Individuals with HIV and patients with AIDS present a variety of pathologic alterations that influence their nutritional status during various stages of the disease. Some studies have revealed a greater level of malnutrition and an elevated excretion of vitamin A in the urine of AIDS patients. Secretion of vitamin A in urine has been associated with infection, fever, and acute diarrhea. Therefore, the monitoring of nutritional status, especially in relation to vitamin A is recommended for patients with HIV and AIDS. Studies show that around 10-40% of HIV-positive women will give birth to children who are also infected. However, the risk factors for transmission from mother to child are not well understood and the effects of maternal nutritional status on fetal transmission are unknown.Vitamin A is an essential micronutrient for normal immune function. Vitamin A deficiency is common among HIV-infected pregnant women and is associated with higher mother-to-child transmission ofHIV-1 and increased infant mortality. The biological mechanisms by which vitamin A deficiency could influence mother-to-child transmission ofHIV-1 include impairment of immune responses in both mother and infant (specifically the CD4 T cell count), abnormal placental and vaginal pathology, and increased HIV viral burden in breastmilk and blood. Some clinical trials have demonstrated that daily micronutrient supplementation, including vitamin A, should be considered during pregnancy to reduce mother-to-child transmission ofHIV-1 , Severe vitamin A deficiency (<20 micrograms/Dl) has been associated with a 20-fold increased risk ofhaving HIV-1 DNA in breast milk among women with <400 CD4 cells/mm3 , Women with CD4 cell depletion, especially those with vitamin A deficiency, may be at increased risk of transmitting HIV-1 to their infants through breast milk.
The relationship between ethanol and vitamin A has been clear for quite some time now. In adults, ethanol ingestion appears to alter vitamin A metabolism and tissue distribution , Associations have also been made between fetal alcohol syndrome and malformations induced by toxicity and deficiency of vitamin A , One explanation for this may be the role alcohol plays in altering retinoic acid levels. Studies show that retinoic acid appears to curb the adverse effects of alcohol , Ethanol has been found to inhibit alcohol dehydrogenase, an enzyme that normally converts retinal to retinoic acid. The resulting decrease in retinoic acid may negatively alter the development and maturation of the immune system. The associations between retinoic acid and alcohol are further strengthened by other studies. Retinoic acid and ethanol reverse or block each others effects in studies on isolated neuroblastoma cells , and ethanol treatment has been found to promote deficits in vitamin A. Although these studies clarify the effects of ethanol on vitamin A levels, further studies are needed to determine how these factors contribute to immune system damage and an increased likelihood of mother to child transmission ofHIV-1.
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