Skip to main content
×
×
Home

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

  • M. E. Visser (a1), G. Maartens (a2), G. Kossew (a3) and G. D. Hussey (a3)
Abstract

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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Plasma vitamin A and zinc levels in HIV-infected adults in Cape Town, South Africa
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Plasma vitamin A and zinc levels in HIV-infected adults in Cape Town, South Africa
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Plasma vitamin A and zinc levels in HIV-infected adults in Cape Town, South Africa
      Available formats
      ×
Copyright
Corresponding author
*Corresponding Author: Ms Marianne Visser, fax +27 21 4066534, email mvisser@uctgsh1.uct.ac.za
References
Hide All
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, 10511056.
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, 370374.
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, 701708.
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, 480484.
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, 9194.
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, 11791186.
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, 602608.
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.
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, 10761081.
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, 15171524.
Fawzi WW & Hunter DJ (1998) Vitamins in HIV disease progression and vertical transmission. Epidemiology 9, 457466.
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, 127133.
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, 246254.
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., 5156.
Fleck A (1989) Clinical and nutritional aspects of changes in acute-phase proteins during inflammation. Proceedings of the Nutrition Society 48, 347354.
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, 386391.
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, 900908.
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, 976980.
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, 325332.
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, 40594064.
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, 4451.
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.
James WPT, Ferro-Luzzi A & Waterlow JC (1988) Definition of chronic energy deficiency in adults. European Journal of Clinical Nutrition 42, 969981.
Joint United Nations Programme on HIV/AIDS (UNAIDS) (2002) Report on the Global HIV/AIDS Epidemic. Barcelona: UNAIDS.
Kafwembe EM, Kelly P & Ngalande P (2001) Vitamin A levels in HIV/AIDS. East African Medical Journal 78, 451453.
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, 495500.
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, 515518.
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, 934941.
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, 877880.
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, 386391.
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, 595600.
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, 865869.
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, 719727.
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, 10291032.
Nuget J & Clark S (1985) Retinoids, Differentiation and Disease. London: Pitman Publishing.
Pilch SM (1987) Analysis of vitamin A data from the health and nutrition examination surveys. Journal of Nutrition 117, 636640.
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.
Post FA, Wood R & Maartens G (1996) CD4 and total lymphocyte counts as predictors of HIV disease progression. Quarterly Journal of Medicine 89, 505508.
Raynes JG (1994) Carbohydrate binding proteins and immune responses. Biochemical Society Transactions 22, 6974.
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, 771773.
Semba RD (1994) Vitamin A immunity and infection. Clinical Infectious Diseases 19, 489499.
Semba RD (1997) Vitamin A and human immunodeficiency virus infection. Proceedings of the Nutrition Society 56, 459469.
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, 11961202.
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, 21492154.
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, 611616.
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, 219222.
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, 15931597.
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.
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, 469478.
Semba RD & Tang AM (1999) Micronutrients and the pathogenesis of human immunodeficiency virus infection. British Journal of Nutrition 81, 181189.
Shankar AH & Prasad AS (1998) Zinc and immune function: the biological basis of altered resistance to infection. American Journal of Clinical Nutrition 68, Suppl., 447S463S.
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, 388392.
Tang AM, Graham NMH, Semba RD & Saah AJ (1997) Association between vitamin A and E levels and HIV-1 disease progression. AIDS 11, 613620.
Tietzman NW (1987) Fundamentals of Clinical Chemistry, 3rd ed, Philadelphia, PA: WB Saunders.
Underwood B (1990a) Methods for assessment of vitamin A status. Journal of Nutrition 120, 14591463.
Underwood B (1990b) Biochemical and histological methodologies for assessing Vitamin A status in human populations. Methods in Enzymology 190, 242251.
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, 711718.
Young B, Gleeson M & Cripps AW (1991) C-Reactive Protein: A critical review. Pathology 23, 118124.
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, 689697.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 61 *
Loading metrics...

Abstract views

Total abstract views: 81 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st January 2018. This data will be updated every 24 hours.