Women infected with the human immunodeficiency virus (HIV) that causes AIDS have a higher prevalence of vitamin A (retinol) deficiency than the general population. Furthermore, this deficiency is significantly associated with cervical cancerous lesions, squamous intraepithelial lesions (SILs). This association remains intact independent of markers of HIV disease stage, status of human papilloma virus (HPV, implicated as causing cervical cancer) infection, and overall nutritional state, according to new findings from the Women's Interagency HIV Study (WIHS). This multicenter longitudinal study of HIV-infected and at-risk women was cosponsored by the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Centers for Disease Control and Prevention.
Lead author, Audrey L. French, M.D., of Cook County Hospital and Rush Medical College, and her colleagues measured serum retinol concentrations in 1,314 women enrolled in the WIHS and correlated the results with concurrent cervical cytology. At the initial visit, 15.5 percent of the women had retinol concentrations consistent with deficiency (less than 1.05 µmol/L). Cervical SILs were nearly twice as likely to be found in women with retinol concentrations less than 1.05 µmol/L in the group overall (odds ratio, OR 1.63) and in a subset of women with genital herpes virus (OR 1.75).
These findings suggest that retinol deficiency may contribute to the development of cervical SILs in HIV-infected women. Also, vitamin A deficiency among the women studied was due to socioeconomic and behavioral factors rather than advanced HIV disease. This was indicated by the lack of association of CD4 cell count (indicator of immune status) and HIV type 1 RNA with retinol concentrations, as well as by the relative health of the HIV-infected women. A nutritional adjunct to therapy for cervical dysplasia would probably have widespread appeal, but the potential benefit would have to outweigh the risk (high doses of vitamin A are toxic and tumor-forming).
See "Association of vitamin A deficiency with cervical squamous intraepithelial lesions in human immunodeficiency virus-infected women," by Dr. French, Lynn M. Kirstein, L. Stewart Massad, and others, in the October 2000 Journal of Infectious Diseases 182, pp. 1084-1089.
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