Nutrition Support (formerly Macronutrients and Micronutrients)
At the end of this section you will be provided with
references older than
2004.
Austin J, Singhal N, R Voigt et al. A
community randomized controlled clinical trial of mixed carotenoids and
micronutrient supplementation of patients with acquired immunodeficiency
syndrome. European Journal of Clinical Nutrition, 2006, 60: 1266–1276.
This prospective double blind placebo controlled trial investigated the
impact of carotenoids supplements on survival and health of AIDS patients. 331
adults with advanced AIDS on conventional management were recruited during
routine clinic visits. 166 persons were recruited to act as control. All
participants received daily oral multivitamins including vitamin A and trace
elements. Half of the patients received an additional daily oral natural mixed
carotenoids, equivalent to 120 000 IU (72 mg) of beta carotene daily. Follow
up was quarterly at routine clinic visits. Mean duration of follow-up was 13
months. 36 participants died by 18 months. Serum carotene concentration <1,0
mol/l was present in 16% participants at baseline. After 18 months and
compared to controls, serum carotene concentration increased significantly to
twice the baseline levels among participants who received carotenoids
(p<.0001). The mortality was increased in participants who did not received
carotenoids treatment compared to those who did, but this trend was not
significant (p=.11). However in multivariate analysis survival was
significantly and independently improved in those with higher baseline serum
carotene concentration (p=.04) or higher baseline CD4 T lymphocyte counts
(p=.005). It seems that low serum carotene concentration is common in AIDS
patients and can predict death among advanced AIDS patients. Supplementation
as used here may correct micronutrient deficiency and improve survival. This
finding needs to be confirmed and the mechanism of action still need to be
clarified.
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Batterham MJ. Investigating heterogeneity in studies of resting energy
expenditure in persons with HIV/AIDS: a meta-analysis. American Journal of
Clinical Nutrition, 2005, 81(3): 702-13.
There is conflicting data on resting energy expenditure (REE) in HIV/AIDS
infected individuals, and up to now the differences reported have not been
clear. This meta analysis aimed to ascertain the potential difference in REE
between HIV positive persons and healthy control persons. The author wanted as
well to explore the possible variations of REE in various clinical subgroups,
such as individuals with lipodystrophy, those losing weight, asymptomatic
individuals, or even those with stable weight. 58 studies reached the inclusion
criteria. After analysis it occurs that REE is significantly higher in HIV
infected persons than in the healthy control group. The subgroup analysis
proposed that persons with symptomatic infection have significantly elevated REE
compared to other HIV subgroups. Conclusions for other subgroups are not
available because of a lack of significant data. Finally, the author calls for
further research to investigate the effect of highly active antiretroviral
therapy on REE in HIV.
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Baylin A, Villamor E, Rifai N et
al. Effect of vitamin supplementation to HIV-infected pregnant women on the
micronutrient status of their infants. European Journal of Clinical Nutrition,
2005, 59(8): 960-968.
This randomized controlled trial intended to determine if a supplement of
different vitamin regimens to HIV infected women during pregnancy and
lactation is related to an increased serum concentration of vitamin A, B12 and
E of their infants during the first 6 months of life. The authors included 716
mother-infant pairs in Dar-es-Salaam Tanzania. The women were allocated to
receive a daily dose of either vitamin A, multivitamins (B, C and E),
multivitamims including A, or placebo. Analysis was based on intention to
treat. Baseline mother and child characteristics did not differ across
treatment arms, except for serum vitamin E, hemoglobin levels, and infection
with intestinal parasites. Supplementation started at the first prenatal visit
and continued after delivery throughout the breastfeeding period. Serum
concentration of vitamins A, E and B12 was measured in infants at 6 weeks and
6 months of life. Maternal vitamin A supplementation increased significantly
infant serum retinol at 6 weeks and 6 months, and decreased the prevalence of
vitamin A deficiency, but had no impact on serum vitamins E or B12.
Multivitamin supplementation is strongly associated with an increase in serum
vitamin B12 at 6 weeks and 6 months (mean differences=176 pmol/l, P<0.0001 and
127 pmol/l, P<0.0001, respectively) and less strongly with vitamin E. This
last treatment was related to a decrease in the prevalence of vitamin B12
deficiency. An issue raised by the authors is a lack of information about
complementary feeding of the children during the study period, and that serum
concentration of vitamins does not accurately reflect the underlying vitamin
status. It occurs that vitamin supplementation to HIV-infected women seems to
be effective in improving vitamin status of infants during the first 6 months
of age.
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Bobat R, Coovadia H, Stephen C et
al. Safety and efficacy of zinc supplementation for children with HIV-1
infection in South Africa: a randomised double-blind placebo-controlled trial.
Lancet, 2005, 366(9500): 1862-1867.
