Review of the literature shows that in adults there are variations in the association of hyporetinemia with disease progression as well as variations in the response to supplementation. Populations that are likely to be deficient in vitamin A show the biggest responses. Additional vitamin A supplementation may not be necessary, and may even be harmful, in adults who already have a good dietary intake of vitamin A and who take many other vitamin supplements. Vitamin A supplementation does not appear to have any impact on mother-to-child transmission of HIV; nevertheless, vitamin A supplementation of pregnant women in the third trimester may be useful to reduce the incidence of low-birthweight and premature infants. the impact of vitamin A on mother-to-child transmission of HIV in preterm infants is awaiting further investigation. Vitamin A supplementation of HIV-infected children appears to be beneficial to reduce the incidence and severity of diarrhea in particular. Randomized, placebo-controlled trials in pregnant women and adults have shown that the association between vitamin A and HIV is probably an association of reverse causality.
References
1.
UNAIDS.Report on the global HIV/AIDS epidemic. UNAIDS/WHO Joint United Nations Programme on HIV/AIDS.Geneva: World Health Organization, June1998.
2.
UNICEF.The progress of the nations 1999.New York: United Nations Children's Fund, 1999.
3.
BlomhoffR., GreenM.H., GreenJ.B., BergT., NorumK.R.Vitamin A metabolism: new perspectives on absorption, transport, and storage. Physiol Rev1991; 71: 951–90.
4.
SembaR.D.The role of vitamin A and related retinoids in immune function. Nutr Rev1998; 56: S38–48.
5.
ScrimshawN.S., TaylorC.E., GordonJ.E.Interactions of nutrition and infection.Geneva: World Health Organization, 1968.
6.
FawziW.W., ChalmersT.C., HerreraM.G., MostellerF.Vitamin A supplementation and child mortality: a meta-analysis. JAMA1993; 269: 898–903.
BaumM.K., CassetiL., BonvehiP., Shor PosnerG., LuY., SauberlichH.Inadequate dietary intake and altered nutrition status in early HIV infection. Nutrition1994; 10: 16–20.
9.
BogdenJ.D., BakerH., FrankO., PerezG., KempF., BrueningK., LouriaD.Micronutrient status and HIV infection. Ann NY Acad Sci1990; 587: 189–95.
10.
SembaR.D., CaiaffaW.T., GrahamN.M., CohnS., VlahovD.Vitamin A deficiency and wasting as predictors of mortality in human immunodeficiency virus-infected injection drug users. J Infect Dis1995; 171: 1196–1202.
11.
KarterD.L., KarterA.J., YarrishR., PattersonC., KassP.H., NordJ., KislakJ.W.Vitamin A deficiency in nonvitamin-supplemented patients with AIDS: a cross-sectional study. J Acquir Immune Defic Syndr Hum Retrovirol1995; 8: 199–203.
12.
UllrichR., SchneiderT., HeiseW., SchmidtW., AverdunkR., RieckenE.O., ZeitzM.Serum β-carotene deficiency in HIV-infected patients. Berlin Diarrhea/Wasting Syndrome Study Group. AIDS1994; 8: 661–5.
13.
ChristianP., WestK.P.Jr., KhatryS.K., KatzJ., ShresthaS.R., PradhanE.K., LeClerqS.C., PokhrelR.P.Night blindness of pregnancy in rural Nepal—nutritional and health risks. Int J Epidemiol1998; 27: 231–7.
14.
NduatiR.W., JohnG.C., RichardsonB.A., OverbaughJ., WelchM., Noinya-AcholaJ., MosesS., HolmesK., OnyangoF., KreissJ.H.Human immunodeficiency virus type 1-infected cells in breast milk: association with immunosuppression and vitamin A deficiency. J Infect Dis1995; 172: 1461–8.
15.
SembaR.D., MiottiP.G., ChiphangwiJ.D., SaahA.J., CannerJ.K., DallabettaG.A., HooverD.R.Maternal vitamin A deficiency and mother-to-child transmission of HIV-1. Lancet1994; 343: 1593–7.
