Important note: Information in this article was accurate in November 2000. The state of the art may have changed since the publication date.
Certain strains of a virus called human papillomavirus (HPV) can infect cells of the cervix and trigger the growth of abnormal cells. In some cases these abnormal cells may turn into pre-cancerous cells, a few of which may eventually develop into cancer cells. Women with HIV infection, because of their weakened immunity, are at increased risk for the development of abnormal growths on their cervix as well as cervical cancer. Regular Pap smears and gynecologic exams to detect and monitor growths on the cervix are an important part of health maintenance for HIV+ women.
Experiments with HPV-infected cells and mice suggest that vitamin A (retinol) and vitamin-A-like compounds have the ability to do the following:
The majority of studies looking at vitamin A levels in non-HIV-infected women and cervical disease have not "consistently" found a link, according to some researchers.
Doctors in several American cities conducted a large study to find if there was any connection between HIV+ women having low levels of vitamin A and abnormal growths on the cervix, including pre-cancerous cells. Analysing data from more than 1,300 women, the research team found that its results suggest that a deficiency of vitamin A may spur the growth of abnormal cells on the cervix. Issues about supplementation with vitamin A are highlighted at the end of the report below.
Researchers collected data on 1,314 HIV+ women and performed various analyses looking at factors that were linked to the following developments:
The researchers found that about 16% of the women had less-than-normal levels of vitamin A in their blood. The following factors were linked to low vitamin A levels:
In contrast, CD4+ counts, viral load and race were not linked to having low vitamin A levels.
The low levels of albumin suggest that these women were not getting enough protein from their diet. Low levels of albumin could arise from improper eating habits or poverty. As a result, it is possible that these women also had deficits of other nutrients.
Technicians found that overall about 35% of women developed abnormal cells on their cervix. Only about 16% of the women had pre-cancerous cells. The following factors were associated with having pre-cancerous cervical growths:
The next step is for researchers to test supplements of vitamin A to see if they can reduce the development of abnormal growths on the cervix. In high doses, vitamin A can cause such side effects as severe headaches, diarrhea and vomiting, and in pregnant women, birth defects. Perhaps supplements of mixed carotinoids - such as alpha and beta carotene, lycopene - may be a safer option. Beta carotene is converted into vitamin A by the body when required. Because this conversion is carefully controlled, it does not usually cause vitamin A toxicity. As carotinoids tend to be found together in foods, it is probably a good idea not to supplement with just one carotinoid but a mix of them. Nevertheless, the safety of large doses of mixed carotinoids in HIV+ women needs to be tested. As well, there are also issues about the dosing schedule (every day vs. once or twice weekly) that need to be resolved.
1. Delmas M-C, Larsen C, van Bethem B, et al. Cervical squamous intraepithelial lesions in HIV-infected women: prevalence, incidence and regression. AIDS 2000;14(12):1775-1784.
2. French AL, Kirstein LM, Massad LS, et al. Association of vitamin A deficiency with cervical squamous intraepithelial lesions in human immunodeficiency virus-infected women. Journal of Infectious Diseases 2000;182:1084-1089.
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