The Journal of Nutrition Vol. 127 No. 2 February 1997, pp. 345-351
Copyright ©1997 by the American Society for Nutritional Sciences

Low Serum Vitamin B-12 Concentrations Are Associated With Faster Human Immunodeficiency Virus Type 1 (HIV-1) Disease Progression

Manuscript received 28 May 1996. Initial reviews completed 29 July 1996. Revision accepted 1 November 1996.

Alice M. Tang^*, , Neil M. H. Graham^*, , Ranjit K. Chandra, and Alfred J. Saah^*,

^* Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205;  Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205; and  Janeway Child Health Centre, St. John's, Newfoundland, A1A 1R8, Canada

We conducted a nonconcurrent prospective cohort study to examine associations between serum concentrations of vitamin B-6, vitamin B-12 and folate and the risk of progression to first acquired immunodeficiency syndrome (AIDS) diagnosis and CD4+ cell decline to < 2 × 10⁸ cells/L. The study population was drawn from a cohort of homosexual and bisexual men in the Baltimore-Washington, DC, area. Eligible subjects were human immunodeficiency virus type 1 (HIV-1)-seropositive at study entry and had serum available in the serum repository from their 1984 baseline study visit. Serum micronutrient levels were assessed in 310 subjects. The follow-up period (April 1984 through December 1993) was approximately 9 y. In Kaplan-Meier analyses, participants with low serum vitamin B-12 concentrations (< 120 pmol/L) had significantly shorter AIDS-free time than those with adequate vitamin B-12 concentrations (median AIDS-free time = 4 vs. 8 y, respectively, P = 0.004). This effect persisted in Cox proportional hazards models after adjusting for HIV-1-related symptoms, CD4+ cell count, age, serum albumin, use of antiretroviral therapy before AIDS, frequency of alcohol consumption and serum folate concentration [relative hazard (RH) = 1.89, 95% confidence interval (CI) = 1.15-3.10). To further explore the temporal relation between low serum vitamin B-12 concentrations and disease progression, additional analyses were performed excluding subjects with more advanced disease at baseline. In these analyses, the increase in risk of progression to AIDS for those with low serum vitamin B-12 concentrations remained significant (RH = 2.21, 95% CI = 1.13-4.34), providing further evidence that low vitamin B-12 concentrations preceded disease progression. In contrast, low serum concentrations of vitamin B-6 and folate were not associated with either progression to AIDS or decline in CD4+ lymphocyte count. Intervention studies are needed to determine whether correction of low serum vitamin B-12 concentrations in early HIV-1 infection will influence the natural history of disease progression.

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