vitamin-b-12 and HIV-Infections

This article reviews current literature on the role of micronutrients in human immunodeficiency virus (HIV) infection. Deficiencies of micronutrients are common in HIV-infected persons. They occur due to malabsorption, altered metabolism, gut infection, and altered gut barrier function. There is a compelling association of deficiencies of micronutrients in HIV-infection with immune deficiency, rapid disease progression, and mortality. Also, there is increased risk of vertical HIV transmission from mother to child with deficiency of vitamin A, and of neurological impairment with vitamin B12. The last five years have been exciting in micronutrient research, and there is promise that some micronutrients may be key factors in maintaining health in HIV immunodeficiency, and in reducing mortality. Selenium appears important in reducing virulence of HIV and slowing disease progression. Vitamin A supplementation in pregnant women with HIV may reduce maternal mortality and improve birth outcomes. Supplementation in children with HIV may accelerate growth. Carotenoid supplementation is being evaluated. Vitamin B12 may slow HIV immune deficiency disease progression, and reverse neurological compromise. Clinical benefit of supplementation with some micronutrients may be measurable in the presence of pre-existing deficiency. Apart from improved general nutrition, the impact of micronutrient supplements on health and their optimal use in HIV infection is controversial because there are so few controlled clinical trials. Further research is needed to elucidate the role of micronutrient deficiencies on the course of HIV infection, and the preventive and therapeutic role of supplementation in its clinical management. Nevertheless, current knowledge supports the use of routine multivitamin and trace element supplementation as adjuvant to conventional antiretroviral drug treatment as a relatively low-cost intervention.

Topics: Antioxidants; Carotenoids; Dietary Supplements; HIV Infections; Humans; Micronutrients; Nutrition Assessment; Nutrition Disorders; Vitamin A; Vitamin B 12

AIDS-associated vacuolar myelopathy (VM) is a common neurologic complication of AIDS. Pathologically, VM is characterized by vacuolization in the lateral and posterior columns of the thoracic spinal cord and has a striking similarity with the myelopathy of vitamin B12 deficiency. In autopsy series, 20% to 55% of patients with AIDS have evidence of spinal cord disease consistent with VM. The myelopathy usually manifests late in the course of HIV infection, with slowly progressive weakness of the lower extremities, gait disorder, sensory abnormalities in the legs, impotence in men, and urinary frequency and urgency. Its course is invariably progressive and leads to severe paralysis of the lower limbs, with loss of the ability to walk and of sphincter control. The differential diagnosis is extensive and includes metabolic, infective, and neoplastic spinal cord diseases. The diagnosis is based on the clinical observation and the exclusion of other causes of myelopathy via serologic, radiographic, and cerebrospinal fluid studies. The pathogenesis of VM is unknown. Attempts to detect HIV in the spinal cord have not yielded significant results, and there is no evidence of a relationship between the presence of HIV and the development of myelopathy. A metabolic disorder of the vitamin B12-dependent transmethylation pathway, induced by HIV or cytokine activation, is considered the possible cause of VM associated with AIDS. There is no known treatment for AIDS myelopathy and there is no evidence that antiretroviral drugs can improve the symptoms or slow the progression of VM. The symptomatic treatment includes antispasticity agents, management of sphincter dysfunction, and physical therapy. Experimental treatments are being tested in clinical trials.

Topics: Diagnosis, Differential; Disease Progression; HIV Infections; Humans; Male; Methylation; Muscular Atrophy, Spinal; Parasympatholytics; Physical Therapy Modalities; Vitamin B 12

Dolutegravir-based antiretroviral therapy (ART) is the preferred antiretroviral treatment for children and adolescents living with HIV. A large surveillance study in Botswana previously raised concerns about an association between pre-conception dolutegravir and neural tube defects. Before these concerns were subsequently resolved, we set up a sub-study to look at the effect of dolutegravir on levels of folate and vitamin B12 in children and adolescents within the randomized ODYSSEY trial, as folate and vitamin B12 are known to play a crucial role in neural tube development.. We conducted the sub-study among Ugandan ODYSSEY participants and compared folate and vitamin B12 between children randomized to dolutegravir-based ART (DTG) and non-dolutegravir-based standard-of-care treatment (SOC). Plasma folate was measured at enrolment and week 4 on stored samples; in addition, plasma and red blood cell (RBC) folate and vitamin B12 were assayed at week ≥96 in prospectively collected samples. RBC mean corpuscular volume (MCV) was measured 24-weekly in all ODYSSEY participants. Samples analysed in the sub-study were collected between September 2016 and October 2020.. A total of 229 children aged ≥6 years were included in the sub-study with median age at trial enrolment of 12.3 (interquartile range [IQR] 9.0, 14.7) years, and CD4 count of 501 (IQR 228, 695); 112 (49%) children were male. Most participants (225/229, 98%) had plasma folate results at enrolment and 214 (93%) children had results available for RBC folate, vitamin B12 and plasma folate at week ≥96. MCV results were analysed on 679 children aged ≥6 years enrolled in ODYSSEY. At week 4, mean plasma folate was significantly higher in the dolutegravir arm than in SOC (difference [DTG-SOC] 1.6 ng/ml, 95% CI 0.8, 2.3; p<0.001), and this difference persisted to week ≥96 (2.7 ng/ml, 95% CI 1.7, 3.7; p<0.001). Mean RBC folate at ≥96 weeks was also higher in the DTG arm (difference 73 ng/ml, 95% CI 3, 143; p = 0.041). There was no difference in the treatment arms for vitamin B12 levels at ≥96 weeks or change in MCV through trial follow-up.. Plasma and RBC folate levels were higher in children and adolescents receiving dolutegravir-based ART than on other ART regimens. Further studies are needed to clarify the mechanisms of these interactions and the clinical implications of increased blood folate levels.

Topics: Adolescent; Child; Erythrocyte Indices; Female; Folic Acid; HIV Infections; Humans; Male; Vitamin B 12

The MAINTAIN study is an on-going RCT comparing high-dose micronutrient and anti-oxidant supplementation versus recommended daily allowance (RDA) vitamins in slowing HIV immune deficiency progression in ART-naïve people with HIV infection.. We planned analysis of the first 127 participants to determine the baseline prevalence of serum micronutrient deficiencies and correlates, as well as tolerance and adherence to study interventions.. Participants receive eight capsules twice daily of 1) high-dose or 2) RDA supplements for two years and are followed-up quarterly for measures of immune deficiency progression, safety and tolerability. Regression analysis was used to identify correlates of micronutrient levels at baseline. Adherence was measured by residual pill count, self-report using the General Treatment Scale (GTS) and short-term recall HIV Adherence Treatment Scale (HATS).. Prior micronutrient supplementation (within 30 days) was 27% at screening and 10% of study population, and was not correlated with baseline micronutrient levels. Low levels were frequent for carotene (24%<1 nmol/L), vitamin D (24%<40 nmol/L) and serum folate (20%<15 nmol/L). The proportion with B12 deficiency (<133 pmol/L) was 2.4%. Lower baseline levels of B12 correlated lower baseline CD4 count (r = 0.21, p = 0.02) with a 21 pmol/L reduction in B12 per 100 cells/µL CD4. Vitamin D levels were higher in men (p<0.001). After a median follow-up of 1.63 years, there were 19 (15%) early withdrawals from the study treatment. Mean treatment adherence using pill count was 88%. Subjective adherence by the GTS was 81% and was moderately but significantly correlated with pill count (r = 0.29, p<0.001). Adherence based on short-term recall (HATS) was >80% in 75% of participants.. Micronutrient levels in asymptomatic HIV+ persons are in keeping with population norms, but micronutrient deficiencies are frequent. Adherence levels are high, and will permit a valid evaluation of treatment effects.. ClinicalTrials.gov NCT00798772.

