Reference: JAMA 2013 Nov 27;310(20):2154 (level 2 [mid-level] evidence)
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Micronutrient deficiencies are common in patients with HIV infection and may occur very early in the course of disease, affecting immune function and disease progression. In low-resource settings where availability of antiretroviral therapy (ART) can be limited, other interventions to slow disease progression may be particularly valuable. Previous studies have suggested that micronutrient supplements may improve HIV markers in patients with advanced disease. A recent randomized trial in Botswana evaluated the effects of supplementation in 878 treatment-naïve adults with early, asymptomatic HIV infection.
Patients with HIV infection subtype C were randomized to 1 of 4 daily treatments for 2 years: multivitamins plus selenium (in 1 tablet) vs. multivitamin only vs. selenium only vs. placebo. Vitamins included thiamin 20 mg, riboflavin 20 mg, niacin 100 mg, vitamin B6 25 mg, vitamin B12 50 mcg, folic acid 800 mcg, vitamin C 500 mg, and vitamin E 30 mg. The selenium dose was 200 mcg. All patients had a CD4 count > 350/mcL and no history of AIDS-defining conditions at baseline. The primary outcome was disease progression defined as CD4 count ≤ 250/mcL, and the secondary outcome was a composite of disease progression, development of AIDS-defining conditions, and AIDS-related death.
A total of 24.9% of patients were lost to follow-up or dropped out of the trial (with 7.5% discontinuing due to pregnancy). The incidence of the composite outcome (progression plus AIDS outcomes) was significantly reduced in the multivitamin plus selenium group (6.48 per 100 person-years) compared to placebo (10.95 per 100 person-years, p = 0.04). Incidence in the other 2 groups was not significantly different from placebo. For the primary outcome of disease progression, incidence in both the multivitamin plus selenium group and the multivitamin alone group were significantly reduced compared to placebo. The rates of adverse events were similar among groups, and there were no significant differences in HIV viral load among groups.
These results suggest an inexpensive way to improve treatment for HIV patients early in the course of the disease in low-resource settings. It remains to be seen whether the benefits would also be found in parts of the world where most patients have access to a diet that is more likely to supply all of the essential nutrients.
For more information, see the HIV infection topic in DynaMed.