Vitamin A Deficiency Associated with Increased Death Rate

A study of HIV-positive intravenous drug users found that
those with a vitamin A deficiency (about 15 percent of the
HIV-positive persons studied) had a death rate several times
as high as those who did not have a vitamin A deficiency.
While this study does not prove that correcting the
deficiency will improve survival, it strongly suggests that
conclusion.

Other studies (unrelated to HIV) have shown that vitamin A
deficiency does impair both cellular and humoral immunity.
Also, vitamin A supplementation in developing countries has
been found to reduce childhood mortality by 20 percent to 54
percent. And vitamin A stores in the body may be reduced by
infection, suggesting that a vicious circle can develop, with
infection depleting vitamin A, and the deficiency causing
more infection.

But on the other hand, recent studies have found that
retinoic acid, which is the active form of vitamin A in the
body, can increase HIV replication in laboratory tests. This
raises the concern that vitamin A supplementation might not
always be helpful in HIV disease. In addition, the
association found in the study does not prove causality,
because patients who were sicker (and more likely to die
anyway) may have therefore developed nutritional
deficiencies, due to malabsorption or other causes.

Reference: Semba RD, Graham NMH, Caiaffa WT, Margolick JB,
Clement L, and Vlahov D. Increased Mortality Associated With
Vitamin A Deficiency During Human Immunodeficiency Virus Type
1 Infection. Archives of Internal Medicine. September 27,
1993; volume 153, pages 2149-2154.

Comment

The studies needed to get definite answers about use of
vitamin A in HIV disease have not been done and may never be
done. In the meantime, people must make decisions on the
information available.

The usual recommendation for vitamin A supplementation is to
use beta carotene, not vitamin A itself. Vitamin A is toxic
in overdose; beta carotene is safer because the body only
converts what it needs to vitamin A. Also, beta carotene is
an antioxidant (vitamin A itself is not), and there are
indications that antioxidants might help to reduce
progression of HIV disease.

The scientifically ideal study would give beta carotene,
and/or vitamin A, to randomly chosen HIV-positive patients
within a study group, then follow them for years to see if
there was a difference in death rate between those who
received the supplementation and those who did not. A more
practical study would use modern tests for viral activity or
viral load, instead of looking for differences in death rate.
This way, results could be obtained in weeks instead of
years, and without serious risk of harming volunteers in the
trial. These results would not give an ultimate answer of
what supplementation is best, but they probably would
establish that certain doses could be used without risk of
increasing HIV activity. Once that is shown, the clear course
of action would be to use the supplements, since there is
overwhelming evidence that vitamin A can reduce the risk of
other infectious diseases, and beta carotene is safe, readily
available, and not expensive.

Meanwhile, it appears that people with HIV should be using at
least some beta carotene (unless their physician recommends
otherwise) to prevent possible vitamin A deficiencies. Even
more importantly, this study re-emphasizes the need for good
overall nutrititional support in AIDS treatment.