AIDS TREATMENT NEWS Issue # 185, October 15, 1993
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.
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