Abstract:
background
Results from observational studies suggest that micronutrient status is a determinant
of the progression of human immunodeficiency virus (HIV) disease.
methods
We enrolled 1078 pregnant women infected with HIV in a double-blind, placebo-controlled
trial in Dar es Salaam, Tanzania, to examine the effects of daily supplements of
vitamin A (preformed vitamin A and beta carotene), multivitamins (vitamins B, C, and E),
or both on progression of HIV disease, using survival models. The median follow-up
with respect to survival was 71 months (interquartile range, 46 to 80).
results
Of 271 women who received multivitamins, 67 had progression to World Health Organization
(WHO) stage 4 disease or died — the primary outcome — as compared with
83 of 267 women who received placebo (24.7 percent vs. 31.1 percent; relative risk,
0.71; 95 percent confidence interval, 0.51 to 0.98; P=0.04). This regimen was also associated
with reductions in the relative risk of death related to the acquired immunodeficiency
syndrome (0.73; 95 percent confidence interval, 0.51 to 1.04; P=0.09), progression
to WHO stage 4 (0.50; 95 percent confidence interval, 0.28 to 0.90; P=0.02),
or progression to stage 3 or higher (0.72; 95 percent confidence interval, 0.58 to 0.90;
P=0.003). Multivitamins also resulted in significantly higher CD4+ and CD8+ cell
counts and significantly lower viral loads. The effects of receiving vitamin A alone were
smaller and for the most part not significantly different from those produced by placebo.
Adding vitamin A to the multivitamin regimen reduced the benefit with regard to
some of the end points examined.
conclusions
Multivitamin supplements delay the progression of HIV disease and provide an effective,
low-cost means of delaying the initiation of antiretroviral therapy in HIV-infected
women.
