To determine whether nutritional status affects immunological markers of HIV-1 disease progression.Design
A longitudinal study, to evaluate the relationship between plasma levels of nutrients and CD4 cell counts, along and in combination with β2-microglobulin (β2M; AIDS index) over an 18-month follow-up.Methods
Bicohemical measurements of nutritional status including plasma proteins, zinc, iron and vitamins B,, B2/ Be, B12 (cobalamin), A, E, C and folate and immunological markers [lymphocyte subpopulations (CD4) and β2M] were obtained in 108 HIV-1-seropositive homosexual men at baseline and over three 6-month time periods. Changes in nutrient status (e.g., normal to deficient, deficient to normal), were compared with immunological parameters in the same time periods using an autoregressive model.Results
Development of deficiency of vitamin A or vitamin B12 was associated with a decline in CD4 cell count (P= 0.0255 and 0.0377, respectively), while normalization of vitamin A, vitamin B12 and zinc was associated with higher CD4 cell counts (P= 0.0492, 0.0061 and 0.0112, respectively). These findings were largely unaffected by ziddvudine use. For vitamin B12, low baseline status significantly predicted accelerated HIV-1 disease progression determined by CD4 cell count (P= 0.041) and the AIDS index (P= 0.005).Conclusions
These data suggest that micronutrient deficiencies are associated with HIV-1 disease progression and raise the possibility that normalization might increase symptom-free survival.