Topics: Adult; Anti-HIV Agents; Carotenoids; CD4 Lymphocyte Count; Diet; Dietary Supplements; Disease Progression; Female; Folic Acid; HIV Infections; Humans; Male; Micronutrients; Middle Aged; Patient Compliance; Recommended Dietary Allowances; Self Report; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency

Preliminary evidence suggests that improved nutrition early in HIV infection may delay progression to AIDS and delay the initiation or improve the effectiveness of antiretroviral drug therapy. There are few studies that evaluate food-based interventions in drug-naïve, HIV-infected women and their children. Meat provides several nutrients identified as important in maintaining immune function and lean body mass.. To design supplemental meat and soybean biscuits for use in a randomized trial examining the effect of meat in the diet of drug-naïve, HIV-infected rural Kenyan women on changes in weight, lean body mass, morbidity, nutritional status, and activities of daily living of the women and growth and development of their children.. We designed three supplemental biscuits: one with added dried beef another with added soybean flour, and a wheat biscuit to serve as a control biscuit to be used in a randomized feeding intervention in drug-naïve, HIV-infected rural Kenyan women and their children. The nutritional contents of the different types of biscuit were examined and compared.. The three biscuits were isocaloric. Meat biscuits provided more lysine, vitamin B12, and bioavailable zinc. Soybean biscuits provided more total and absorbable iron; however, higher fiber and phytate contents may inhibit nutrient absorption. Data analysis for clinical outcomes of the trial is ongoing.. The "biscuit model" is useful for nutrition supplementation studies because it can be provided in a blinded and randomized fashion, safely and privately in a home under directly observed consumption by a highly stigmatized population. It is well received by adults and children, and the biscuits can be produced locally with available, simple, affordable technology.

Topics: Animals; Child; Child, Preschool; Diet; Dietary Proteins; Dietary Supplements; Female; Glycine max; Health Status; HIV Infections; Humans; Infant; Iron; Kenya; Lysine; Meat; Nutritional Status; Nutritive Value; Rural Population; Triticum; Vitamin B 12; Zinc

The effect of multiple micronutrient supplementation on vitamin B₁₂ and folate has hither to not been reported in African HIV infected children. This paper describes vitamin B₁₂ and folate status of Ugandan HIV infected children aged 1-5 years and reports the effect of multiple micronutrient supplementation on serum vitamin B12 and folate concentrations.. Of 847 children who participated in a multiple micronutrient supplementation trial, 214 were assessed for vitamin B₁₂ and folate concentrations pre and post supplementation. One hundred and four children were randomised to two times the recommended dietary allowance (RDA) of a 14 multiple micronutrient supplement (MMS) and 114 to a 'standard of care' supplement of 6 multivitamins (MV). Serum vitamin B12 was measured by an electrochemiluminescence immunoassay and folate by a competitive protein-binding assay using Modular E (Roche) automatic analyzer. Vitamin B₁₂ concentrations were considered low if less than 221 picomoles per litre (pmol/L) and folate if < 13.4 nanomoles per litre (nmol/L). The Wilcoxon Signed Ranks test was used to measure the difference between pre and post supplementation concentrations.. Vitamin B₁₂ was low in 60/214 (28%) and folate in 62/214 (29.0%) children. In the MMS group, the median concentration (IQR) of vitamin B₁₂ at 6 months was 401.5 (264.3 - 518.8) pmol/L compared to the baseline of 285.5 (216.5 - 371.8) pmol/L, p < 0.001. The median (IQR) folate concentrations increased from 17.3 (13.5-26.6) nmol/L to 27.7 (21.1-33.4) nmol/L, p < 0.001. In the 'standard of care' MV supplemented group, the median concentration (IQR) of vitamin B₁₂ at 6 months was 288.5 (198.8-391.0) pmol/L compared to the baseline of 280.0 (211.5-386.3) pmol/L while the median (IQR) folate concentrations at 6 months were 16.5 (11.7-22.1) nmol/L compared to 15.7 (11.9-22.1) nmol/L at baseline. There was a significant difference in the MMS group in both vitamin B₁₂ and folate concentrations but no difference in the MV group.. Almost a third of the HIV infected Ugandan children aged 1-5 years had low serum concentrations of vitamin B₁₂ and folate. Multiple micronutrient supplementation compared to the 'standard of care' supplement of 6 multivitamins improved the vitamin B12 and folate status of HIV infected children in Uganda.. http://ClinicalTrials.govNCT00122941).

Topics: Child, Preschool; Dietary Supplements; Female; Folic Acid; Follow-Up Studies; HIV Infections; Humans; Immunoassay; Infant; Male; Micronutrients; Nutrition Policy; Prevalence; Uganda; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

A prospective, randomized study was conducted to evaluate the role of vitamin B12 and folinic acid supplementation in preventing zidovudine (ZDV)-induced bone marrow suppression. Seventy-five human immunodeficiency virus (HIV)-infected patients with CD4+ cell counts < 500/mm3 were randomized to receive either ZDV (500 mg daily) alone (group I, n = 38) or in combination with folinic acid (15 mg daily) and intramascular vitamin B12 (1000 micrograms monthly) (group II, n = 37). Finally, 15 patients were excluded from the study (noncompliance 14, death 1); thus, 60 patients (31 in group I and 29 in group II) were eligible for analysis. No significant differences between groups were found at enrollment. During the study, vitamin B12 and folate levels were significantly higher in group II patients; however, no differences in hemoglobin, hematocrit, mean corpuscular volume, and white-cell, neutrophil and platelet counts were observed between groups at 3, 6, 9 and 12 months. Severe hematologic toxicity (neutrophil count < 1000/mm3 and/or hemoglobin < 8 g/dl) occurred in 4 patients assigned to group I and 7 assigned to group II. There was no correlation between vitamin B12 or folate levels and development of myelosuppression. Vitamin B12 and folinic acid supplementation of ZDV therapy does not seem useful in preventing or reducing ZDV-induced myelotoxicity in the overall treated population, although a beneficial effect in certain subgroups of patients cannot be excluded.

