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Micronutrients and the pathogenesis of human immunodeficiency virus infection

Published online by Cambridge University Press:  09 March 2007

R. D. Semba*
Affiliation:
Departments of Ophthalmology and Epidemiology School of Medicine and School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland, USA
A. M. Tang
Affiliation:
Departments of Ophthalmology and Epidemiology School of Medicine and School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland, USA
*
*Corresponding author: Dr Richard D. Semba, Ocular Immunology Service, 550 North Broadway, Suite 700, Baltimore, MD 21205, USA, fax +1 410 955 0629, email [email protected]
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Abstract

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Micronutrient deficiencies may be common during human immunodeficiency virus (HIV) infection. Insufficient dietary intake, malabsorption, diarrhoea, and impaired storage and altered metabolism of micronutrients can contribute to the development of micronutrient deficiencies. Low plasma or serum levels of vitamins A, E, B6, B12 and C, carotenoids, Se, and Zn are common in many HIV-infected populations. Micronutrient deficiencies may contribute to the pathogenesis of HIV infection through increased oxidative stress and compromised immunity. Low levels or intakes of micronutrients such as vitamins A, E, B6 and B12, Zn and Se have been associated with adverse clinical outcomes during HIV infection, and new studies are emerging which suggest that micronutrient supplementation may help reduce morbidity and mortality during HIV infection.

Type
Review article
Copyright
Copyright © The Nutrition Society 1999

References

Abrams, B, Duncan, D & Hertz-Picciotto, I (1993) A prospective study of dietary intake and acquired immune deficiency syndrome in HIV-seropositive homosexual men. Journal of Acquired Immune Deficiency Syndromes 6, 949958.Google ScholarPubMed
Allard, JP, Aghdassi, E, Chau, J, Tam, C, Kovacs, CM, Salit, IE & Walmsley, SL (1998) Effects of vitamin E and C supplementation on oxidative stress and viral load in HIV-infected subjects. AIDS 12, 16531659.CrossRefGoogle Scholar
Baruchel, S & Wainberg, MA (1992) The role of oxidative stress in disease progression in individuals infected by the human immunodeficiency virus. Journal of Leukocyte Biology 52, 111114.CrossRefGoogle ScholarPubMed
Batman, PA, Miller, ARO, Forster, SM, Harris, JRW, Pinching, AJ & Griffin, GE (1989) Jejunal enteropathy associated with human immunodeficiency virus infection: quantitative histology. Journal of Clinical Pathology 42, 275281.CrossRefGoogle ScholarPubMed
Baum, M, Cassetti, L, Bonvehi, P, Shor-Posner, G, Lu, Y & Sauberlich, H (1994) Inadequate dietary intake and altered nutrition status in early HIV-1 infection. Nutrition 10, 1620.Google ScholarPubMed
Baum, MK, Mantero-Atienza, E, Shor-Posner, G, Fletcher, MA, Morgan, R, Eisdorfer, C, Sauberlich, HE, Cornwell, PE & Beach, RS (1991) Association of vitamin B6 status with parameters of immune function in early HIV-1 infection. Journal of Acquired Immune Deficiency Syndromes 4, 11221132.Google ScholarPubMed
Baum, MK, Shor-Posner, G, Bonvehi, P, Cassetti, I, Lu, Y, Mantero-Atienza, E, Beach, RS & Sauberlich, HE (1992) Influence of HIV infection on vitamin status and requirements. Annals of the New York Academy of Sciences 669, 165173.CrossRefGoogle ScholarPubMed
