SERUM CAROTENE DEFICIENCY IN HIV-INFECTED PATIENTS

Objective: To assess total serum carotene concentration in HIV-infected patients as an indicator of fat malabsorption in correlation with diarrhoea, secondary enteric infections, and blood lymphocyte subsets. Design: Prospective study. Setting: Two referral-based tertiary care centres in Berlin, Germany. Patients: A total of 33 controls and 116 HIV-infected patients who had complete microbiological evaluation of stools and biopsies obtained at upper endoscopy because of diarrhoea (n = 54), or other symptoms (n = 62), were studied. Main outcome measures: Total serum carotene concentration was determined spectrophotometrically. Results: Total serum carotene concentration was abnormal (< 0.88 mu mol/l) in 77% of HIV-infected patients and significantly decreased compared with controls [0.47 mu mol/l (range, 0.06-1.69 mu mol/l) versus 1.37 mu mol/l (range, 0.88-2.92 mu mol/l); P< 0.0001]. Total serum carotene concentration did not differ between AIDS patients and patients at earlier disease stages, between patients with or without secondary enteric infections, or between patients with or without fever In patients at earlier disease stages, but not in AIDS patients, total serum carotene concentration was lower for patients with than without diarrhoea. The percentage of CD4 lymphocytes (r = 0.364; P< 0.001), CD4 count (r = 0.28; P = 0.001 3), and CD4/CD8 ratio (r = 0.38; P< 0.001) in the peripheral blood correlated with total serum carotene levels in HIV-infected patients. Conclusion: HIV-infected patients frequently have abnormal total serum carotene concentrations indicating fat malabsorption which may contribute to diarrhoea. Furthermore, total serum carotene concentrations correlate with immunologic abnormalities in HIV infection.