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Open Access Research article

Higher pre-infection vitamin E levels are associated with higher mortality in HIV-1-infected Kenyan women: a prospective study

Susan M Graham16*, Jared M Baeten1, Barbra A Richardson2, Daniel D Bankson35, Ludo Lavreys46, Jeckoniah O Ndinya-Achola6, Kishorchandra Mandaliya7, Julie Overbaugh8 and R Scott McClelland146

Author Affiliations

1 Department of Medicine, Box 356420, University of Washington, Seattle, Washington 98195, USA

2 Department of Biostatistics, Box 357232, University of Washington, Seattle, Washington 98195, USA

3 Department of Laboratory Medicine, Box 357110, University of Washington, Seattle, Washington 98195, USA

4 Department of Epidemiology, Box 357236, University of Washington, Seattle, Washington 98195, USA

5 Department of Pathology and Laboratory Medicine Service, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, Washington 98108, USA

6 Department of Medical Microbiology, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya

7 Coast Provincial General Hospital, P.O. Box 90231, Mombasa, Kenya

8 Division of Human Biology, Fred Hutchinson Cancer Research Center, P.O. Box 19024, Seattle, Washington 98109, USA

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BMC Infectious Diseases 2007, 7:63  doi:10.1186/1471-2334-7-63

Published: 26 June 2007

Abstract

Background

Low vitamin E levels are often found in HIV-1 infection, and studies have suggested that higher levels may decrease the risk of disease progression. However, vitamin E supplementation has also been reported to increase CCR5 expression, which could increase HIV-1 replication. We hypothesized that vitamin E levels at HIV-1 acquisition may influence disease progression.

Methods

Vitamin E status was measured in stored samples from the last pre-infection visit for 67 Kenyan women with reliably estimated dates of HIV-1 acquisition. Regression analyses were used to estimate associations between pre-infection vitamin E and plasma viral load, time to CD4 count <200 cells/μL, and mortality.

Results

After controlling for potential confounding factors, each 1 mg/L increase in pre-infection vitamin E was associated with 0.08 log10 copies/mL (95% CI -0.01 to +0.17) higher set point viral load and 1.58-fold higher risk of mortality (95% CI 1.15–2.16). The association between higher pre-infection vitamin E and mortality persisted after adjustment for set point viral load (HR 1.55, 95% CI 1.13–2.13).

Conclusion

Higher pre-infection vitamin E levels were associated with increased mortality. Further research is needed to elucidate the role vitamin E plays in HIV-1 pathogenesis.