Baum, MK, Shor-Posner, G, Lai, S, Zhang, G, Fletcher, MA, Sauberlich, H & Page, JB (1997) High risk of mortality in HIV infection is associated with selenium deficiency. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 15, 370374.CrossRefGoogle ScholarPubMed
Baum, MK, Shor-Posner, G, Lu, Y, Rosner, B, Sauberlich, HE, Fletcher, MA, Szapocznik, J, Eisdorfer, C, Buring, JE & Hennekens, CH (1995) Micronutrients and HIV-1 disease progression. AIDS 9, 10511056.CrossRefGoogle ScholarPubMed
Beach, RS, Mantero-Atienza, E, Eisdorfer, C & Fordyce-Baum, MK (1988) Altered folate metabolism in early HIV infection. Journal of the American Medical Association 259, 518.Google ScholarPubMed
Beach, RS, Mantero-Atienza, E, Shor-Posner, G, Javier, JJ, Szapocznik, J, Morgan, R, Sauberlich, HE, Cornwell, PE, Eisdorfer, C & Baum, MK (1992) Specific nutrient abnormalities in asymptomatic HIV-1 infection. AIDS 6, 701708.CrossRefGoogle ScholarPubMed
Bogden, JD, Baker, H, Frank, O, Perez, G, Kemp, F, Bruening, K & Louria, D (1990) Micronutrient status and human immunodeficiency virus (HIV) infection. Annals of the New York Academy of Sciences 587, 189195.CrossRefGoogle ScholarPubMed
Boudes, P, Zittoun, J & Sobel, A (1990) Folate, vitamin B12, and HIV infection. Lancet 335, 14011402.CrossRefGoogle ScholarPubMed
Burkes, RL, Cohen, H, Krailo, M, Sinow, RM & Carmel, R (1987) Low serum cobalamin levels occur frequently in the acquired immune deficiency syndrome and related disorders. European Journal of Haematology 38, 141147.CrossRefGoogle ScholarPubMed
Carr, A, Marriott, D, Field, A, Vasak, E & Cooper, DA (1998) Treatment of HIV-1-associated microsporidiosis and crypto-sporidiosis with combination antiretroviral therapy. Lancet 351, 256261.CrossRefGoogle ScholarPubMed
Castaldo, A, Tarallo, L, Palomba, E, Albano, F, Russo, S, Zuin, G, Buffardi, F & Guarino, A (1996) Iron deficiency and intestinal malabsorption in HIV disease. Journal of Pediatric Gastroenterology and Nutrition 22, 359363.Google ScholarPubMed
Castetbon, K, Kadio, A, Bondurand, A, Yao, AB, Barouan, C, Coulibaly, Y, Anglaret, X, Msellati, P, Malvy, D & Dabis, F (1997) Nutritional status and dietary intakes in human immunodeficiency virus (HIV)-infected outpatients in Abidjan, Côte D'Ivoire, 1995. European Journal of Clinical Nutrition 51, 8186.CrossRefGoogle ScholarPubMed
Chambon, P (1996) A decade of molecular biology of retinoic acid receptors. FASEB Journal 10, 940954.CrossRefGoogle ScholarPubMed
Cirelli, A, Ciardi, M, de Simone, C, Sorice, F, Giordano, R, Ciaralli, L & Costantini, S (1991) Serum selenium concentration and disease progress in patients with HIV infection. Clinical Biochemistry 24, 211214.CrossRefGoogle ScholarPubMed
Coodley, GO, Coodley, MK, Lusk, R, Green, TR, Bakke, AC, Wilson, D, Wachenheim, D, Sexton, G & Salveson, C (1996) Beta-carotene in HIV infection: an extended evaluation. AIDS 10, 967973.CrossRefGoogle ScholarPubMed
Coodley, G & Girard, DE (1991) Vitamins and minerals in HIV infection. Journal of General Internal Medicine 6, 472479.CrossRefGoogle ScholarPubMed
Coutsoudis, A, Bobat, RA, Coovadia, HM, Kuhn, L, Tsai, WY & Stein, ZA (1995) The effects of vitamin A supplementation on the morbidity of children born to HIV-infected women. American Journal of Public Health 85, 10761081.CrossRefGoogle ScholarPubMed
D'Agati, V & Appel, GB (1997) HIV infection and the kidney. Journal of the American Society of Nephrology 8, 138152.CrossRefGoogle ScholarPubMed
Dhur, A, Galan, P & Hercberg, S (1991) Folate status and the immune system. Progress in Food and Nutrition Science 15, 4360.Google ScholarPubMed