16.
SembaR.D., MiottiP.G., ChiphangwiJ.D., LiombaG., YangL.P., SaahA.J., DallabettaG.A., HooverD.R.Infant mortality and maternal vitamin A deficiency during human immunodeficiency virus infection. Clin Infect Dis1995; 21: 966–72.
17.
PhuapraditW., ChaturachindaK., TaneepanichskulS., SirivarasryJ., KhupulsupK., LerdvuthisoponN.Serum vitamin A and β-carotene levels in pregnant women infected with human immunodeficiency virus-1. Obstet Gynecol1996; 87: 564–7.
18.
MoodleyD., MoodleyJ., CoutsoudisA., CoovadiaH.M., GouwsE.Vitamin A levels in normal and HIV-infected pregnant women. S Afr Med J1998; 88: 1029–32.
19.
GreenbergB.L., SembaR.D., VinkP.E., FarleyJ.J., SivapalasingamM., SteketeeR.W., TheaD., SchoenbaumR.E.Vitamin A deficiency and maternal-infant transmission of HIV in two metropolitan areas in the United States. AIDS1997; 11: 325–32.
OmeneJ.A., EasingtonC.R., GlewR.H., ProsperM., LedlieS.Serum beta-carotene deficiency in HIV-infected children. J Natl Med Assoc1996; 88: 789–93.
22.
HendersonR.A., TalusanK., HuttonN., YolkenR.H., CaballeroB.Serum and plasma markers of nutritional status in children infected with the human immunodeficiency virus. J Am Diet Assoc1997; 97: 1377–81.
23.
SommerA., WestK.P.Jr.Vitamin A deficiency: health, survival and vision.New York: Oxford University Press, 1996: 19–61.
24.
StephensonC.B., AlvarezJ.O., KohatsurJ., HardmeierR., KennedyJ.I., GammonR.B.Vitamin A is excreted in the urine during acute infection. Am J Clin Nutr1994; 60: 388–92.
25.
KabandaA., VandercamB., BernardA., LauwerysR., van Ypersele de StrihouC.Low molecular weight proteinuria in human immunodeficiency virus-infected patients. Am J Kid Dis1996; 27: 803–8.
26.
FilteauS.M., MorrisS.S., AbbottR.A., TomkinsA.M., KirkwoodB.R., ArthurP., RossD.A., GyapongJ.O., RaynesJ.G.Influence of morbidity on serum retinol of children in a community-based study in northern Ghana. Am J Clin Nutr1993; 58: 192–7.
27.
RosalesF.J., RossC.Inflammation in human immunodeficiency virus type 1 infection as a cause of decreased plasma retinol [letter]. J Infect Dis1996; 173: 507–8.
28.
SembaR.D., GrahamN.M., CaiaffaW.T., MargolickJ.B., ClementL., VlahovD.Increased mortality associated with vitamin A deficiency during human immunodeficiency virus type 1 infection. Arch Intern Med1993; 153: 2149–54.
TangA.M., GrahamN.M., SembaR.D., SaahA.J.Association between serum vitamin A and E levels and HIV-1 disease progression. AIDS1997; 11: 613–20.
31.
BaumM.K., Shor PosnerG., LaiS., ZhangF., LaiH., FletcherM.A., SauberlichH., PageJ.B.High risk of HIV-related mortality is associated with selenium deficiency. J Acquir Immune Defic Syndr Hum Retrovirol1997; 15: 370–4.
32.
JollyP.E., MoonT.D., MitraA.K., del RosarioG.R., BlountS., ClemonsT.E.Vitamin A depletion in hospital and clinic patients with acquired immunodeficiency syndrome—a preliminary report. Nutr Res1997; 17: 1427–41.
33.
MellorsJ.W., RinaldoC.R.Jr., GuptaP., WhiteR.M., ToddJ.A., KingsleyL.A.Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science1996; 272: 1167–70.
34.
