Micronutrients and HIV-1 disease progression

Objective: 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: Biochemical measurements of nutritional status including plasma proteins, zinc, iron and vitamins B₁, B₂, B₆, 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 zidovudine 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.