Topics: Adult; Anemia; Bone Marrow Diseases; CD4 Lymphocyte Count; Female; Folic Acid; Hematologic Diseases; HIV Infections; Humans; Leucovorin; Male; Neutropenia; Prospective Studies; Vitamin B 12; Zidovudine

Topics: Anemia; Clinical Trials as Topic; Drug Therapy, Combination; HIV Infections; Humans; Vitamin B 12; Zidovudine

Human papillomavirus can cause preinvasive, high-grade squamous intraepithelial lesions (HSILs) as precursors to cancer in the anogenital area, and the microbiome is suggested to be a contributing factor. Men who have sex with men (MSM) living with human immunodeficiency virus (HIV) have a high risk of anal cancer, but current screening strategies for HSIL detection lack specificity. Here, we investigated the anal microbiome to improve HSIL screening. We enrolled participants living with HIV, divided into a discovery (n = 167) and validation cohort (n = 46), and who were predominantly (93.9%) cisgender MSM undergoing HSIL screening with high-resolution anoscopy and anal biopsies. We identified no microbiome composition signatures associated with HSILs, but elevated levels of microbiome-encoded proteins producing succinyl coenzyme A and cobalamin were significantly associated with HSILs in both cohorts. Measurement of these candidate biomarkers alone in anal cytobrushes outperformed anal cytology as a diagnostic indicator for HSILs, increasing the sensitivity from 91.2% to 96.6%, the specificity from 34.1% to 81.8%, and reclassifying 82% of false-positive results as true negatives. We propose that these two microbiome-derived biomarkers may improve the current strategy of anal cancer screening.

Topics: Anus Neoplasms; Biomarkers; Early Detection of Cancer; HIV Infections; Homosexuality, Male; Humans; Male; Papillomaviridae; Sexual and Gender Minorities; Vitamin B 12

Women living with HIV (WLHIV) have a higher prevalence of anemia than women without HIV, possibly related to the effects of HIV and antiretroviral medications.. To estimate the prevalence of anemia in the third trimester of pregnancy and the effect of anemia on preterm births in WLHIV in the longitudinal, US-based Pediatric HIV/AIDS Cohort Study (PHACS).. During the third trimester, we obtained up to three 24-hour dietary recalls to estimate daily intakes of nutrients and measured serum concentrations of iron, vitamin B6, vitamin B12, zinc, folate, ferritin, total iron-binding capacity (TIBC), and high sensitivity C-reactive protein. Third trimester anemia was defined as hemoglobin < 11 g/d and iron-deficiency anemia (IDA) was defined as low ferritin, high TIBC, and low transferrin saturation. A preterm birth was defined as birth at < 37 completed weeks of gestation, regardless of etiology. We fit separate modified Poisson regression models for each outcome (anemia, preterm birth) and each main exposure, adjusted for confounders, and report adjusted prevalence ratios (aPR) and 95% CIs.. Of the 267 WLHIV, 50% were anemic in the third trimester, of whom 43.5% (n = 57/131) had IDA. On average, women with anemia were younger, were more likely to be black, started antiretroviral medications in the second trimester, had a low CD4 count (<200 cells/mm3) early in pregnancy, and were less likely to meet recommended intakes for iron, B6, and folate. The prevalence of anemia was greater in WLHIV with a low CD4 count (aPR = 1.65; 95% CI: 1.20-2.27) and high HIV viral load (>10,000 copies/mL; aPR = 1.38; 95% CI: 1.02-1.87). In total, 16% of women delivered preterm. Anemia was associated with a 2-fold (aPR = 2.04; 95% CI: 1.12-3.71) higher prevalence of preterm births.. Anemia is common in pregnant WLHIV, highlighting the need to address the underlying factors and clinical outcomes of anemia in this population.

Topics: Adult; Anemia; Anemia, Iron-Deficiency; C-Reactive Protein; Female; Ferritins; Folic Acid; HIV; HIV Infections; Humans; Infant, Newborn; Iron; Iron-Binding Proteins; Longitudinal Studies; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Premature Birth; Prevalence; United States; Vitamin B 12; Vitamin B 6; Zinc

To investigate the role of homocysteine in neuronal injury in HIV infection.. Using a cross-sectional design and archived samples, we compared concentrations of plasma homocysteine and cerebrospinal fluid (CSF) neurofilament light protein (NFL), a sensitive marker of neuronal injury, in 83 HIV-1-infected subjects without antiretroviral treatment. We also analyzed plasma vitamin B12, serum folate, CSF, and plasma HIV RNA, the immune activation marker neopterin in CSF and serum, and albumin ratio as a marker of blood-brain barrier integrity. Twenty-two subjects provided a second sample median of 12.5 months after antiretroviral treatment initiation.. A significant correlation was found between plasma homocysteine and CSF NFL concentrations in untreated individuals (r = 0.52, p < 0.0001). As expected, there was a significant inverse correlation between homocysteine and B12 (r = -0.41, p < 0.001) and folate (r = -0.40, p = < 0.001) levels. In a multiple linear regression analysis homocysteine stood out as an independent predictor of CSF NFL in HIV-1-infected individuals. The correlation of plasma homocysteine and CSF NFL was also present in the group receiving antiretroviral therapy (r = 0.51, p = 0.016).. A correlation between plasma homocysteine and axonal injury, as measured by CSF NFL, was found in both untreated and treated HIV. While this study is not able to prove a causal link, homocysteine and functional B12/folate deficiency appear to play a role in neural injury in HIV-infected individuals.

Topics: Adult; Antiretroviral Therapy, Highly Active; Female; Folic Acid; HIV Infections; Homocysteine; Humans; Male; Middle Aged; Neurofilament Proteins; Neurons; Vitamin B 12

Haematological complications are common in HIV patients and it can be because of infection per se or secondary to opportunistic infections and antiretroviral therapy. Evan's syndrome, i.e., autoimmune haemolytic anaemia with thrombocytopenia is however a very rare occurrence inspite of high direct Coomb's test positivity in HIV patients. We are reporting one such rare case of Evan's syndrome in HIV patient probably first such reported case from India.

Topics: Adult; AIDS-Related Opportunistic Infections; Anemia, Hemolytic, Autoimmune; Antiretroviral Therapy, Highly Active; Erythrocyte Transfusion; Glucocorticoids; HIV Infections; Humans; Male; Prednisolone; Thrombocytopenia; Treatment Outcome; Vitamin B 12; Vitamin B Complex

A better understanding of the relationship of homocysteine with cardiovascular risk factors is needed. The objectives of this study were to assess the serum level of homocysteine in HIV-infected patients and to analyse the possible association of increased levels of the amino acid with cardiovascular risk factors, demographic and clinical characteristics of participants.. Cross-sectional study carried out as a supplementary task to the usual controls necessary in HIV-infected patients in the outpatient clinic of the Hospital General of Castellon, Spain. For two consecutive visits the demographic, clinical and HIV-related characteristics and blood analyses results were obtained for each participant. Homocysteine serum level was documented and the possible association of the amino acid with all the other study variables was assessed with a multiple linear regression analysis.. A total of 145 patients were included. The mean homocysteine serum level of all participants was 11.9 ± 5.9 µmol/L. A total of 54 patients (37%) presented homocysteine serum levels higher than the upper limit of normal. An association was found between higher homocysteine serum level and the following variables: family history of early coronary disease (P = 0.027), sexual HIV risk behaviour (P = 0.016), hepatitis C virus co-infection (P = 0.002), higher height (P = 0.002), higher diastolic blood pressure (P = 0.049), lower serum level of folic acid (P <0.001), and lower serum level of vitamin B12 (P = <0.001).. In the HIV population, increased homocysteine serum level is associated with sexual risk behaviour and hepatitis C virus coinfection.