WellesS.L., JacksonJ.B., Yen-LiebermanB., DemeterL., JapourA.J., SmeatonL.M., JohnsonV.A., KuritzkesD.R., D'AquilaR.T., ReichelderferP.A., RichmanD.D., ReichmanR., FischlM., DolinR., CoombsR.W., KahnJ.O., McLarenC., ToddJ., KwokS., CrumpackerC.S.Prognostic value of plasma human immunodeficiency virus type I (HIV-1) RNA levels in patients with advanced HIV-1 disease and with little or no prior zidovudine therapy. J Infect Dis1996; 174: 696–703.
35.
GarciaP.M., KalishL.A., PittJ., MinkoffH., QuinnT.C., BurchettS.K., KomegayJ., JacksonB., MoyeJ., HansonC., ZorillaC., LewJ.F.Maternal levels of plasma human immunodeficiency virus type I RNA and the risk of perinatal transmission. N Engl J Med1999; 341: 394–402.
36.
SembaR.D., LylesC.M., MargolickJ.B., CaiaffaW.T., FarzadeganH., CohnS., VlahovD.Vitamin A supplementation and human immunodeficiency virus load in injection drug users. J Infect Dis1998; 177: 611–6.
37.
CampW.L., AllenS., AlvarezJ.O., JollyP.E., WeissH.L., PhillipsJ.F., KaritaE., SerufilaA., VermundS.H.Serum retinol and HIV-1 RNA viral load in rapid and slow progressors. J Acquir Immune Defic Syndr Hum Retrovirol1998; 18: 401–6.
38.
ReadJ.S., BethelJ., HarrisD.R., MeyerW.A., KorelitzJ., MofensonL.M., MoyeJ., PahwaS., RichK., NugentR.P.Serum vitamin A concentrations in a North American cohort of human immunodeficiency virus type 1-infected children. National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. Pediatr Infect Dis J1999; 18: 134–42.
39.
AbramsB., DuncanD., Hertz-PicciottoL.A prospective study of dietary intake and acquired immune deficiency syndrome in HIV-seropositive homosexual men. J Acquir Immune Defic Syndr1993; 6: 949–58.
40.
TangA.M., GrahamN.M., KirbyA.J., McCallL.D., WillettW.C., SaahA.J.Dietary micronutrient intake and risk of progression to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus type 1 (HIV-1)-infected homosexual men. Am J Epidemiol1993; 138: 937–51.
41.
TangA.M., GrahamN.M., SaahA.J.Effects of micronutrient intake on survival in human immunodeficiency virus type 1 infection. Am J Epidemiol1996; 143: 1244–56.
42.
Working Group on Mother-to-Child Transmission of HIV.Rates of mother-to-child transmission of HIV-1 in Africa, America and Europe: results from 13 perinatal studies. J Acquir Immune Defic Syndr Hum Retrovirol1995; 8: 506–10.
43.
BurgerH., KovacsA., WeisterB., GrimsonR., NachmanS., TropperP., van BennekumA.M., ElieM.C., BlanerW.S.Maternal serum vitamin A levels are not associated with mother-to-child transmission of HIV-1 in the United States. J Acquir Immune Defic Syndr Hum Retrovirol1997; 14: 321–6.
44.
BurnsD.N., FitzGeraldG., SembaR., HershowR., ZorrillaC., PittS., HammillH., CooperE.R., FowlerM.G., LandesmanS.Vitamin A deficiency and other nutritional indices during pregnancy in human immunodeficiency virus infection: prevalence, clinical correlates, and outcome. Women and Infants Transmission Study Group. Clin Infect Dis1999; 29: 328–34.
45.
CoutsoudisA., PillayK., SpoonerE., KuhnL., CoovadiaH.M.Randomized trial testing the effect of vitamin A supplementation on pregnancy outcomes and early mother-to-child transmission in Durban, South Africa. AIDS1999; 13: 1517–24.
46.
