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Hypervitaminosis A is associated with immunological non-response in HIV-1-infected adults: a case-control study

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Abstract

For people living with HIV, determinants of immunological non-response (INR) to combined antiretroviral therapy (cART) have not been fully elucidated. In a case-control study, we evaluated the influence of the nutritional and antioxidant status in HIV-1 adults whose cART was initiated between January 2001 and December 2013. Cases had persistent CD4 counts < 350/μL vs. > 350/μL for controls, after at least 2 years of cART with persistent viral loads (VL) < 50 copies/mL. Twelve cases and twenty-eight control subjects with the same CD4 count at cART initiation were compared for their nutritional and antioxidant status after age adjustment at dosage assessment. Patients were predominantly male (70%), Caucasian (82%) and at AIDS stage (62%). The median age was 53, and the median CD4 count was 245/mm3 for cases and 630/mm3 for controls after a median time of 7 years on cART. Despite higher energy intakes in cases, anthropometric data was comparable between groups who had similar vitamins B9/B12/C/D/E, zinc, citrulline and glutamine levels. Nine cases (75%) and 8 controls (29%) had hypervitaminosis A (> 2.70 μmol/L) (p = 0.030). Cases had lower erythrocyte resistance when exposed to a controlled free radical attack (p = 0.014). Most cases had hypervitaminosis A and altered antioxidant capacities that could affect immunological response. Wide-scale studies are required, but in the meantime, screening of their vitamin A status must be encouraged in these patients.

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Acknowledgements

We thank Sylvie Vandamme, Philippe Choisy, Faïza Ajana, Isabelle Alcaraz, Christophe Allien, Véronique Baclet, Thomas Huleux, Agnès Meybeck, Bertrand Riff and Michel Valette for their help with data acquisition.

Author information

Authors and Affiliations

  1. Hôpital Gustave Dron, Service universitaire des maladies infectieuses et du voyageur, Tourcoing, France

    Hugues Melliez, Sylvie Mazzella, Vincent Derdour, Olivier Robineau, Eric Senneville & Raphaël Biekre

  2. Hôpital de la région de Saint-Omer, Service de médecine interne, Helfaut, France

    Hugues Melliez

  3. Laboratoire LARA SPIRAL, Couternon, France

    Michel Prost

  4. CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, University Lille, F-59000, Lille, France

    Hélène Behal

  5. Service de Biochimie, Hôpital Cochin, APHP et Service de Nutrition, Faculté de Pharmacie, Université de Paris, Paris, France

    Nathalie Neveux & Luc Cynober

  6. Biochimie hormonologie, Hôpital Universitaire Robert Debré APHP, Paris, France

    Jean-François Benoist

  7. Lip (Sys)2, Université Paris-Sud, Chatenay Malabry, France

    Jean-François Benoist

  8. Centre de Pathologies-Biologie, CHRU de Lille, Lille, France

    Isabelle Kim

  9. Laboratoire d’Analyses Médicales, CH Dron, Tourcoing, France

    Evelyne Sauser

  10. U1286 – Infinite – Institute for Translational Research in Inflammation, University Lille, F-59000, Lille, France

    David Seguy

  11. Inserm, U1286, F-59000, Lille, France

    David Seguy

  12. CHU Lille, Endocrinologie, Diabétologie, Maladies Métabolique et Nutrition, F-59000, Lille, France

    David Seguy

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  1. Hugues Melliez
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  14. David Seguy
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Correspondence to Hugues Melliez.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval

All procedures in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by both local and national ethics committees (CPP, Comité de Protection des Personnes; CNIL, Commission Nationale de l’Informatique et des Libertés. Authorisation number: 1697172).

Informed consent

Eligible individuals were selected from the French Nadis® database which contains clinical and biological information collected during routine practice and for which participants have given their written informed consent for research use. For this study, non-opposition has been verified with the patient.

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Melliez, H., Prost, M., Behal, H. et al. Hypervitaminosis A is associated with immunological non-response in HIV-1-infected adults: a case-control study. Eur J Clin Microbiol Infect Dis 39, 2091–2098 (2020). https://doi.org/10.1007/s10096-020-03954-0

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