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Micronutrients in HIV/AIDS

Pregnancy and Micronutrients

Vitamin B Complex in HIV/AIDS

Vitamin B1 (Thiamine)

Thiamine is water soluble, B-complex vitamin necessary for metabolism of proteins, carbohydrates and fats. Thiamine is involved as a cofactor in numerous enzymes, and is essential in every cell for ATP production via the Krebs cycle.

Muri et al [i], found that Thiamine deficiency in HIV-positive patients was found in a higher percentage than previously reported. Thiamine deficiency is not only present in advanced stages of HIV infection, but also in clinically asymptomatic patients.

In prospective epidemiological studies, thiamine intakes above 7.5 mg (RDA = 1.5 mg) were associated with increased survival. The highest levels of vitamin B1 and vitamin C intake were associated with significantly decreased progression from HIV to AIDS. [ii]

Moderate to severe thiamine deficiency has been observed in up to 23% of HIV positive or AIDS-diagnosed non-alcoholic individuals[iii].  This study concluded that thiamine deficiency was most likely resulted from the cachexia and catabolic characteristic of AIDS.

In view of:

1. the confirmed neuropathological evidence of Wernicke’s encephalopathy in AIDS patients,

2. the significant thiamine deficiency in these patients and

3. the difficulties of clinical diagnosis of Wernicke’s encephalopathy

It was recommended that dietary thiamine supplementation be initiated in all newly diagnosed cases of AIDS or AIDS-related complex

Vitamin B6 (Pyridoxine)

Vitamin B6 deficiency appears to be prevalent in CDC stage III individuals, despite an adequate dietary intake of B6[iv]. 34% of 44 asymptomatic HIV-positive subjects in the study were B6 deficient, as evidenced by assessment of red cell aspartate aminotransferase stimulation.

Another 30% had marginal B6 status, despite dietary intake over RDA levels in most of the subjects in the study. Vitamin B6 status in these patients was significantly associated with immune function; deficient patients showed decreased lymphocyte mitogen responsiveness and reduced natural killer cell cytotoxicity when compared to those who were B6 replete/HIV positive (p< .04). Vitamin B6 deficiencies have been linked to lowered immunologic function as well as increased risk for certain malignancies[v][vi].

Vitamin B12 (Cobolamine)

Vitamin B12 deficiency, defined as a low serum B12 level, occurs commonly in HIV/AIDS; the incidence varies from 10-35 percent, depending on the population size and stage of progression.[vii][viii]  Even in studies of asymptomatic HIV-positive patients, 7% have been found to have frank B12 deficit.[ix] B12 malabsorption is common in HIV; mechanisms include 

Production of gastric parietal cell antibodies

Intrinsic factor antibodies

• Duodenal and colonic inflammation [x]

• Gastric acid hyposecretion [xi]

Research by Herbert et al has detailed some of the mechanisms involved in B12 malabsorption and metabolism in HIV infection [xii]. By assessing levels of holotranscobalamin II (a cobalamin-binding protein) they found evidence of negative B12 balance and B12 deficits in 52 of 95 HIV-positive patients, 79 of whom had normal serum B12 levels (above 250 pg/ml). Negative B12 balance (excretion exceeding absorption) was found in patients with serum levels as high as 500-749 pg/ml, evidenced by low levels of cobalamin-binding (less than 40pg/ml cobalamin on holotranscobalamin II). The authors theorize nerve tissue may be damaged by metabolic changes, such as increased homocysteine and methylmalonate, which are secondary to B12 deficit but are not necessarily correlated with low serum levels of B12. 

In 108 HIV-positive men who were followed for 18 months, the development of B12 deficiency was associated with a declining CD4 count (p= 0.0377), while normalization of B12 levels was associated with higher CD4 counts (p= 0.0061).1 In this study, low baseline B12 significantly predicted progression to AIDS, as reflected by CD4 count (P=0.041) and an AIDS index–a composite measurement of CD4 cell count and beta 2-microglobulin levels. 

Cognitive changes in HIV and AIDS, commonly referred to as AIDS dementia complex, is evidenced by cognitive, behavioral, and motor function abnormalities [xiii].While AIDS dementia is most commonly seen in end-stage AIDS, neurological symptoms are the first evidence of AIDS in 10 percent of patients.[xiv]  Vitamin B12 levels were assayed in 64 asymptomatic HIV+ patients, and a significant association was found between low serum B12 levels and cognitive deficits in information processing speed and visuo-spatial problem-solving skills. [xv] Low B12 levels in 64 HIV+ patients referred to a neurology clinic correlated with presence of both peripheral neuropathy and myelopathy. [xvi] Twenty percent had either low serum B12 levels or positive Schilling test. Five of eight symptomatic patients who received parenteral B12 repletion therapy had atherapeutic response within one week of treatment. Reversal of a case of advanced AIDS dementia complex has been achieved by parenteral B12 therapy [xvii]. Vitamin B12 repletion may have a direct effect on immunity in HIV+ patients. A study of HIV-negative B12-deficient patients receiving B12 injections of 500 mcg every other day for two weeks resulted in improved lymphocyte counts, CD8+ counts, and improved NK cell activity [xviii].