Duh, EJ, Maury, WJ, Folks, TM, Fauci, AS & Rabson, AB (1989) Tumor necrosis factor alpha activates human immunodeficiency virus type 1 through induction of nuclear factor binding to the NF-κB sites in the long terminal repeat. Proceedings of the National Academy of Sciences, USA 86, 59745978.CrossRefGoogle Scholar
Dworkin, BM (1994) Selenium deficiency, HIV infection and the acquired immunodeficiency syndrome (AIDS). Chemico-Bio-logical Interactions 91, 181186.CrossRefGoogle ScholarPubMed
Dworkin, BM, Rosenthal, WS, Wormser, GP & Weiss, L (1986) Selenium deficiency in the acquired immunodeficiency syndrome. Journal of Parenteral and Enteral Nutrition 10, 405407.CrossRefGoogle ScholarPubMed
Ehrenpreis, ED, Carlson, SJ, Boorstein, HL & Craig, RM (1994) Malabsorption and deficiency of vitamin B12 in HIV-infected patients with chronic diarrhea. Digestive Diseases and Sciences 39, 21592162.CrossRefGoogle ScholarPubMed
Falutz, J, Tsoukas, C & Gold, P (1988) Zinc as a cofactor in human immunodeficiency virus-induced immunosuppression. Journal of the American Medical Association 259, 28502851.CrossRefGoogle ScholarPubMed
Fawzi, WW, Msamanga, GI, Spiegelman, D, Urassa, EJN, McGrath, N, Mwakagile, D, Antelman, G, Mbise, R, Herrera, G, Kapiga, S, Willett, W, Hunter, DJfor the Tanzania Vitamin and HIV Infection Trial Team (1998) Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet 351, 14771482.CrossRefGoogle Scholar
Fuchs, D, Zangerle, R, Artner-Dworzak, E, Weiss, G, Fritsch, P, Tilz, GP, Dierich, MP & Wachter, H (1993) Association between immune activation, changes of iron metabolism and anaemia in patients with HIV infection. European Journal of Haematology 50, 9094.CrossRefGoogle ScholarPubMed
Gibson, R (1990) Principles of Nutritional Assessment. New York, NY: Oxford University Press.Google Scholar
Gillen, JS, Shike, M, Alcock, N, Urmacher, C, Krown, S, Kurtz, RC, Lightdale, CJ & Winawer, SJ (1985) Malabsorption and mucosal abnormalities of the small intestine in the acquired immunodeficiency syndrome. Annals of Internal Medicine 102, 619622.CrossRefGoogle Scholar
Goodgame, RW, Kimball, K, Ou, CN, White, AC Jr, Genta, RM, Lifschitz, CH & Chappell, CL (1995) Intestinal function and injury in acquired immunodeficiency syndrome-related cryptosporidiosis. Gastroenterology 108, 10751082.CrossRefGoogle ScholarPubMed
Graham, NMH, Sorensen, D, Odaka, N, Brookmeyer, R, Chan, D, Willett, WC, Morris, JS & Saah, AJ (1991) Relationship of serum copper and zinc levels to HIV-1 seropositivity and progression to AIDS. Journal of Acquired Immune Deficiency Syndromes 4, 976980.Google ScholarPubMed
Greenberg, BL, Semba, RD, Vink, PE, Farley, JJ, Sivapalasingam, M, Steketee, RW, Thea, DM & Schoenbaum, EE (1997) Vitamin A deficiency and maternal-infant transmission of HIV in two metropolitan areas in the United States. AIDS 11, 325332.CrossRefGoogle ScholarPubMed
Greenson, JK, Belitsos, PC, Yardley, JH & Bartlett, JG (1991) AIDS enteropathy: occult enteric infections and duodenal mucosal alterations in chronic diarrhea. Annals of Internal Medicine 114, 366372.CrossRefGoogle ScholarPubMed
Harriman, GR, Smith, PD, Horne, MK, Fox, CH, Koenig, S, Lack, EE, Lane, HC & Fauci, AS (1989) Vitamin B12 malabsorption in patients with acquired immunodeficiency syndrome. Archives of Internal Medicine 149, 20392041.CrossRefGoogle ScholarPubMed
