Google Scholar
James, WPT, Ferro-Luzzi, A & Waterlow, JC (1988) Definition of chronic energy deficiency in adults. European Journal of Clinical Nutrition 42, 969–981.Google ScholarPubMed
Joint United Nations Programme on HIV/AIDS (UNAIDS) (2002) Report on the Global HIV/AIDS Epidemic. Barcelona: UNAIDS.Google Scholar
Kafwembe, EM, Kelly, P & Ngalande, P (2001) Vitamin A levels in HIV/AIDS. East African Medical Journal 78, 451–453.CrossRefGoogle Scholar
Kelly, P, Musonda, R, Kafwembe, E, Kaetano, L, Keane, E & Farthing, M (1999) Micronutrient supplementation in the AIDS diarrhoea-wasting syndrome in Zambia: A randomized controlled trial. AIDS 134, 495–500.CrossRefGoogle Scholar
Koch, J, Neal, EA, Schlott, MJ, Garcia-Shelton, YL, Chan, MF, Weaver, KE & Cello, JP (1996) Zinc levels and infections in hospitalized patients with AIDS. Nutrition 12, 515–518.CrossRefGoogle ScholarPubMed
Louw, JA, Werbeck, A, Louw, ME, Kotze, T, Cooper, R & Labadarios, D (1992) Blood vitamin concentrations during the acute-phase response. Critical Care Medicine 20, 934–941.CrossRefGoogle Scholar
Martin, DJ, Blackburn, NK, O'Connell, KF, Brant, ET & Goetsch, EA (1995a) Evaluation of the World Health Organization antibody-testing strategy for the individual patient diagnosis of HIV infection (strategy III). South African Medical Journal 85, 877–880.Google ScholarPubMed
Martin, DJ, Sim, GM, Sole, GJ, Rymer, L, Shalekoff, S, van Niekerk, ABN, Becker, P, Weilbach, CN, Iwanik, J, Keddy, K, Miller, GB, Ozbay, B, Ryan, A, Viscovic, T & Woolf, M (1995b) CD4 lymphocyte count in African patients co-infected with HIV and tuberculosis. Journal of the Acquired Immune Deficiency Syndromes and Human Retrovirology 8, 386–391.CrossRefGoogle ScholarPubMed
Mejiia, LA & Chew, F (1988) Hematologic effect of supplementing anemic children with vitamin A alone or in combination with iron. American Journal of Clinical Nutrition 48, 595–600.CrossRefGoogle Scholar
Melchior, J, Niyongabo, T, Henzel, D, Durack-Brown, I, Henri, S & Boulier, A (1999) Malnutrition and wasting, immunodepression and chronic inflammation as independent predictors of survival in HIV-infected patients. Nutrition 15, 865–869.CrossRefGoogle ScholarPubMed
Mocchegiani, E, Veccia, S, Ancarani, F, Scalise, G & Fabris, N (1995) Benefit of oral zinc supplementation as an adjunct to Zidovudine (AZT) therapy against opportunistic infections in AIDS. International Journal of Immunopharmacology 17, 719–727.CrossRefGoogle ScholarPubMed
Moodley, D, Moodley, J, Coutsoudis, A, Coovadia, HM & Gouws, E (1998) Vitamin A levels in normal and HIV-infected pregnant women. South African Medical Journal 88, 1029–1032.Google Scholar
Nuget, J & Clark, S (1985) Retinoids, Differentiation and Disease. London: Pitman Publishing.Google Scholar
Pilch, SM (1987) Analysis of vitamin A data from the health and nutrition examination surveys. Journal of Nutrition 117, 636–640.CrossRefGoogle Scholar
Piwoz, EG & Preble, EA (2000) A Review of the Literature and Recommendations for Nutritional Care and Support in Sub-Saharan Africa. Support for Analysis and Research in Africa (SARA) Project. Washington, DC: United States Agency for International Development (USAID), Academy for Educational Development.Google Scholar
Post, FA, Wood, R & Maartens, G (1996) CD4 and total lymphocyte counts as predictors of HIV disease progression. Quarterly Journal of Medicine 89, 505–508.CrossRefGoogle ScholarPubMed
Raynes, JG (1994) Carbohydrate binding proteins and immune responses. Biochemical Society Transactions 22, 69–74.CrossRefGoogle Scholar
Rwangabwoba, JM, Fischman, H & Semba, RD (1998) Serum vitamin A levels during tuberculosis and human immunodeficiency virus infection. International Journal of Tuberculosis and Lung Disease 2, 771–773.Google ScholarPubMed
Semba, RD (1994) Vitamin A immunity and infection. Clinical Infectious Diseases 19, 489–499.CrossRefGoogle ScholarPubMed