MostadS.B., OverbaughJ., De VangeD.M., WelchM.J., ChohanB., MandaliyaK., NyangeP., MartinH.L., Ndinya-AcholaJ., BwayoJ.J., KreissJ.K.Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina. Lancet1997; 350: 922–7.
47.
JohnG.C., NduatiR.W., Mbori-NgachaD., OverbaughJ., WelchM., RichardsonB.A., Ndinya-AcholaJ., BwayoJ., KriegerJ., OnyangoF., KreissJ.K.Genital shedding of human immunodeficiency virus type 1 DNA during pregnancy: association with immunosuppression, abnormal cervical or vaginal discharge, and severe vitamin A deficiency. J Infect Dis1997; 175: 57–62.
48.
SembaR.D., MiottiP., ChiphangwiJ.D., HendersonR., DallabettaG., YangL.P., HooverD.Maternal vitamin A deficiency and child growth failure during human immunodeficiency virus infection. J Acquir Immune Defic Syndr Hum Retrovirol1997; 14: 219–22.
49.
GarewalH.S., AmpelN.M., WatsonR.R., PrabhalaR.H., DolsC.L.A preliminary trial of beta-carotene in subjects infected with the human immunodeficiency virus. J Nutr1992; 122: 728–32.
50.
CoodleyG.O., NelsonH.D., LovelessM.O., FolkC.Beta-carotene in HIV infection. J Acquir Immune Defic Syndr1993; 6: 272–6.
51.
CoodleyG.O., CoodleyM.K., LuskR., GreenT.R., BakkeA.C., WilsonD., WachenheimD., SextonG., SalvesonC.Beta-carotene in HIV infection: an extended evaluation. AIDS1996; 10: 967–73.
52.
NimmagaddaA.P., BurriB.J., NeidlingerT., O'BrienW.A., GoetzM.B.Effect of oral beta-carotene supplementation on plasma human immunodeficiency virus (HIV) RNA levels and CD4 counts in HIV-infected patients. Clin Infect Dis1998; 27: 1311–2.
53.
KellyP., MusondaR., KafwembeE., KaetanoL., KeaneE., FarthingM.Micronutrient supplementation in the AIDS diarrhoea-wasting syndrome in Zambia: a randomized controlled trial. AIDS1999; 13: 495–500.
54.
PoliG., KinterA.L., JustementJ.S., BresslerP., KehrlJ.H., FauciA.S.Retinoic acid mimics transforming growth factor β in the regulation of human immunodeficiency virus expression in monocytic cells. Proc Natl Acad Sci USA1992; 89: 2689–93.
55.
TurpinJ.A., VargoM., MeltzerM.S.Enhanced HIV-1 replication in retinoid-treated monocytes: retinoid effects mediated through mechanisms related to cell differentiation and to a direct transcriptional action on viral gene expression. J Immunol1992; 148: 2539–46.
56.
SembaR.D., LylesC.M., MargolickJ.B., CaiaffaW.T., FarzadeganH., CohnS., VlahovD.Vitamin A supplementation and human immunodeficiency virus load in injection drug users. J Infect Dis1998; 177: 611–6.
57.
HumphreyJ.H., QuinnT., FineD., LedermanH., Yamini-RoodsariS., WuL.S., MoellerS., RuffA.J.Short-term effects of large-dose vitamin A supplementation on viral load and immune response in HIV-infected women. J Acquir Immune Defic Syndr Hum Retrovirol1999; 20: 44–51.
58.
CoutsoudisA., MoodleyD., PillayK., HarriganR., StoneC., MoodleyJ., CoovadiaH.M.Effects of vitamin A supplementation on viral load in HIV-1-infected pregnant women [letter]. J Acquir Immune Defic Syn Hum Retrovirol1997; 15: 86–7.
59.
DubowitzL.M.S., DubowitzV., GoldbergC.Clinical assessment of gestational age in the newborn infant. J Pediatr1970; 77: 1–10.
60.
IsraelE.J.Neonatal necrotizing enterocolitis, a disease of the immature intestinal mucosal barrier. Acta Paediatr1994; 396; S27–S32.
