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Micronutrient supplementation in HIV patients.

Baum M, Campa A, Lai S, Sales Martinez S, Tsalaile L, Burns P, Farahani M, Li Y, van Widenfelt E, Page J, Bussmann H, Fawzi W, Moyo S, Makhema J,Thior I, Essex M, Marlink R. 2013. Effect of micronutrient supplementation on disease progression in asymptomatic, antiretroviral-naive, HIV infected adults in Botswana: a randomized clinical trial. JAMA 310: 2154-63.

Human immunodeficiency virus (HIV) is a disease which is challenging worldwide, but perhaps nowhere more so than Africa. In this condition, micronutrient deficiencies, which are known to affect immune function, are present long before the development of HIV-related symptoms and are associated with increased disease progression. In countries such as Botswana, which has one of the highest rates of HIV in the world, along with a more severe strain (HIV subtype C), cost-effective interventions are needed to slow progression early in the disease. This is not only beneficial for patients and their families, but would allow increased time for resource-limited countries to prepare their healthcare systems and allot needed resources for HIV interventions such as antiretroviral therapy (ART).

Other clinical trials have shown micronutrient interventions to improve markers of HIV progression and mortality but most of these were conducted in the late stages of the disease, or in pregnant women. The current study is the first to test the effects of long-term micronutrient supplementation in the early stage of the disease, in ART-naive patients. Amongst those nutrients known to have beneficial effects on the immune system are B vitamins, vitamin C and E and the trace mineral selenium. Selenium in particular may have an important role in preventing HIV replication. Thus, in this study, groups received a daily supplement of multivitamins alone, selenium (200 pg) alone, the combination of multivitamins plus selenium or placebo, taken as 1 pill per day. A total of 878 patients participated in the trial and were randomised into one of the four groups. They took the supplements daily and attended monthly follow-ups for 24 months. Both participants and personnel of the study were blinded to the randomisation.

The main goals of the trial were to determine whether the supplements could enhance the immune system and slow HIV disease progression during the early stages of the disease. Thus, outcome measures reflected this --they included CD4 count, HIV viral load, plasma micronutrients and blood chemistries, as well as data on morbidity and mortality. The primary endpoint was HIV disease progression.

After 24 months, treatment with multivitamins + selenium compared to placebo significantly reduced the risk of reaching the primary endpoint of a CD4 count of 250/pL or less. Selenium supplementation alone had no effect on this parameter. For the secondary outcome of the composite of a CD4 count of 250/pL or less, AIDS-defining conditions or AIDS-related death, supplementation with multivitamin + selenium was again significantly better than placebo.

These and other secondary and tertiary outcomes showed that a single supplement of B vitamins, vitamins C and E, and selenium, as compared with placebo, (administered early in HIV disease) reduced the risk of reaching a CD4 cell count of 250/pL or less in 2 years. There was also an evident benefit with an earlier end point of a CD4 cell count of 350/pL or less, which is the current standard for providing ART in Botswana. Thus, it shows promise in slowing HIV disease progression in HIV-infected, ART-naive patients, and may be recommended as a beneficial intervention to help delay the need to begin ART. In developing nations, this may give governments and policy-makers more time to gather their resources and develop the necessary programs of implementation.

N.b. (The multivitamins included thiamine, 20mg; riboflavin, 20mg; niacin, 100mg; vitaminB6, 25mg; vitaminB12, 50g.g; folic acid, 800 g.g; vitamin C, 500 mg; and vitamin E, 30 mg.)
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Publication:Australian Journal of Herbal Medicine
Article Type:Abstract
Geographic Code:6BOTS
Date:Mar 1, 2014
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