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

• Published in: British journal of nutrition Vol. 89; no. 4; pp. 475 - 482
• Main Authors: Visser, M. E., Maartens, G., Kossew, G., Hussey, G. D.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01-04-2003
• Subjects: Acquired immune deficiency syndrome; Adult; Africa; AIDS; Antiretroviral agents; Biological and medical sciences; Body weight; C-Reactive Protein; C-Reactive Protein - analysis; CD4 Lymphocyte Count; Cross-Sectional Studies; Female; HIV; HIV infection; HIV Infections - blood; HIV Infections - immunology; Human immunodeficiency virus; Human viral diseases; Humans; Infections; Infectious diseases; Lymphocytes; Male; Medical sciences; Mortality; Multivariate Analysis; Outpatient care facilities; Patients; Plasma; Proteins; South Africa; Tropical medicine; Tuberculosis; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Vitamin A; Vitamin A - blood; Weight Loss; Zinc; Zinc - blood; South Africa; Africa; United States > US; Cape Town South Africa; Vitamin A; C-Reactive Protein; HIV infection; Zinc; Africa; Human; Immunopathology; Nutrition; Pathophysiology; Nutrition disorder; Vitamin; AIDS; HIV infection: Vitamin A: Zinc: C-Reactive Protein: Africa; Immune deficiency; Retinol; Infection; Micronutrient; Clinical stage; Viral disease; Cross sectional study; Adult; Malnutrition; C reactive protein; Nutritional status
• ISSN: 0007-1145; 1475-2662
• DOI: 10.1079/BJN2002806

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.