61.
FawziW.W., MsamangaG.I., SpiegelmanD., UrassaE.J., McGrathN., MwakagileD., AntelmanG., MbiseR., HerreraG., KapigaS., WillettW., HunterD.J.Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet1998; 351: 1477–82.
62.
FawziW.W., MbiseR.L., HertzmarkE., FatakiM.R., HerreraM.G., NdossiG., SpiegelmanD.A randomized trial of vitamin A supplements in relation to mortality among human immunodeficiency virus-infected and uninfected children in Tanzania. Pediatr Infect Dis1999; 18: 127–33.
63.
SembaR.D., KumwendaN., HooverD.R., TahaT.E., QuinnT.C., MtimaralyeL., BiggarR.J., BroadheadR., MiottiP.G., SokollL.J., van der HoevenL., ChiphangwiJ.A.Human immunodeficiency virus load in breast milk, mastitis, and mother-to-child transmission of human immunodeficiency virus type I. J Infect Dis1999; 180: 93–8.
64.
World Health Organization.Safe vitamin A dosage during pregnancy and lactation: recommendations and report of a consultation. WHO/NUT/98.4.Geneva: WHO, 1998.
65.
NobackC.R., TakahashiY.I.Micro morphology of the placenta of rats reared on marginal vitamin A–deficient diet. Acta Anat1978; 102: 195–202.
66.
KuhnL., SteketeeR.W., WeedonJ., AbramsE.J., LambertG., BamjiM., SchoenbaumE., FarleyJ., NesheimS.R., PalumboP., SimondsR.J., TheaD.M.Distinct risk factors for intrauterine and intrapartum human immunodeficiency virus transmission and consequences for disease progression in infected children. J Infect Dis1999; 179: 52–8.
67.
WestK.P.Jr, KatzJ., KhatryS.K., LeClerqS.C., PradhanE.K., ShresthaS.R., ConnorP.B., DaliS.M., ChristianP., PokhrelR.P., SommerA.Double blind, cluster randomised trial of low dose supplementation with vitamin A or beta-carotene on mortality related to pregnancy in Nepal. the NNIPS-2 Study Group. BMJ1999; 318: 570–5.
68.
LorenziP., SpicherV.M., LaubereauB., HirschelB., KindC., RudinC., IrionO., KaiserL.Antiretroviral therapies in pregnancy: maternal, fetal and neonatal effects. AIDS1998; 12: F241–7.
69.
KennedyC.M., CoutsoudisA., KuhnL., PillayK., MburuA., SteinZ., CoovadiaH.Randomized controlled trial assessing the effect of vitamin A supplementation on maternal morbidity during pregnancy and postpartum among HIV-infected women. J Aquir Immune Defic Syndr2000; 24: 37–44.
70.
CoutsoudisA., BobatR.A., CoovadiaH.M., KuhnL., TsaiW.Y., SteinZ.A.The effects of vitamin A supplementation on the morbidity of children born to HIV-infected women. Am J Public Health1995; 85: 1076–81.
FilteauS.M., RollinsN.C., CoutsoudisA., SullivanK.R., WillumsenJ.F., TomkinsA.The effect of antenatal vitamin A and β-carotene supplementation on gut integrity of infants of HIV-infected South African women. J Pediatr Gastroenterol Nutr2001; 32: 464–70.
73.
HanekomW.A., YogevR., HealdL.M., EdwardsK.M., HusseyG.D., ChadwickE.G.Effect of vitamin A therapy on serologic responses and viral load changes after influenza vaccination in children infected with the human immunodeficiency virus. Pediatrics2000; 136: 550–2.
74.
StallingsR.Y., StoltzfusR.J., SchulzeK., MiottiP.Negative association of an acute phase protein with maternal serum retinol in HIV infection. In: Abstracts of the 18th International Vitamin A Consultative Group Meeting (Egypt).Washington, DC: International Life Sciences Institute, 1997: 103.