Topics: Adult; Cardiovascular Diseases; Coinfection; Cross-Sectional Studies; Female; Folic Acid; Hepacivirus; Hepatitis C; HIV; HIV Infections; Homocysteine; Humans; Male; Risk Factors; Risk-Taking; Sexual Behavior; Vitamin B 12

Vitamin A supplementation starting at 6 months of age is an important child survival intervention; however, not much is known about the association between vitamin A status before 6 months and mortality among children born to HIV-infected women. Plasma concentrations of vitamins A and B-12 were available at 6 weeks of age (n = 576 and 529, respectively) for children born to HIV-infected women and they were followed up for morbidity and survival status until 24 months after birth. Children in the highest quartile of vitamin A had a 49% lower risk of death by 24 months of age compared to the lowest quartile (HR: 0.51, 95% CI: 0.29-0.90; P-value for trend = 0.01). Higher vitamin A levels were protective in the sub-groups of HIV-infected and un-infected children but this was statistically significant only in the HIV-uninfected subgroup. Higher vitamin A concentrations in plasma are protective against mortality in children born to HIV-infected women.

Topics: Child, Preschool; Dietary Supplements; Double-Blind Method; Female; Follow-Up Studies; HIV Infections; HIV-1; Humans; Infant; Infant Mortality; Infectious Disease Transmission, Vertical; Male; Morbidity; Pregnancy; Pregnancy Complications, Infectious; Proportional Hazards Models; Prospective Studies; Randomized Controlled Trials as Topic; Risk Factors; Survival Analysis; Tanzania; Vitamin A; Vitamin B 12; Vitamin B Complex; Vitamins

To analyze the effect of antiretroviral therapy on homocysteine levels in HIV-1-infected patients.. Observational, prospective study of patients with AIDS.. We included patients with HIV-1 infection naive for antiretroviral drugs. Before and after 6 months of treatment, we evaluated fasting and postoral methionine load plasma homocysteine, serum vitamins B6 and B12, and intraerythrocyte folate levels.. We studied 69 patients who began therapy for a 6-month period. Fasting and postoral methionine load plasma homocysteine levels increased significantly after 6 months of antiretroviral therapy with respect to basal values (P < 0.001). Fasting hyperhomocysteinemia was present in 7.3% of patients before treatment and in 89.9% after 6 months of therapy (P = 0.0001). Postoral methionine load hyperhomocysteinemia was found in 4.5% of subjects before therapy vs. 98.5% at the end of study period (P = 0.001). These results were not associated with folate or vitamins B6 or B12 levels.. In patients with HIV-1 infection, fasting and postoral methionine load plasma homocysteine levels increased after 6 months of antiretroviral treatment. Nutritional abnormalities were not responsible for hyperhomocysteinemia, suggesting that enzymatic disturbances in the metabolic pathways of homocysteine may occur.

Topics: Adult; Aged; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Erythrocytes; Female; Folic Acid; HIV Infections; HIV-1; Homocysteine; Humans; Male; Metabolic Diseases; Middle Aged; Plasma; Prospective Studies; Vitamin B 12; Vitamin B 6

Neurologic and hematologic abnormalities are common in HIV-infected children and may be related to concomitant deficiencies in serum B12 and folate, which are highly prevalent in HIV-infected adults. We sought to determine the prevalence of B12 and folate deficiencies in HIV-infected children in the United States.. Cross-sectional information on demographics, folate and B12 levels, hematological parameters, concurrent CD4%, HIV-viral load and antiretroviral regimens were abstracted from the medical records of 103 vertically infected children followed in an outpatient pediatric HIV clinic in the Bronx, during 2001-2002.. Mean age was 10 years (+/-4.4 years), 46% were male, 53% African-American and 46% Hispanic. Nineteen percent had significant immunologic suppression and 18 children had AIDS. All were receiving combination antiretroviral therapy and 66% were on a protease inhibitor-based regimen. Sixteen were taking cotrimoxazole prophylaxis. None were taking multivitamins or manifested clinical evidence of gastrointestinal malabsorption. All patients had serum folate or B12 levels within or above the normal range. Children with elevated B12 were significantly more likely to be younger (P = 0.0002) and have higher mean folate levels (P = 0.0004) compared with children with normal serum B12. In a multivariate logistic regression analysis, factors independently associated with elevated levels of vitamin B12 included: elevated serum folate [odds ratio (OR): 3.2; P = 0.01], nonnucleoside reverse transcriptase inhibitor use (OR: 0.38; P = 0.05) and female sex (OR: 0.67; P = 0.42). Folate and B12 deficiencies are uncommon in HIV-infected children in the United States, suggesting that routine supplementation with B12 and folate is not indicated without confirmation of micronutrient deficiency.

Topics: Adolescent; Anti-HIV Agents; CD4 Lymphocyte Count; Child; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; HIV Infections; HIV-1; Humans; Infectious Disease Transmission, Vertical; Male; Retrospective Studies; Viral Load; Vitamin B 12; Vitamin B 12 Deficiency

We conducted a study to determine the role of iron, folate and vitamin B12 in HIV-infected patients with anaemia attending a tertiary-care hospital in southern Brazil. Low serum folate levels were found in 14 (41%) HIV-infected patients; parameters of iron deficiency such as low transferring saturation index and ferritin in 10 (30%); and combined folate and iron deficiency in five (14%). Vitamin B12 deficiency was found in only two (6%) patients who presented with mean corpuscular volumes within the normal range. Our study has shown that folate and iron deficiency were frequently detected in HIV-infected patients at our institution, and should be considered in the differential diagnosis of anaemia in all HIV-infected patients independent of their HIV stage of progression.

Topics: Adult; Anemia; Brazil; Cross-Sectional Studies; Erythrocyte Indices; Female; Folic Acid; HIV Infections; HIV-1; Hospitals, Teaching; Humans; Iron; Male; Middle Aged; Pregnancy; Surveys and Questionnaires; Vitamin B 12; Young Adult

A retrospective review was conducted on serum vitamin B12 levels in an HIV-infected outpatient cohort, many of whom received antiretroviral therapy. B12 levels were obtained at most staging visits (every six months) and when clinically indicated. For each serum B12 level, laboratory values and clinical symptoms were recorded. Thirty-two patients (32/251 or 13%) had at least one low B12 level (<211pg/mL) during the course of their HIV infection. Within two years of their initial HIV presentation, 6/57 patients had a low serum B12. Using multiple linear regression analysis, a higher serum B12 level was significantly associated with higher folate levels, African-American race, and lower mean corpuscular volume. B12 levels increased significantly after initiating antiretroviral therapy (416 vs 535 pg/mL, P=0.04). In conclusion, low serum B12 levels occur commonly among HIV-infected patients, even at early stages without overt symptoms of B12 deficiency. Antiretroviral therapy may increase serum B12 levels.