Herzenberg, LA, De Rosa, SC, Dubs, JG, Roederer, M, Anderson, MT, Ela, SW, Deresinski, SC & Herzenberg, LA (1997) Glutathione deficiency is associated with impaired survival in HIV disease. Proceedings of the National Academy of Sciences USA 94, 19671972.CrossRefGoogle ScholarPubMed
Hussey, G, Hughes, J, Potgieter, S, Kessow, G, Burgess, J, Beatty, D, Keraan, M & Carlesle, E (1996) Vitamin A status and supplementation and its effects on immunity in children with AIDS. In Abstracts of the XVII International Vitamin A Consultative Group Meeting, Guatemala City, p. 6. Washington, DC: International Life Sciences Institute.Google Scholar
Haug, C, Müller, F, Aukrust, P & Freland, SS (1994) Subnormal serum concentration of 1,25-vitamin D in human immunodeficiency virus infection: correlation with degree of immune deficiency and survival. Journal of Infectious Diseases 169, 889893.CrossRefGoogle ScholarPubMed
Jordão, AA Jr, Silveira, S, de Castro Figueiredo, JF & Vannucchi, H (1998) Urinary excretion and plasma vitamin E levels in patients with AIDS. Nutrition 14, 423426.CrossRefGoogle Scholar
John, GC, Nduati, RW, Mbori-Ngacha, D, Overbaugh, J, Welch, M, Richardson, BA, Ndinya-Achola, J, Bwayo, J, Krieger, J, Onyango, F & Kreiss, JK (1997) Genital shedding of human immunodeficiency virus type 1 DNA during pregnancy: association with immunosuppression, abnormal cervical or vaginal discharge, and severe vitamin A deficiency. Journal of Infectious Diseases 175, 5762.CrossRefGoogle ScholarPubMed
Jolley, PE, Moon, TD, Mitra, AK, del Rosario, GR, Blount, S & Clemons, TE (1997) Vitamin A depletion in hospital and clinic patients with acquired immunodeficiency syndrome — a preliminary report. Nutrition Research 17, 14271441.CrossRefGoogle Scholar
Kabanda, A, Vandercam, B, Bernard, A, Lauwerys, R & van Ypersele de Strihou, C (1996) Low molecular weight proteinuria in human immunodeficiency virus-infected patients. American Journal of Kidney Diseases 27, 803808.CrossRefGoogle ScholarPubMed
Kalebic, T, Kinter, A, Poli, G, Anderson, ME, Meister, A & Fauci, AS (1991) Suppression of human immunodeficiency virus expression in chronically infected monocyte cells by glutathione, glutathione ester, and N-acetylcysteine. Proceedings of the National Academy of Sciences USA 88, 986990.CrossRefGoogle Scholar
Keating, J, Bjarnason, I, Somasundaram, S, Macpherson, A, Francis, N, Price, AB, Sharpstone, D, Smithson, J, Menzies, IS & Gazzard, BG (1995) Intestinal absorptive capacity, intestinal permeability and jejunal histology in HIV and their relation to diarrhoea. Gut 37, 623629.CrossRefGoogle ScholarPubMed
Koch, J, Garcia-Shelton, YL, Neal, EA, Chan, MF, Weaver, KE & Cello, JP (1996 a) Steatorrhea: a common manifestation in patients with HIV/AIDS. Nutrition 12, 507510.CrossRefGoogle ScholarPubMed
Koch, J, Neal, EA, Schlott, MJ, Garcia-Shelton, YL, Chan, MF, Weaver, KE & Cello, JP (1996 b) Zinc levels and infections in hospitalized patients with AIDS. Nutrition 12, 515518.CrossRefGoogle ScholarPubMed
Kotler, DP (1998) Antioxidant therapy and HIV infection: 1998. American Journal of Clinical Nutrition 67, 79.CrossRefGoogle ScholarPubMed
Kotler, DP, Gaetz, HP, Lange, M, Klein, EB & Holt, PR (1984) Enteropathy associated with the acquired immunodeficiency syndrome. Annals of Internal Medicine 101, 421428.CrossRefGoogle ScholarPubMed
Luder, E, Godfrey, E, Godbold, J & Simpson, DM (1995) Assessment of nutritional, clinical, and immunologic status of HIV-infected, inner-city patients with multiple risk factors. Journal of the American Dietetic Association 95, 655660.CrossRefGoogle ScholarPubMed
