Recommended dose for repair of serum vitamin A levels in patients with HIV infection/AIDS may be insufficient because of high urinary losses

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 22; no. 5; pp. 483 - 489
• Main Authors: Neves, Fabio F., Vannucchi, Hélio, Jordão, Alceu A., Figueiredo, José Fernando C.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2006; Elsevier; Elsevier Limited
• Subjects: Acquired immune deficiency syndrome; acquired immunodeficiency syndrome; Acquired Immunodeficiency Syndrome - blood; Acquired Immunodeficiency Syndrome - complications; Acquired Immunodeficiency Syndrome - metabolism; Adult; AIDS; Antiretroviral drugs; Biological and medical sciences; blood serum; carotenes; CD4 Lymphocyte Count; Children & youth; Dietary Supplements; dosage; Dose-Response Relationship, Drug; Drug therapy; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; HIV; HIV Infections - blood; HIV Infections - complications; HIV Infections - metabolism; Human immunodeficiency virus; Humans; Male; Middle Aged; Nutrient loss; Nutritional Requirements; Patient Selection; patients; Retinol; Treatment Outcome; Urinary loss; urine; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Viral Load; Vitamin A; Vitamin A - blood; Vitamin A - metabolism; Vitamin A - therapeutic use; Vitamin A - urine; Vitamin A Deficiency - drug therapy; Vitamin A Deficiency - etiology; vitamin deficiencies; vitamin supplements; Vitamins - blood; Vitamins - metabolism; Vitamins - therapeutic use; Vitamins - urine; Brazil; Vitamin A; AIDS; HIV; Urinary loss; Retinol; Urine; Immunopathology; Vitamin; Retroviridae; Immune deficiency; Lentivirus; Infection; Virus; Vertebrata; Mammalia; Viral disease; Serum; Human immunodeficiency virus; Repair; Dose
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2005.11.008

Retinol deficiency is quite frequent in the population of human immunodeficiency virus (HIV)-infected individuals. Serum retinol levels of less than 1.05 μmol/L determine a 3.5 to five times higher death risk. However, studies evaluating the efficacy of retinol supplementation in HIV-seropositive individuals have reported conflicting results. The World Health Organization recommends the treatment of vitamin A deficiency in seropositive individuals in the same manner as for seronegative individuals, but clinical studies proving the efficacy of this scheme are lacking. The proposal of the present study was to assess the efficacy of supplementation with high retinol doses in HIV-infected patients with vitamin A deficiency. Twenty-five adult HIV-seropositive individuals were monitored over a period of 9 months, with determination of serum and urinary retinol every 3 months. The subjects received retinol palmitate doses ranging from 300,000 IU to 600,000 IU. Patients whose retinol levels were higher than 1.60 μmol/L were only observed. Eighteen patients received supplementation during clinical monitoring. The dose of 600,000 IU induced a significant mean increase in serum levels of 0.47 μmol/L ( P = 0.049) within a period of three months. Those who received 300,000 IU presented a mean increase of 0.29 μmol/L. In contrast, the patients who did not receive replacement therapy presented a significant decrease ( P = 0.017) in serum retinol levels, with initial and final values of 1.77 μmol/L and 1.55 μmol/L. The individuals with the worst response to supplementation presented a higher urinary loss of retinol at the beginning of the study. Even with a mean retinol supplementation of 771,428 IU during the study period, six patients had marginal serum retinol levels at the end of the study. We conclude that, in view of the high urinary loss of this nutrient, there is the need to redefine the ideal dose for the treatment of HIV-infected individuals.