Topics: Adult; Ambulatory Care; Anti-Retroviral Agents; Ethnicity; Female; HIV Infections; Hospitals, Military; Humans; Male; Medical Records; Military Personnel; Retrospective Studies; Risk Factors; Texas; Vitamin B 12; Vitamin B 12 Deficiency

Before the advent of highly active antiretroviral therapy (HAART), 20% and 10% of HIV-infected patients had low vitamin B-12 and red blood cell folate (RBCF) concentrations, respectively. However, few patients had real vitamin B-12 deficiency.. We evaluated the prevalence of low vitamin B-12 and RBCF concentrations in HIV-infected patients receiving HAART and the usefulness of serum homocysteine (sHcy) for differentiating patients with deficiency from those with harmlessly low vitamin B-12.. The prevalence of low vitamin B-12 and RBCF was evaluated in 126 HIV-infected patients receiving HAART. Moreover, sHcy concentrations were evaluated in 40 HIV-infected patients with low vitamin B-12 and in 37 HIV-infected patients with low RBCF and were compared with those in 128 HIV-infected patients with normal vitamin B-12 and RBCF. sHcy was used to monitor treatment with vitamin B-12 and folic acid in 28 patients (24 with low vitamin B-12 and RBCF and 4 with hyperhomocysteinemia but normal vitamin B-12 and RBCF).. The prevalence of low vitamin B-12 was significantly lower in patients receiving HAART than in previously studied patients who did not receive HAART (8.7% compared with 27%). Nine of the 40 patients (22.5%) with low vitamin B-12 (< or = 200 pmol/L) had hyperhomocysteinemia (> 17.5 micromol homocysteine/L). Nineteen (51.4%) of the 37 patients with low RBCF (< or = 580 nmol/L, percentile 10) had hyperhomocysteinemia. Among the 9 patients with an RBCF concentration < or = 450 nmol/L (percentile 2.5), all had hyperhomocysteinemia. The treatment with vitamin B-12 and folic acid normalized sHcy concentrations.. The prevalence of low vitamin B-12 decreased after the introduction of HAART. The study of sHcy is useful for detecting HIV-infected patients with low vitamin B-12 and real deficiency.

Topics: Adult; Antiretroviral Therapy, Highly Active; Diagnosis, Differential; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; HIV Infections; Homocysteine; Humans; Hyperhomocysteinemia; Male; Nutrition Assessment; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency

The dietary intake of micronutrients and serum micronutrient status have been topics of concern in relation to human immunodeficiency virus (HIV) progression. Most data, however, were collected prior to the introduction of protease inhibitors (PIs). We analyzed dietary intake and serum values of vitamin B(12), including the effect of PIs, in a cohort of persons with HIV infection. During intervals with no PI use, each 1 microg/day increase in B(12) intake was associated with a 1.06 pg/mL increase in serum B(12) levels. However, during intervals with PI use, each 1 microg/day increase in intake was associated with only a 0.12 increase in serum B(12) levels. Adequate serum B(12) levels (>350 pg/mL) cannot be assumed even in the presence of PIs, and dietary supplementation may not be adequate to significantly increase serum B(12) levels. Serum B(12) levels should be determined yearly in persons with HIV infection, regardless of whether they are receiving PI treatment.

Topics: Adult; Cohort Studies; Female; HIV Infections; HIV Protease Inhibitors; Humans; Male; Nutrition Assessment; Vitamin B 12

Topics: Antiretroviral Therapy, Highly Active; HIV Infections; Humans; Vitamin B 12

Weak hyperhomocysteinemia is a risk factor for the development of atherothrombotic vascular complication. Their plasma levels are affected by nutritional and pharmacologic factors, tobacco, certain metabolic state and gender. In HIV+ patients, the wasting syndrome or chronic diarrheas could affect the levels of homocysteine (Hcy), as well as some adverse effects of the new antiretroviral therapies (lipodystrophy syndrome: insulin resistance and/or dislypemia). The levels of Hcy were evaluated in 53 HIV+ patients without any treatment and in 75 HIV+ under treatment with and without metabolic disturbances (n = 43; n = 32, respectively).. 32 HIV negative individuals. We looked for association with folic acid, vitamin B12, lipids, insulin resistance status, activation platelets (soluble P-selectin) and endothelial injury (soluble trombomodulin) markers; and also their relation with tobacco, disease status and kind of treatment. There were no statistically significant differences in the mean levels of vitamin B12, Hcy, P-selectin and insulin resistance status between the control group and the HIV+; 16.4% of the 128 HIV+ patients had Hcy > or = 15 mumol/L and the control group had 12.9% (p = 0.617). The levels of Hcy correlated with the levels of folic acid (Rho = -0.314, p < 0.01) and age (Rho = 0.277, p < 0.01) among HIV+. There were no statistically significant differences in the levels of Hcy neither between smokers and non smokers (p = 0.452) nor between HIV+ AIDS or HIV+ no AIDS (p = 0.774) nor with the use of certain antiretrovirals (p = 0.801). The hyperhomocysteinemia (a well known atherothrombotic risk factor) is not frequently associated with HIV infected patients. The levels of Hcy would not seem to be influenced either by the HIV condition or by the antiretroviral treatments or their adverse effects.

Topics: Adult; Anti-HIV Agents; Arteriosclerosis; Biomarkers; Case-Control Studies; Female; Folic Acid; HIV Infections; Homocysteine; Humans; Hyperhomocysteinemia; Insulin Resistance; Male; P-Selectin; Risk Factors; Smoking; Vitamin B 12

Topics: Adult; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Female; HIV Infections; Humans; Male; Viral Load; Vitamin B 12

White matter vacuolization of the spinal cord is common in patients with AIDS and may lead to clinical manifestations of myelopathy. The pathogenesis of AIDS-associated myelopathy (AM) is unknown and may be related to metabolic abnormalities rather than to direct HIV infection. The striking pathologic similarity between AM and the vacuolar myelopathy associated with vitamin B(12) deficiency suggests that abnormal metabolism of the B(12)-dependent transmethylation pathway may be important in the pathogenesis of AM.. The authors compared S-adenosyl-methionine (SAM), methionine, homocysteine, and glutathione in serum and CSF of 15 patients with AM vs. 13 HIV-infected controls without myelopathy (HWM). They also compared the results with a non-HIV--infected reference population (NC). All patients had normal B(12), folate, and methylmalonic acid levels.. There was a decrease in CSF SAM in the AM group compared with the HWM group (p < 0.0001) and the NC group (p < 0.0001). CSF SAM in the HWM group was also lower than that in the NC group (p = 0.015). Serum methionine was also reduced in serum of the myelopathic group compared with the NC group (p = 0.006).. AM is associated with an abnormality of the vitamin B(12)-dependent transmethylation pathway.

Topics: Adult; Female; Glutathione; HIV Infections; Homocysteine; Humans; Male; Methionine; Methylation; Middle Aged; S-Adenosylmethionine; Spinal Cord Diseases; Vitamin B 12

Too much homocysteine in the blood is associated with an increased risk of heart and circulatory diseases. Blood tests can detect the problem, and it can often be treated with nutrition and suplements. Here is some background on this potential approach to reducing cardiovascular risk.

