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Altered Folate Metabolism in Early HIV Infection-Reply FREE

Richard S. Beach, MD, PhD; Emlio Mantero-Atienza, MD, MPH; Carl Eisdorfer, MD, PhD; Marianna K. Fordyce-Baum, PhD
JAMA. 1988;259(21):3129-3129. doi:10.1001/jama.1988.03720210018015
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In Reply.  —We appreciate the comments by Tilkian et al regarding our finding of elevated serum and red blood cell folate levels in early HIV infection. We, too, considered vitamin B12 deficiency and the vitamin B12—folate trap as a possible cause of the apparent elevation of folate levels.1 However, there was no significant correlation between folate and serum vitamin B12 levels in our patients (r=.12; P =.51). While approximately 25% of our patients were vitamin B12 deficient, they were not consistently the same subjects with the elevated folate levels (Figure). Consequently, an alternative explanation should be sought.As pointed out by Tilkian and coworkers, cellular lysis might result in transient elevation of serum nutrient levels. However, our patients had elevated levels of both serum and, most notably, erythrocyte folate. Therefore, release of intracellular folate alone cannot explain our findings. The binding of folate

REFERENCES

Herbert V:  Nutrition science as a continually unfolding story: The folate and vitamin B12 paradigm. Am J Clin Nutr 1987;;46:387-402.
Colman N, Herbert V:  Folate-binding proteins. Ann Rev Med 1980;;31:433-439.
 Riboflavin binding by plasma immunoglobulins. Nutr Rev 1987;;45:103-105.
Trimble JJ, Murthy CS, Bakker A, et al:  A gene for dihydrofolate reductase in a herpesvirus. Science 1988;;239:1145-1147.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Herbert V:  Nutrition science as a continually unfolding story: The folate and vitamin B12 paradigm. Am J Clin Nutr 1987;;46:387-402.
Colman N, Herbert V:  Folate-binding proteins. Ann Rev Med 1980;;31:433-439.
 Riboflavin binding by plasma immunoglobulins. Nutr Rev 1987;;45:103-105.
Trimble JJ, Murthy CS, Bakker A, et al:  A gene for dihydrofolate reductase in a herpesvirus. Science 1988;;239:1145-1147.
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