American Journal of Epidemiology Vol. 138, No. 11: 937-951
Copyright © 1993 by The Johns Hopkins University School of Hygiene and Public Health
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Dietary Micronutrient Intake and Risk of Progression to Acquired Immunodeficiency Syndrome (AIDS) in Human Immunodeficiency Virus Type 1 (HlV-1)-infected Homosexual Men
1Department of Epidemiology, The Johns Hopkins University, School of Hygiene and Public Health Baltimore, MD
2Department of Medicine, The Johns Hopkins University, School of Medicine Baltimore, MD
3Departments of Epidemiology and Nutrition, Harvard School of Public Health, Channing Laboratory, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital Boston, MA
Reprint requests to Dr. N. M. H. Graham, Department of Epidemiology, The Johns Hopkins University School of Hygiene and Public Health, 624 N. Broadway, Baltimore, MD 21205
The authors sought to determine if different levels of dietary intake of micronutrients are associated with the progression of human immunodeficiency virus type 1 (HIV-1) infection to acquired immunodeficiency syndrome (AIDS). A total of 281 HIV-1 sero-positive homosexual/bisexual men were seen semiannually since 1984 at the Baltimore/Washington, DC site of the Multicenter AIDS Cohort Study. Participants completed a self-administered semiquantitative food frequency questionnaire at baseline. Levels of daily micronutrient intake at baseline were examined in relation to subsequent progression to AIDS (1987 Centers for Disease Control definition; n = 108) during a median follow-up period of 6.8 years. For each nutrient, the authors used a Cox proportional hazards model to adjust for age, presence of symptoms, CD4+ lymphocyte count, energy intake, use of antiretrovirals, and use of Pneumocystis carinii pneumonia prophylaxis. The highest levels of total intake (from food and supplements) of vitamins C and B, and niacin were associated with a significantly decreased progression rate to AIDS: vitamin C (relative hazard (RH) = 0.55, 95% confidence interval (Cl) 0.34–0.91), vitamin B1 (RH = 0.60, 95% Cl 0.36–0.98), and niacin (RH = 0.52, 95% Cl 0.31–0.86). The relation between total vitamin A intake and progression to AIDS appeared to be U-shaped; the lowest and highest quartiles of intake did most poorly, while the middle two quartiles were associated with significantly slower progression to AIDS (RH = 0.55, 95% Cl 0.35–0.88). Increased intake of zinc was monotonically and significantly associated with an increased risk of progression to AIDS (for highest vs. lowest quartiles, RH = 2.06, 95% Cl 1.16=3.64). In a final multinutrient model, vitamin A, niacin, and zinc remained significantly associated with progression to AIDS, while vitamin C was only marginally significant.
acquired immunodeficiency syndrome; ascorbic acid; HIV-1; niacin; nutrition; thiamine; vitamin A; zinc
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