Topics: Diet; Folic Acid; Heart Diseases; HIV Infections; Homocysteine; Humans; Vitamin B 12

Topics: Adult; Avitaminosis; Child; Diagnosis, Differential; Female; Folic Acid; Folic Acid Deficiency; HIV Infections; Homocysteine; Humans; Hyperhomocysteinemia; Infant; Infant, Newborn; Male; Methylmalonic Acid; Pediatrics; Pregnancy; Vitamin B 12

Our aim was the detection of possible deficiencies of folate and cobalamin by the measurement of plasma total homocysteine (tHcy) in 69 human immunodeficiency virus (HIV) -infected children on antiretroviral treatment. We studied the relationship of these vitamins and methionine with tHcy values.. Plasma tHcy was determined by high-performance liquid chromatography with fluorescence detection, folate and cobalamin by competitive protein-binding chemiluminescence, and methionine by ion exchange chromatography.. Significant differences were observed between tHcy concentrations in the HIV-infected patients and the reference values for children of similar ages (P < 0.0001). Folate values were significantly lower in HIV-infected children compared with our reference paediatric population (P < 0.0001), but cobalamin concentrations were similar between patients and reference values. A significantly negative correlation was found between tHcy and folate (r = - 0.596; P < 0.0001), and a significantly positive correlation between folate and the methionine : tHcy ratio (r = 0.501; P < 0.0001). Plasma tHcy was significantly higher (P = 0.008), while folate values and methionine : tHcy ratios were significantly lower (P = 0.007 and P = 0.042), in patients on protease inhibitor treatment than in patients on other antiretroviral therapies.. The hyperhomocysteinaemia and low methionine : tHcy ratios observed in our group of HIV-infected children are probably a consequence of the low folate values, which interfere in the remethylation of homocysteine to methionine. Patients on protease inhibitor treatment showed significantly higher plasma tHcy concentrations, and lower folate values and methionine : tHcy ratios, compared with patients on other antiretroviral therapies. Hyperhomocysteinaemia is associated with the risk of premature stroke, which may have adverse consequences in the evolution of disease.

Topics: Adolescent; Anti-HIV Agents; Child; Child, Preschool; Female; Folic Acid Deficiency; HIV Infections; HIV-1; Homocysteine; Humans; Hyperhomocysteinemia; Infant; Male; Methionine; Statistics as Topic; Vitamin B 12

The eight most important supplements for people on HAART are listed. Multi-vitamins, L-glutamine, alpha lipoic acid, and milk thistle are among the supplements discussed. Recommended doses are provided for some supplements.

Topics: Acetylcysteine; Anti-HIV Agents; Antioxidants; Dietary Supplements; Drug Therapy, Combination; Glutamine; HIV Infections; Humans; Plants, Medicinal; Silybum marianum; Thioctic Acid; Vitamin B 12; Vitamins

New data are showing a correlation between low vitamin B12 levels and cognitive impairment. Further, cognitive changes observed were in both early and late stages of HIV infection, even when abnormal blood levels are not yet apparent. Results suggest early B12 clinical intervention as a possible prevention of such early-onset cognitive changes. Dosage levels can be as high as 1,000 micrograms in nasal gel or injection, administered two to seven times per week and combined with folic acid (5,000 to 10,000 micrograms per day).

Topics: Cognition Disorders; Cohort Studies; HIV Infections; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

Oxidative stress has been suggested to be an important factor in the immunopathogenesis of human immunodeficiency virus (HIV) infection. Reduced plasma thiols may lead to production of reactive oxygen species, thus contributing to the oxidative stress. We quantified the total, reduced, and protein-bound forms of the thiols homocysteine, cysteine, cysteinylglycine, and methionine in plasma from 21 HIV-infected patients and 15 healthy control subjects and compared the results with clinical and immunologic indexes. The HIV-infected patients had significantly higher concentrations of reduced homocysteine in plasma compared with control subjects. No significant differences in reduced homocysteine concentrations were noted when asymptomatic and symptomatic HIV-infected patients were compared, and we did not find any relation between reduced homocysteine concentrations and other markers of immunodeficiency. The HIV-infected patients had normal total homocysteine concentrations. The reduced cysteinylglycine concentration tended to be elevated in the patient group. No differences between HIV-infected patients and control subjects were found for reduced or total cysteine. Compared with control subjects, the HIV-infected patients had lower concentrations of methionine in plasma, and a significant correlation was found between low concentrations of methionine and low CD4+ lymphocyte counts in blood. Elevated concentrations of reduced homocysteine could possibly contribute to formation of reactive oxygen species, leading to accelerated immunologic deterioration and increased HIV replication.

Topics: Adult; CD4 Lymphocyte Count; Cysteine; Dipeptides; Female; Folic Acid; HIV Antibodies; HIV Infections; HIV-1; Homocysteine; Humans; Interleukin-2; Lymphocytes; Male; Methionine; Middle Aged; Oxidation-Reduction; Oxidative Stress; Vitamin B 12

The deoxyuridine suppression test (dUST) was used to evaluate human immunodeficiency virus type 1 positive (HIV-1) patients with low serum levels of vitamin B12 and/or low red cell folate and to assess any possible interferences of azydothymidine (AZT) in this test. The dUST was studied in 29 HIV-1 positive patients, 18 without low serum vitamin B12 or low red cell folate and 11 with low serum vitamin B12 (6 patients), low red cell folate (4 patients) and 1 case with both. The role of AZT was studied using different concentrations (0.2, 2.5 and 10 microM/ml) in 2 groups: 1 group of 5 patients with vitamin B12 and/or folate deficiency and another group consisting of 13 healthy subjects. Methotrexate (MTX)(50 micrograms/ml) was added to induce a folate megaloblastic pattern in the latter group. Results of the dUST in the HIV-1 group without low levels of serum vitamin B12 fell within the health-related reference interval values. A vitamin B12 deficiency was only detected in 1 case in the HIV-1 group with low serum vitamin B12, although a folate deficiency pattern was observed in the 4 patients with low red cell folate. In the healthy subjects AZT induced a dose-dependent decrease of the MTX-induced folate megaloblastic pattern. The pattern was also observed in the group of patients with vitamin B12 or folate deficiency, although AZT did not entirely interfere with the dUST. The effect of AZT on the dUST was attributed to a decrease in the incorporation of the isotope in the absence of deoxyuridine. The dUST is useful in differentiating vitamin B12 deficient patients from HIV-1 infected patients with low levels of serum vitamin B12.

