HIV/AIDS

H/A: Micronutrient Supplementation (2009)

• Intervention
  Is there evidence that micronutrient supplementation benefits people with HIV infection?

  • Conclusion

    13 publications were reviewed to evaluate micronutrient supplementation for people with HIV infection, including a Cochrane review published in 2005. The authors of the Cochrane review concluded that there was no conclusive evidence to show that micronutrient supplementation effectively reduces morbidity and mortality among HIV-infected adults, but that in children, there is evidence of benefit of vitamin A supplementation. Subsequent research reports that micronutrient deficiencies are common in HIV-infected individuals. Two randomized controlled trials based on adult men and women published since 2005 report increased morbidity and mortality in those not taking vitamin supplementation. In several publications of a randomized controlled trial in HIV-infected pregnant women, multivitamin supplementation improved nutritional status of their infants and children. Further research regarding type, dose and duration of micronutrient supplementation is needed. 

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Micronutrient supplementation for people with HIV infection
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Austin J, Singhal N, Voigt R, Smaill F, Gill MJ, Walmsley S, Salit I, Gilmour J, Schlech WF, Choudhri S, Rachlis A, Cohen J, Trottier S, Toma E, Phillips P, Ford PM, Woods R, Singer J, Zarowny DP, Cameron DW, for the CTN 091/CRIR Carotenoids Study Group. A community randomized controlled clinical trial of mixed carotenoids and micronutrient supplementation of patients with Acquired Immunodeficinecy Syndrome. European Journal of Clinical Nutrition, 2006: 60; 1,266-1,276.
      • Baylin A, Villamor E, Rifai N, Msmanga G, Fawzi WW. Effect of micronutrient supplementation to HIV-infected pregnant women on the micronutrient status of their infants. Eur J Clin Nutr. 2005; 59: 960-968.
      • Fawzi WW, Msamanga GI, Kupka R, Spiegelman D, Villamor E, Mugusi F, Wei R, Hunter D. Multivitamin supplementation improves hematologic status in HIV-infected women and their children in Tanzania. Am J Clin Nutr. 2007; 85: 1,335-1,343.
      • Hendricks KM, Sansevero M, Houser RF, Tang AM, Wanke CA. Dietary supplement use and nutrient intake in HIV-infected persons.  AIDS Reader. 2007; 17: 211-216,  223-227. 
      • Irlam JH, Visser ME, Rollins N, Siegfried N. Micronutrient supplementation in children and adults with HIV infection. Cochrane Database of Systematic Reviews. 2005; (4): Art. No:CD003650. DOI:10.1002/14651858.CD003650.pub2.
      • Jones CY, Tang AM, Forrester JE, Huang J, Hendricks KM, Knox TA, Spiegelman D, Semba RD, Woods MN. Micronutrient levels and HIV disease status in HIV-infected patients on highly active antiretroviral therapy in the Nutrition for Healthy Living Cohort. J Acquir Immune Defic Syndr. 2006; 43(4): 475-482.
      • Kaiser JD, Campa AM, Ondercin JP, Leoung GS, Pless RF, Baum MK. Micronutrient supplementation increases CD4 count in HIV-infected individuals on highly active antiretroviral therapy: A prospective, double-blinded, placebo-controlled trial. J Acquir Immune Defic Syndr. 2006; 42: 523-528.
      • Kruzich LA, Marquis GS, Carriquiry AL, Wilson CM, Stephensen CB. US youths in the early stages of HIV disease have low intakes of some micronutrients important for optimal immune function. J Am Diet Assoc. 2004; 104: 1,095-1,101.
      • McGrath N, Bellinger D, Robins J, Msamanga GI, Tronick E, Fawzi WW. Effect of maternal multivitamin supplementation on the mental and psychomotor development of children who are born to HIV-1-infected mothers in Tanzania. Pediatrics, 2006; 117; e216-e225.
      • Merchant AT, Msamanga G, Villamor E, Saathoff E, O'Brien M, Hertzmark E, Hunter DJ, Fawzi WW. Multivitamin supplementation of HIV-positive women during pregnancy reduces hypertension. J Nutr. 2005; 135: 1,776-1,781.
      • Papathakis PC, Rollins NC, Chantry CJ, Bennish ML, Brown KH. Micronutrient status during lactation in HIV-infected and HIV-uninfected South African women during the first six months after delivery. Am J Clin Nutr. 2007; 85: 182-192. 
      • Villamor E, Saathoff E, Bosch RJ, Hertzmark E, Baylin A, Manji K, Msamanga G, Hunter DJ, Fawzi WW. Vitamin supplementation of HIV-infected women improves postnatal child growth. American Journal of Clinical Nutrition, 2005; 81: 880-888.
      • Villamor E, Saathoff E, Manji K, Msamanga G, Hunter DJ, Fawzi WW. Vitamin supplements, socioeconomic status and morbidity events as predictors of wasting in HIV-infected women from Tanzania. Am J Clin Nutr. 2005; 82(4): 857-865.
  • Search Plan and Results: Multivitamin Use 2007