RESEARCH Current Research Continuing Education Questionnaire, page 1185 Meets Learning Need Codes 2060, 2090, 3000, 4160, 5000, and 5250 US Youths in the Early Stages of HIV Disease Have Low Intakes of Some Micronutrients Important for Optimal Immune Function LAURIE A. KRUZICH, MS, RD; GRACE S. MARQUIS, PhD; ALICIA L. CARRIQUIRY, PhD; CRAIG M. WILSON, MD; CHARLES B. STEPHENSEN, PhD ABSTRACT Objective We examined the association between micronu- trient intakes and human immunodeficiency virus (HIV) infection in youths who were at increased nutritional risk because of the demands of growth and disease as well as poor dietary habits. Design This was a cross-sectional study to collect dietary intake data using the Block Food Frequency Question- naire (98.2). Anthropometric, biochemical, clinical, and sociodemographic data were available. Subjects/Setting Participants included 264 HIV-infected and 127 HIV-uninfected adolescents and young adults from the Reaching for Excellence in Adolescent Care and Health network, a multisite observational study on HIV progression. Statistical Analyses CD4 + T cells were stratified for HIV- infected youths: 500, 200 to 499, and 200 cells/L. Mi- cronutrient intakes were compared by presence of HIV in- fection, using two-sample Student’s t tests. Categoric analyses used  2 test. Generalized linear regression deter- mined predictors of vitamins A, C, and E; iron; and zinc intakes. Results Almost half (49.0%) of the HIV-infected partici- pants had CD4 + T cells 500 cells/L. After controlling for other factors, HIV-infected participants with CD4 + T cells 500 had decreased iron intake (P.05) and tended to be associated with lower intakes of vitamins C and E (P.10) compared with those with more advanced disease and HIV-uninfected youths. Among those youths with CD4 + T cells between 200 and 499 cells/L, a high anx- iety score was associated with a sixfold increase in vita- min A intake as compared with those with a low score. Applications/Conclusions Given the increased micronutrient requirements, nutrition counseling with HIV-infected youths should focus on early increase of intake of foods rich in micronutrients to improve growth, slow disease progression, and increase survival. J Am Diet Assoc. 2004;104:1095-1101. Y ouths with human immunodeficiency virus (HIV) infection may be at increased nutritional risk be- cause of the energy and micronutrient demands nec- essary to compensate for infection as well as support growth and development of adolescence. In addition, ad- olescents and young adults often have lifestyle and eating habits that lead to poor-quality diets. An analysis of a nationally representative survey of US adolescents dem- onstrated inadequate intakes of zinc; iron; and vitamins A, C, and E (1). Diet has been linked to HIV disease progression and survival. Intakes of vitamins A, C, and E and iron during early infection have been positively associated with CD4 + T cells and survival after a 6- to 8-year follow-up period (2-4). In contrast, vitamin A and -carotene intake during early HIV infection had a U-shaped relationship with risk of developing AIDS (3,4); both deficiencies and excessive intakes were associated with decreased immune function and increased disease progression. Among adults infected with HIV, Woods and colleagues (5) reported that macro- nutrient, but not micronutrient, intakes from food in- creased with decreasing CD4 + T cells. Vitamin and min- eral supplement use, however, was greatest among those with CD4 + T cells 200 cells/L. In contrast to adults, little is known about the relation- ship between dietary intake and HIV infection among youths. The primary purpose of this study was to deter- L. A. Kruzich is dietetic internship placement coordina- tor and G. S. Marquis is an assistant professor, Depart- ment of Food Science and Human Nutrition, and A. L. Carriquiry is an associate provost, Department of Statis- tics, Iowa State University, Ames. C. M. Wilson is an associate professor, Department of Pediatrics and Medi- cine, University of Alabama at Birmingham. C. B. Ste- phensen is a research scientist, USDA Western Human Nutrition Research Center, Department of Nutrition, University of California-Davis. Address correspondence to: Laurie A. Kruzich, MS, RD, Department of Food Science and Human Nutrition, 220 Mackay Hall, Iowa State University, Ames, IA 50011. E-mail: lkruzich@iastate.edu Copyright © 2004 by the American Dietetic Association. 0002-8223/04/10407-0003$30.00/0 doi: 10.1016/j.jada.2004.04.021 © 2004 by the American Dietetic Association Journal of THE AMERICAN DIETETIC ASSOCIATION 1095