Topics: Anemia, Megaloblastic; Bone Marrow; Cells, Cultured; Deoxyuridine; Folic Acid; HIV Infections; HIV-1; Humans; Intestinal Absorption; Methotrexate; Vitamin B 12; Vitamin B 12 Deficiency; Zidovudine

The mechanisms underlying acid secretory failure in patients with HIV disease are unknown. We evaluated, in a series of preliminary studies, changes associated with parietal cell structure and function in early and late HIV disease, in an attempt to elucidate possible underlying mechanisms. Gastric acid and intrinsic factor secretion, vitamin B12 absorption, and light and electron microscopic evaluation of gastric mucosa were evaluated in patients with early and late HIV infection (AIDS) and compared to non-HIV-infected controls. Immunolocalization of HIV-related antigens in gastric mucosa was also examined. Fasting gastric juice pH and intrinsic factor (IF) concentration in AIDS and HIV infected subjects were significantly different from controls (P = 0.012 and P = 0.025, respectively for pH, and 0.029 and 0.035 for IF; ANOVA LSD test). By contrast, maximal acid output (MAO) was significantly lower in AIDS, but not HIV-infected subjects (P = 0.043 and P = 0.322, respectively). Similarly, Schilling test phases 1 and 2 results were significantly lower in AIDS, but not HIV-infected subjects. Varying degrees of vacuolar degeneration of parietal cells were seen on light microscopy. On electron microscopy (EM), tubulovesicles were reduced and intracellular canaliculi dilated with striking loss of microvilli. Immunofluorescent staining with antibodies to gp120, gp41, p24, and p17 demonstrated positive punctate signals in the cytoplasm of gastric glands, which includes parietal cells. Immunogold EM with anti-gp120, localized predominantly to the microvilli of intracellular canaliculi in parietal cells. Abnormal secretory function of parietal cells occurs early in HIV disease, affects acid as well as intrinsic factor secretion, and is associated with morphological changes in the acid secretory apparatus.

Topics: Acquired Immunodeficiency Syndrome; Adult; Fluorescent Antibody Technique; Gastric Juice; Gastric Mucosa; HIV Antigens; HIV Enteropathy; HIV Infections; Humans; Intestinal Absorption; Intrinsic Factor; Lymphocytes; Male; Middle Aged; Parietal Cells, Gastric; Vitamin B 12

Various cobalamins act as important enzyme cofactors and modulate cellular function. We investigated cobalamins for their abilities to modify productive human immunodeficiency virus-1 (HIV-1) infection of hematopoietic cells in vitro. We show that hydroxocobalamin (OH-Cbl), methylcobalamin (Me-Cbl), and adenosylcobalamin Ado-Cbl (Ado-Cbl) inhibit HIV-1 infection of normal human blood monocytes and lymphocytes. The inhibitory effects were noted when analyzing the monocytotropic strains HIV-1-BaL and HIV-1-ADA as well as the lymphocytotropic strain HIV-1-LAI. Cobalamins did not modify binding of gp120 to CD4 or block early steps in viral life cycle, inhibit reverse transcriptase, inhibit induction of HIV-1 expression from cells with established or latent infection, or modify monocyte interferon-alpha production. Because of the ability to achieve high blood and tissue levels of cobalamins in vivo and the general lack of toxicity, cobalamins should be considered as potentially useful agents for the treatment of HIV-1 infection.

Topics: Cells, Cultured; HIV Infections; HIV-1; Humans; In Vitro Techniques; Lymphocytes; Monocytes; Virus Replication; Vitamin B 12

To determine whether information processing speed is influenced by change in plasma cobalamin status in human immunodeficiency virus type 1 disease.. A longitudinal study, using autoregression, to evaluate the relationship between plasma cobalamin status and change in information processing speed assessed by Posner Letter Matching, Sternberg Short-Term Memory Search, Figure Visual Scanning and Discrimination of Pictures, and continuous paired associates learning tasks.. University of Miami (Fla) School of Medicine from fall 1987 through summer 1991.. Eighty-four human immunodeficiency virus type 1-infected homosexual men aged 20 to 55 years. None of the subjects displayed acquired immunodeficiency syndrome-defining symptoms at baseline; over the course of the study, 9.5% progressed to acquired immunodeficiency syndrome.. Biochemical measurement of plasma cobalamin; performance on information processing speed tasks.. Significant improvement in the Posner Letter Matching NI-PI (Name Identity minus Physical Identity) differential was associated with becoming cobalamin adequate or remaining adequate. Becoming cobalamin deficient, in contrast, was associated with a significant decline in the speed of accessing overlearned name codes.. Normalization of plasma cobalamin inadequacy in human immunodeficiency virus type 1 disease may provide significant improvement in the speed of retrieving overlearned information from long-term memory.

Topics: Adult; HIV Infections; Humans; Longitudinal Studies; Male; Mental Processes; Middle Aged; Neuropsychological Tests; Vitamin B 12

Deficiency of vitamin B12 is commonly reported in HIV-infected patients. We measured vitamin B12 levels in 36 HIV-infected patients with chronic diarrhea (> 3 stools/day for six weeks or more). Eight patients had an identifiable cause of diarrhea. Vitamin B12 levels were low in 39%. Sixteen of these patients were selected to undergo further testing, eight patients with low levels of vitamin B12 and eight with normal B12 levels. These 16 patients had both a stage II Schilling test and measurement of multiple serum D-xylose concentrations performed after both oral and intravenous doses of D-xylose. Integrated areas under the curves (AUC) for D-xylose concentration versus time were calculated for intravenous and oral doses, and D-xylose bioavailability was determined. Stage II Schilling tests were abnormal in 11 patients, (69%). D-Xylose bioavailability correlated closely with vitamin B12 absorption (r = 0.648, P < 0.01). Comparisons of mean values for CD4 count, serum albumin, Karnovsky score, six-month weight loss, 1-hr serum D-xylose levels and MCV failed to reveal a significant difference between those with and without abnormal serum vitamin B12 levels. These data indicate that below-normal levels of vitamin B12 are highly prevalent in HIV-infected patients with chronic diarrhea. Malabsorption of vitamin B12 occurs in the setting of an enteropathic process effecting both the proximal and distal small bowel. Since no risk factors for vitamin B12 deficiency could be identified, screening for vitamin B12 deficiency in HIV-infected patients with chronic diarrhea is strongly recommended.

Topics: Chronic Disease; Diarrhea; HIV Infections; HIV-1; Humans; Intestinal Absorption; Linear Models; Malabsorption Syndromes; Male; Prevalence; Schilling Test; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency; Xylose

Vitamin B12 and folate status were determined in 35 male HIV seropositive patients. Of these, 16 were asymptomatic (CDC II/III) and 19 were symptomatic (CDC IV) according to the Centre for Disease Control (CDC) Classification. Deviations from normal values for serum B12, serum folate and red cell folate were not a common finding in this sample of patients. No patient had low serum B12. One CDC IV patient and two CDC II/III patients were found to have raised serum B12. Dietary intake of vitamin B12 was well above the Reference Nutrient Intake for all patients. Three patients displayed low folate values (one CDC IV patient had low serum folate, one had low red cell folate and one CDC II/III patient had both). No patient displayed elevated serum or red cell folate. Only 56% of the CDC II/III and 36% of the CDC IV group were meeting the Lower Reference Nutrient Intake for folate. The only significant difference between the CDC II/III group and the CDC IV group was a lower red cell folate (although within the normal laboratory range) in the CDC IV group. There was no significant difference in dietary intake and haematological status between the drug users and the homosexuals.