Semba, RD (1997) Vitamin A and human immunodeficiency virus infection. Proceedings of the Nutrition Society 56, 459–469.CrossRefGoogle ScholarPubMed
Semba, RD, Caiffa, WT, Graham, NMH, Cohn, S & Vlahov, D (1995) Vitamin A deficiency and wasting as predictors of mortality in human immunodeficiency virus-infected injection drug users. Journal of Infectious Diseases 171, 1196–1202.CrossRefGoogle ScholarPubMed
Semba, RD, Graham, NMH, Caiaffa, WT, Margolick, JB, Clement, L & Vlahov, D (1993) Increased mortality associated with vitamin A deficiency during human immunodeficiency virus type 1 infection. Archives of Internal Medicine 153, 2149–2154.CrossRefGoogle ScholarPubMed
Semba, RD, Lyles, CM, Margolick, JB, Caiaffa, WT, Farzadegan, H, Cohn, S & Vlahov, D (1998) Vitamin A supplementation and human immunodeficiency virus load in injection drug users. Journal of Infectious Diseases 177, 611–616.CrossRefGoogle ScholarPubMed
Semba, RD, Miotti, P, Chiphangwe, JD, Henderson, R, Dallabettta, G, Yang, LP & Hoover, DR (1997a) Maternal vitamin A deficiency and child growth failure during human immunodeficiency virus infection. Journal of the Acquired Immune Deficiency Syndromes and Human Retrovirology 14, 219–222.CrossRefGoogle ScholarPubMed
Semba, RD, Miotti, PG, Chiphangwe, JD, Saah, AJ, Canner, JK, Dallabetta, GA & Hoover, DR (1994) Maternal vitamin A deficiency and mother-to-child transmission of HIV-1. Lancet 343, 1593–1597.CrossRefGoogle ScholarPubMed
Semba, RD, Miotti, PG & Taha, TE (1997b) Maternal Vitamin A Supplementation and Mother-to-Child Transmission of HIV Abstracts of the XVIII IVACG Meeting (Cairo). Washington, DC: International Life Science Institute, Human Nutrition Institute.Google Scholar
Semba, RD, Muhilal, & West, KP Jr (1992) Impact of vitamin A supplementation on hematological indicators of iron metabolism and protein status in children. Nutrition Research 12, 469–478.CrossRefGoogle Scholar
Semba, RD & Tang, AM (1999) Micronutrients and the pathogenesis of human immunodeficiency virus infection. British Journal of Nutrition 81, 181–189.CrossRefGoogle ScholarPubMed
Shankar, AH & Prasad, AS (1998) Zinc and immune function: the biological basis of altered resistance to infection. American Journal of Clinical Nutrition 68, Suppl., 447S–463S.CrossRefGoogle ScholarPubMed
Stephenson, CB, Alvarez, JO, Kohatsu, J, Hardmeier, R, Kennedy, JI & Gammon, RB (1994) Vitamin A is excreted in the urine during acute infection. American Journal of Clinical Nutrition 60, 388–392.CrossRefGoogle Scholar
Tang, AM, Graham, NMH, Semba, RD & Saah, AJ (1997) Association between vitamin A and E levels and HIV-1 disease progression. AIDS 11, 613–620.CrossRefGoogle Scholar
Tietzman, NW (1987) Fundamentals of Clinical Chemistry, 3rd ed, Philadelphia, PA: WB Saunders.Google Scholar
Underwood, B (1990a) Methods for assessment of vitamin A status. Journal of Nutrition 120, 1459–1463.CrossRefGoogle ScholarPubMed
Underwood, B (1990b) Biochemical and histological methodologies for assessing Vitamin A status in human populations. Methods in Enzymology 190, 242–251.CrossRefGoogle ScholarPubMed
World Health Organization International Collaborating Group for the Study of the World Health Organization Staging System (1993) Proposed "World Health Organization Staging System for HIV Infection and Disease": preliminary testing by an international collaborative cross-sectional study. AIDS 7, 711–718.Google Scholar
Young, B, Gleeson, M & Cripps, AW (1991) C-Reactive Protein: A critical review. Pathology 23, 118–124.CrossRefGoogle ScholarPubMed
Zinc Investigators' Collaborative Group (1999) Prevention of diarrhoea and pneumonia by zinc supplementation in children from developing countries: Pooled analysis of randomised controlled trials. Journal of Pediatrics 135, 689–697.CrossRefGoogle Scholar