McCorkindale, C, Dybevik, K, Coulston, AM & Sucher, KP (1990) Nutritional status of HIV-infected patients during the early disease stages. Journal of the American Dietetic Association 90, 12361241.CrossRefGoogle ScholarPubMed
Mantero-Atienza, E, Sotomayor, MG, Shor-Posner, G, Fletcher, MA, Sauberlich, HE, Beach, RS & Baum, MK (1991) Selenium status and immune function in asymptomatic HIV-1 seropositive men. Nutrition Research 11, 12371250.CrossRefGoogle Scholar
Mastroiacovo, P, Ajassa, C, Berardelli, G, Bruni, R, Catania, N, Fidanza, A, Pace, A & Zanzoglous, S (1996) Antioxidant vitamins and immunodeficiency. International Journal of Vitamin and Nutrition Research 66, 141145.Google ScholarPubMed
Meydani, SN & Beharka, AA (1998) Recent developments in vitamin E and the immune response. Nutrition Reviews 56, Suppl. 2, S49S58.CrossRefGoogle Scholar
Miller, ARO, Griffin, GE, Batman, P, Farquar, C, Forster, SM, Pinching, AJ & Harris, JRW (1988) Jejunal mucosal architecture and fat absorption in male homosexuals infected with human immunodeficiency virus. Quarterly Journal of Medicine 69, 10091019.Google ScholarPubMed
Miller, TL, Orav, EJ, Martin, SR, Cooper, ER McIntosh K & Winter, HS (1991) Malnutrition and carbohydrate malabsorption in children with vertically transmitted human immunodeficiency virus 1 infection. Gastroenterology 100, 12961302.CrossRefGoogle ScholarPubMed
Miller, TL, Orav, EJ, Martin, SR, Cooper, ER McIntosh K & Winter, HS (1991) Malnutrition and carbohydrate malabsorption in children with vertically transmitted human immunodeficiency virus 1 infection. Gastroenterology 100, 12961302.CrossRefGoogle ScholarPubMed
Mocchegiani, E, Veccia, S, Ancarani, F, Scalise, G & Fabris, N (1995) Benefit of oral zinc supplementation as an adjunct to zidovudine (AZT) therapy against opportunistic infections in AIDS. International Journal of Immunopharmacology 17, 719727.CrossRefGoogle ScholarPubMed
Mostad, SB, Overbaugh, J, De Vange, DM, Welch, MJ, Chohan, B, Mandaliya, K, Nyange, P, Martin, HL Jr, Ndinya-Achola, J, Bwayo, JJ & Kreiss, JK (1997) Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina. Lancet 350, 922927.CrossRefGoogle Scholar
Mueller, BU, Tannenbaum, S & Pizzo, PA (1996) Bone marrow aspirates and biopsies in children with human immunodeficiency virus infection. Journal of Pediatric Hematology/Oncology 18, 266271.CrossRefGoogle ScholarPubMed
National Research Council (1989) Recommended Dietary Allowances, 10th ed. Washington, DC: National Academy Press.Google Scholar
Nduati, RW, John, GC, Richardson, BA, Overbaugh, J, Welch, M, Ndinya-Achola, J, Moses, S, Holmes, K, Onyango, F & Kreiss, JK (1995) Human immunodeficiency virus type 1-infected cells in breast milk: association with immunosuppression and vitamin A deficiency. Journal of Infectious Diseases 172, 14611468.CrossRefGoogle ScholarPubMed
Niyongabo, T, Bouchaud, O, Henzel, D, Melchior, JC, Samb, B, Dazza, MC, Ruggeri, C, Begue, JC, Couland, JP & Larouzé, B (1997) Nutritional status of HIV-seropositive subjects in an AIDS clinic in Paris. European Journal of Clinical Nutrition 51, 637640.CrossRefGoogle Scholar
Ockenga, J, Tillmann, HL, Trautwein, C, Stoll, M, Manns, MP & Schmidt, RE (1997) Hepatitis B and C in HIV-infected patients: Prevalence and prognostic value. Journal of Hepatology 27, 1824.CrossRefGoogle Scholar
Paltiel, O, Falutz, J, Veilleux, M, Rosenblatt, DS & Gordon, K (1995) Clinical correlates of subnormal vitamin B12 levels in patients infected with the human immunodeficiency virus. American Journal of Hematology 49, 318322.CrossRefGoogle ScholarPubMed