Topics: Diet Records; Energy Intake; Erythrocytes; Folic Acid; HIV Infections; HIV Seropositivity; Homosexuality; Humans; Male; Reference Values; Substance Abuse, Intravenous; Vitamin B 12

Vitamin B12 deficiency may result in a number of neurological and neuropsychiatric disorders. Patients with human immunodeficiency virus type 1 (HIV-1) infection may have a high rate of vitamin B12 deficiency and nervous system disease. Vitamin B12 deficiency may contribute to neurological disease in HIV-1-infected individuals.. To evaluate the possible contribution of vitamin B12 deficiency to neurological disease in HIV-1-infected individuals.. Comparison of serum vitamin B12 levels with neurological, neuropsychological, and mood state abnormalities in 153 HIV-1-positive subjects and 57 high-risk seronegative controls. A subgroup of 67 subjects underwent additional extensive clinical neurophysiological, cerebrospinal fluid, and magnetic resonance imaging evaluations.. No statistically significant relationships were noted between vitamin B12 levels and abnormalities on any of the measures examined.. This study does not indicate an important role for vitamin B12 deficiency in the neurological disease of HIV-1 infection.

Topics: Adult; Female; HIV Infections; HIV-1; Humans; Male; Nervous System Diseases; Neuropsychological Tests; Vitamin B 12; Vitamin B 12 Deficiency

The replication of human immunodeficiency virus (HIV) may be modulated in part by host factors such as DNA methylation. Hypermethylation of the HIV provirus may suppress viral replication and play a role in the establishment of latency. HIV seropositive individuals have decreased levels of metabolites involved in methylation. It is proposed that metabolites such as S-adenosylmethionine (SAM), methylcobalamin and methyltetrahydrofolate be explored as potential therapeutic agents in HIV infected individuals.

Topics: Acquired Immunodeficiency Syndrome; DNA, Viral; HIV; HIV Infections; HIV Seropositivity; Humans; Methylation; Proviruses; S-Adenosylmethionine; Tetrahydrofolates; Virus Replication; Vitamin B 12

Studies of cognitive function in subjects with human immunodeficiency virus type 1 (HIV-1) infection who remain relatively asymptomatic (ie, Centers for Disease Control stages II and III) have provided widely variable estimates of cognitive impairment. In view of the finding that approximately 25% of asymptomatic HIV-1-infected subjects demonstrate either marginal or overt vitamin B12 deficiency, we have investigated plasma vitamin B12 status as a potential cofactor in studies of HIV-1-related cognitive impairment. When cognition was assessed in asymptomatic (Centers for Disease Control stages II and III) HIV-1-infected participants taking into consideration vitamin B12 status, those subjects with low plasma vitamin B12 levels (less than 180 pmol/L) performed more poorly than did those with normal (greater than or equal to 180 pmol/L) vitamin B12 status on specific measures of information processing speed and visuospatial problem-solving skills. These findings suggest that concurrent vitamin B12 deficiency may be a cofactor in subtle cognitive changes observed in the asymptomatic stages of HIV-1 infection. These differences in prevalence of low plasma vitamin B12 levels may help to explain differences among studies in the proportion of HIV-1-infected subjects showing cognitive impairment.

Topics: Adult; Cognition Disorders; HIV Infections; HIV-1; Humans; Male; Neuropsychological Tests; Space Perception; Visual Perception; Vitamin B 12; Vitamin B 12 Deficiency

P-Cobalamins have been reported to be decreased in patients with HIV infection. Because of this, we found it of interest to examine both cobalamin-saturated binding proteins (holo-transcobalamin, holo-TC and holo-haptocorrin, holo-HC) and cobalamin unsaturated binding proteins (apo-transcobalamin, apo-TC and apo-haptocorrin, apo-HC). The results are given as range and (median). Eighteen male HIV-infected patients with plasma cobalamins below 200 pmol/l were studied. We found low concentrations of holo-TC (37-88 (47.5) pmol/l) and holo-HC (64-184 (135.5) pmol/l). The concentration of apo-TC and apo-HC was increased (480-1730 (1025) pmol/l; 70-800 (235) pmol/l). It is concluded that, in HIV-infected patients, low plasma cobalamin does not reflect a low concentration of transcobalamin or haptocorrin. In 20 HIV-infected patients and 31 patients with malignant haematological diseases, the TC isopeptide patterns were determined. In the HIV group, an increased frequency of TC isopeptide X was found and the overall distribution of TC isopeptides was significantly different from the reference population (p less than 0.05). There was no difference between the group of patients with malignant haematological diseases and the reference group.

Topics: Adult; Chromatography, Gel; HIV Infections; Humans; Isoelectric Focusing; Male; Middle Aged; Transcobalamins; Vitamin B 12

An increased prevalence of vitamin B12 deficiency has been reported in patients infected by the human immunodeficiency virus (HIV). We report an unexpectedly high prevalence (20%) of such abnormal vitamin B12 metabolism in a population of HIV-infected patients referred for neurological evaluation. This abnormality was associated with both peripheral neuropathy and myelopathy. A majority of those treated with cyanocobalamin had a therapeutic response. Selected neuropathological results suggest a relationship between vitamin B12 deficiency and vacuolar myelopathy. Vitamin B12 deficiency may be a frequent and treatable cause of neurological dysfunction in patients with HIV infection.

Topics: HIV Infections; Humans; Nervous System Diseases; Neurologic Examination; Parenteral Nutrition; Peripheral Nervous System Diseases; Spinal Cord; Spinal Cord Diseases; Vitamin B 12

A prospective study of 60 consecutively admitted patients with HIV infection was performed to document the prevalence, etiology and manifestations of low serum vitamin B-12 in such patients. Low serum B-12 levels were found in 10 patients (16.7%). In 6, vitamin B-12 absorption was impaired and hog intrinsic factor addition did not improve it. Patients with low vitamin B-12 levels showed lower hemoglobin, leukocytes, lymphocytes, CD4 lymphocytes and CD4/CD8 lymphocyte ratio than HIV patients with physiological serum vitamin B-12 levels. However, bone marrow megaloblastosis was found in only 3 low vitamin B-12 patients and the deoxyuridine suppression test was pathological in only 1 case. In 7 patients, parenteral treatment was begun with variable response despite serum vitamin B-12 correction. In conclusion, low serum vitamin B-12 is often found in HIV-infected patients and it could be related to malabsorption, but clear megaloblastic abnormalities and treatment response could not be demonstrated. A decreased concentration of the serum binders due to disturbances in the leukocytes and related immunocompetent cell may play an additional role.

Topics: Adult; Anemia; Female; Gastric Acid; HIV Infections; Humans; Hydroxocobalamin; Intrinsic Factor; Leukocyte Count; Male; Prospective Studies; Vitamin B 12

Topics: Adult; Biological Transport; HIV Infections; HIV-1; Humans; Male; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Adult; Aged; Female; Folic Acid; Folic Acid Deficiency; HIV Infections; Humans; Male; Middle Aged; Vitamin B 12