HIV-1 Infection Alters the Retinol-Binding Protein:Transthyretin Ratio Even in the Absence of the Acute Phase Response

• Published in: The Journal of nutrition Vol. 136; no. 6; pp. 1624 - 1629
• Main Authors: Baeten, Jared M, Wener, Mark H, Bankson, Daniel D, Lavreys, Ludo, Richardson, Barbra A, Mandaliya, Kishorchandra, Bwayo, Job J, McClelland, R. Scott
• Format: Journal Article
• Language: English
• Published: Bethesda, MD American Society for Nutrition 01.06.2006; American Society for Nutritional Sciences
• Subjects: acute phase proteins; Acute-Phase Reaction - metabolism; Adult; Biological and medical sciences; deficiency diseases; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; HIV infections; HIV Infections - metabolism; HIV-1; Human immunodeficiency virus 1; human nutrition; Humans; inflammation; nutrition assessment; nutritional status; prealbumin; Prealbumin - metabolism; randomized clinical trials; retinol-binding protein; Retinol-Binding Proteins - metabolism; transthryetin; Vertebrates: anatomy and physiology, studies on body, several organs or systems; vitamin A; Vitamin A Deficiency - metabolism; vitamin supplements; women; Kenya; Immunopathology; Nutrition; HIV-1 virus; Acute; transthyretin; Vitamin; Retroviridae; AIDS; retinol-binding protein; Immune deficiency; Lentivirus; Retinol; Infection; Micronutrient; Virus; Binding protein; vitamin A status; HIV; inflammation; Viral disease; Ratio; Human immunodeficiency virus
• ISSN: 0022-3166; 1541-6100
• DOI: 10.1093/jn/136.6.1624

The ratio of retinol-binding protein (RBP) to transthyretin (TTR) has been proposed as an indirect method with which to assess vitamin A status in the context of inflammation. Few studies have been conducted among adults, and none examined the effect of HIV-1 infection. Our goal was to assess the RBP:TTR ratio among adults, including the effects of HIV-1 and the acute phase response. We used data from a cross-sectional study of 600 Kenyan women, of whom 400 had HIV-1. The effect of vitamin A supplementation among the HIV-1-infected participants was subsequently assessed in a randomized trial. Among HIV-1-uninfected women without an acute phase response, a RBP:TTR cut-off value of 0.25 had ~80% sensitivity and specificity to detect vitamin A deficiency (retinol <0.70 μmol/L). No RBP:TTR cut-off value demonstrated both high sensitivity and specificity among HIV-1 infected women without evidence of inflammation. HIV-1 infection and advanced HIV-1 disease were associated with higher RBP:TTR ratios. The effect of HIV-1 was independent of the acute phase response, which also increased the RBP:TTR ratio. Serum retinol increased with vitamin A supplementation among those with a low RBP:TTR ratio, although the effect was small and was not present among those with concurrent inflammation. Thus, the RBP:TTR ratio has modest ability to predict vitamin A deficiency among healthy adults, but HIV-1 infection alters the ratio, even in the absence of the acute phase response. Our results raise questions about the utility of this measurement given the high prevalence of HIV-1 infection in areas where vitamin A deficiency is common.