Phuapradit, W, Chaturachinda, K, Taneepanichskul, S, Sirivarasry, J, Khupulsup, K & Lerdvuthisopon, N (1996) Serum vitamin A and beta-carotene levels in pregnant women infected with human immunodeficiency virus-1. Obstetrics and Gynecology 87, 564567.CrossRefGoogle ScholarPubMed
Quinn, TC (1996) Global burden of the HIV pandemic. Lancet 348, 99106.CrossRefGoogle ScholarPubMed
Rall, LC & Meydani, SN (1993) Vitamin B6 and immune competence. Nutrition Reviews 51, 217225.CrossRefGoogle ScholarPubMed
Ramsden, DB, Prince, HP, Burr, WA, Bradwell, AR, Black, EG, Evans, AE & Hoffenberg, R (1978) Inter-relationship of thyroid hormones, vitamin A and their binding proteins following acute stress. Clinical Endocrinology 8, 109122.CrossRefGoogle ScholarPubMed
Roy, M, Kiremidjian-Schumacher, L, Wishe, HI, Cohen, MW & Stotzky, G (1995) Supplementation with selenium restores age-related decline in immune cell function. Proceedings of the Society for Experimental Biology and Medicine 209, 369375.CrossRefGoogle ScholarPubMed
Schreck, R, Rieber, P & Baeuerle, PA (1991) Reactive oxygen intermediates as apparently widely used messengers in the activation of the NF-κB transcription factor and HIV-1. EMBO Journal 10, 22472258.CrossRefGoogle ScholarPubMed
Schwenk, A, Bürger, B, Wessel, D, Stützer, H, Ziegenhagen, D, Diehl, V & Schrappe, M (1993) Clinical risk factors for malnutrition in HIV-1-infected patients. AIDS 7, 12131219.CrossRefGoogle ScholarPubMed
Semba, RD (1997) Vitamin A and human immunodeficiency virus infection. Proceedings of the Nutrition Society 56, 459469.CrossRefGoogle ScholarPubMed
Semba, RD (1998) The role of vitamin A and related retinoids in immune function. Nutrition Reviews 56, Suppl. 2, S38S48.CrossRefGoogle ScholarPubMed
Semba, RD, Graham, NMH, Caiaffa, WT, Margolick, JB, Clement, L & Vlahov, D (1993) Increased mortality associated with vitamin A deficiency during human immunodeficiency virus type 1 infection. Archives of Internal Medicine 153, 21492154.CrossRefGoogle ScholarPubMed
Semba, RD, Lyles, C, Margolick, J, Caiaffa, WT, Farzadegan, H, Cohn, S & Vlahov, D (1998) Vitamin A supplementation and human immunodeficiency virus load in injection drug users. Journal of Infectious Diseases 177, 611616.CrossRefGoogle ScholarPubMed
Semba, RD, Miotti, P, Chiphangwi, JD, Henderson, R, Dallabetta, G, Yang, LP & Hoover, DR (1997) Maternal vitamin A deficiency and child growth failure during human immunodeficiency virus infection. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 14, 219222.CrossRefGoogle ScholarPubMed
Semba, RD, Miotti, PG, Chiphangwi, JD, Saah, A, Canner, J, Dallabetta, G & Hoover, DR (1994) Maternal vitamin A deficiency and mother-to-child transmission of HIV-1. Lancet 343, 15931597.CrossRefGoogle ScholarPubMed
Sepkowitz, KA (1998) Effect of HAART on natural history of AIDS-related opportunistic disorders. Lancet 351, 228230.CrossRefGoogle ScholarPubMed
Shankar, AH & Prasad, AS (1998) Zinc and immune function: the biological basis of altered resistance to infection. American Journal of Clinical Nutrition 68, Suppl. 2, 447S463S.CrossRefGoogle ScholarPubMed
Sharpstone, D & Gazzard, B (1996) Gastrointestinal manifestations of HIV infection. Lancet 348, 379383.CrossRefGoogle ScholarPubMed
Skurnick, JH, Bogden, JD, Baker, H, Kemp, FW, Sheffet, A, Quattrone, G & Louria, DB (1996) Micronutrient profiles in HIV-1-infected heterosexual adults. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 12, 7583.CrossRefGoogle ScholarPubMed
