PREVENTION OF HIV SHEDDING IN WOMEN--TRIAL OF VITAMIN A

尽管在治疗和预防艾滋病毒方面取得了令人鼓舞的进展， 在北美和西欧的感染，疫情继续蔓延 在世界许多地方迅速发展。需要新的战略来防止 异性性传播和垂直传播仍然紧迫。HIV-1可以检测到 在感染者的生殖道分泌物中， 证明这是传染性增强的标志。最近的研究 已经发现，在受感染的妇女中， 低血清维生素A浓度与 检测阴道分泌物中的HIV-1 DNA。维生素a缺乏会导致 粘膜上皮的特征性病理变化，包括 阴道，并且与HIV-1感染者和 未受感染的人。此外，孕妇维生素A缺乏症一直是 与HIV-1垂直传播风险显著增加相关。 我们建议进行一项随机双盲安慰剂对照试验， 补充维生素A对HIV-1 DNA感染率和数量的影响 400例HIV感染非妊娠妇女宫颈和阴道分泌物中的RNA 肯尼亚蒙巴萨的妇女。参与者将随机接受为期六周的 每日服用10,000 IU维生素A或安慰剂。宫颈和阴道 将在入组时和6周时采集拭子进行检测， HIV-1 DNA和RNA的定量。此外，还将采集静脉血 在两个时间点定量血浆HIV-1 RNA、CD 4淋巴细胞 计数和血清维生素A水平。维生素A的正常化 补充的HIV-1感染的妇女可以改善生殖器粘膜的完整性， 免疫力，从而可能降低这些妇女的传染性。在 在一项初步研究中，我们发现维生素A补充剂导致了两倍的 阴道HIV-1 DNA检测减少。如果这一初步结果是 在一项全面的临床试验中证实，维生素A补充剂可能会提供一种 简单廉价的干预，以减少异性恋和垂直 HIV-1在发展中国家的传播。

DESCRIPTION: Despite encouraging advances in treating and preventing HIV infection in North America and Western Europe, the epidemic continues to spread rapidly in many parts of the world. The need for new strategies to prevent heterosexual and vertical transmission remains pressing. HIV-1 can be detected in genital tract secretions of infected individuals, and there is epidemiologic evidence that this is a marker of enhanced infectivity. Recent studies of correlates of genital tract shedding of HIV-1 DNA in infected women have found that lower serum concentrations of vitamin A were strongly associated with detection of HIV-1 DNA in vaginal secretions. Vitamin a deficiency leads to characteristic pathological changes in mucosal epithelium, including the vagina, and is correlated with immune dysfunction in both HIV-1 infected and uninfected individuals. In addition, maternal vitamin A deficiency has been associated with significantly increased risk of vertical HIV-1 transmission. We propose a randomized double-blind placebo-controlled trial to assess the effect of vitamin A supplementation on the prevalence and quantity of HIV-1 DNA and RNA in cervical and vaginal secretions in 400 HIV-infected nonpregnant women in Mombasa, Kenya. Participants will be randomized to receive six weeks of daily dosage of either 10,000 IU vitamin A or placebo. Cervical and vaginal swabs will be obtained at enrollment and at six weeks for detection and quantification of HIV-1 DNA and RNA. In addition, venous blood will be obtained at the two time points for quantification of plasma HIV-1 RNA, CD4 lymphocyte count, and serum vitamin A levels. Normalization of vitamin A status in supplemented HIV-1 infected women may improve genital mucosal integrity and immunity, thereby potentially decreasing the infectiousness of these women. In a pilot study, we found that vitamin A supplementation resulted in a two-fold decrease in vaginal HIV-1 DNA detection. If this preliminary result is confirmed in a full-scale clinical trial, vitamin A supplementation may offer a simple inexpensive intervention to decrease heterosexual and vertical transmission of HIV-1 in the developing world.