Smit, E, Graham, NMH, Tang, A, Flynn, C, Solomon, L & Vlahov, D (1996) Dietary intake of community-based HIV-1 seropositive and seronegative injecting drug users. Nutrition 12, 496501.CrossRefGoogle ScholarPubMed
Smith, FR & Goodman, DW (1971) The effects of diseases of the liver, thyroid, and kidneys on the transport of vitamin A in human plasma. Journal of Clinical Investigation 50, 24262436.CrossRefGoogle ScholarPubMed
Soto, B, Sánchez-Quijano, A, Rodrigo, L, del Olmo, JA, Garčˇía-Bengoechea, M, Hernández-Quero, J, Rey, C, Abad, MA, Rodřˇíguez, M, Gilabert, MSGonzález, F, Mirón, P, Caruz, A, Relimpio, F, Torronteras, R, Leal, M & Lissen, E (1997) Human immunodeficiency virus infection modifies the natural history of chronic parenterally-acquired hepatitis C with an unusually rapid progression to cirrhosis. Journal of Hepatology 26, 15.CrossRefGoogle ScholarPubMed
Staal, FJT, Roederer, M, Herzenberg, LA & Herzenberg, LA (1990) Intracellular thiols regulate activation of nuclear factor κB and transcription of human immunodeficiency virus. Proceedings of the National Academy of Sciences USA 87, 99439947.CrossRefGoogle ScholarPubMed
Stockmann, M, Fromm, M, Schmitz, H, Schmidt, W, Riecken, EO & Schulzke, JD (1998) Duodenal biopsies of HIV-infected patients with diarrhoea exhibit epithelial barrier defects but no active secretion. AIDS 12, 4351.CrossRefGoogle ScholarPubMed
Tang, AM, Graham, NMH, Chandra, RK & Saah, AJ (1997 a) Relation between serum vitamin B6, B12, and folate levels and human immunodeficiency virus type 1 (HIV-1) disease progression. Journal of Nutrition 127, 345351.Google ScholarPubMed
Tang, AM, Graham, NMH, Kirby, AJ, McCall, LD, Willett, WC & Saah, AJ (1993) Dietary micronutrient intake and risk of progression to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus type 1 (HIV-1)-infected homosexual men. American Journal of Epidemiology 138, 937951.CrossRefGoogle ScholarPubMed
Tang, AM, Graham, NMH & Saah, AJ (1996) Effects of micronutrient intake on survival in human immunodeficiency virus type 1 infection. American Journal of Epidemiology 143, 12441256.CrossRefGoogle ScholarPubMed
Tang, AM, Graham, NMH, Semba, RD & Saah, AJ (1997 b) Association between serum vitamin A and E levels and HIV-1 disease progression. AIDS 11, 613620.CrossRefGoogle Scholar
Thurnham, DI, Davies, JA, Crump, BJ, Situnayake, RD & Davis, M (1986) The use of different lipids to express serum tocopherol: lipid ratios for the measurement of vitamin E status. Annals of Clinical Biochemistry 23, 514520.CrossRefGoogle ScholarPubMed
Tilkian, SM, Lefevre, G & Coyle, C (1988) Altered folate metabolism in early HIV infection. Journal of the American Medical Association 259, 31283129.CrossRefGoogle ScholarPubMed
van der Hulst, RRWJ, von Meyenfeldt, MF, van Kreel, BK, Thunnissen, FBJM, Brummer, RJM, Arends, JW & Soeters, PB (1998) Gut permeability, intestinal morphology, and nutritional depletion. Nutrition 14, 16.CrossRefGoogle ScholarPubMed
Ullrich, R, Schneider, T, Heise, W, Schmidt, W, Averdunk, R, Riecken, EO & Zeitz, M (1994) Serum carotene deficiency in HIV-infected patients. AIDS 8, 661665.CrossRefGoogle ScholarPubMed
United Nations Children's Fund (1998) The State of the World's Children 1998. Oxford and New York: Oxford University Press.Google Scholar
Ysseldyke, LL (1991) Nutritional complications and incidence of malnutrition among AIDS patients. Journal of the American Dietetic Association 91, 217218.CrossRefGoogle ScholarPubMed