This South African double blind placebo randomised controlled trial
investigated the safety and efficacity of zinc supplementation for HIV
infected children. Up to now, zinc deficiency is known to impair immune
function and increase risk of infection, and the benefits of zinc
supplementation in reducing the incidence of diarrhea and pneumonia have been
described. Nevertheless the safety of zinc supplementation in children is
uncertain. Therefore, the authors intended to assess the role of zinc in HIV
replication before any mass zinc supplementation could be recommended at a
population scale. 96 children were randomized in 3 age strata to receive
either 10 mg of zinc or placebo for 6 months. The authors did viral load and
percentage of CD4+ measurements at baseline and at 3, 6 and 9 months after the
beginning of the supplementation. The primary outcome measure was plasma HIV
viral load, and analysis was per protocol. Baseline characteristics were
similar between both groups. The differences in the viral load at the end of
the supplementation and 3 months after the end of the treatment were not
statistically significant between groups. The mean CD4+ percentage and median
haemoglobin concentration were also similar at the end of the study. Children
in the treatment group seem to be less likely to suffer from watery diarrhea
than those receiving placebo (incidence 7,4% versus 14,5%, p=.001). Finally,
zinc given at a dose of 10 mg per day for 6 months to HIV children aged from 6
to 60 months does not result in an increase of viral load and seems to reduce
the incidence of diarrhea. The authors propose that programmes to enhance zinc
intake in deficient populations with a high prevalence of HIV infection can be
implemented without concern for adverse effects on virus replication. They
also call for further research, through larger studies, to assess the efficacy
of zinc supplementation in children across age groups, with different degrees
of disease and malnutrition, and for those receiving antiretroviral therapy.
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Coyne-Meyers K, Trombley LE. A Review of
Nutrition in Human Immunodeficiency Virus Infection in the Era of Highly Active
Antiretroviral Therapy. Nutrition in Clinical Practice 2004, 19, 4: 340-355.
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here for summary.
Crenn P et al. Hyperphagia contributes to the normal body composition and
protein-energy balance in HIV-infected asymptomatic men. Journal of Nutrition,
2004, 134(9):2301-2306.
Wasting can occur at an early stage of HIV infection. Wasting is defined as
reduced energy intake and increased resting energy expenditure, with a
predominant loss of lean body mass and suggesting disturbance of protein
metabolism. The aim of this experiment was to study protein-energy metabolism in
relation to body composition and oral energy intake in asymptomatic patients
with HIV receiving no active antiretroviral therapy. Stable-weight asymptomatic
male patients were compared with 9 healthy control men. Protein metabolism was
studied in the postabsorptive state. Resting energy expenditure was studied by
indirect calorimetry, body composition by bioelectrical impedance, and energy
intake by dietary records. Body mass index and lean body mass did not differ
between patients and controls. In HIV-infected subjects, energy intake, protein
breakdown, protein synthesis, and REE were greater than in controls. Resting
energy expenditure and protein breakdown were correlated. At the asymptomatic
stage of HIV infection, increased protein turnover seems contributing to the
increase of the resting energy expenditure. It occurs that moderate hyperphagia
should maintain a normal body composition, without significant loss of lean body
mass.
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Dorosko SM. Vitamin A, mastitis,
and mother-to-child transmission of HIV-1 through breast-feeding: current
information and gaps in knowledge. Nutrition Review, 2005, 63(10): 332-346.
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Drain PK, Kupka R, Mugusi F et al. Micronutrients in HIV-positive
persons receiving highly active antiretroviral therapy. American Journal of
Clinical Nutrition, 2007, 85: 333-345.
This article proposes a comprehensive review of available evidence
concerning micronutrients during highly active antiretroviral therapy (HAART).
HIV-positive persons have been shown to have an increased risk of HIV
progression and mortality when a decrease in micronutrients serum is observed.
Among HIV-infected persons without access to HAART micronutrients supplements
can delay disease progression and reduce mortality. While accessibilty to
HAART is growing, the understanding of micronutrients deficiencies and the
role of micronutrients supplements among HIV-positive persons under HAART
remains unclear and has become a priority. The potential benefits of simple
and quite inexpensive micronutrient supplements as an adjunct to HAART may be
valuable. The authors reviewed studies on micronutrient in HAART settings and
point out major limitations. Therefore only few data are available to
determine the real impact of HAART on micronutrients status and the potential
benefits of micronutrients supply to HIV-infected persons receiving HAART. The
authors propose to investigate if HAART initiation restores micronutrients
concentrations independantly of inflammatory markers and whether
micronutrients supply affect HIV outcomes in HIV-infected persons under HAART.
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Faintuch J, Soeters PB and Osmo HG.
Nutritional and metabolic abnormalities in pre-AIDS HIV infection. Nutrition,
2006, 22: 683-690.
Undernutrition has been associated with HIV infection, but mostly in the
late stages of the disease, and may lead to severe wasting and cachexia.
Micronutrients deficiencies are also recognized to occur with the disease, but
their impact on the clinical evolution of the disease is difficult to assess.
This review synthesizes findings pertinent to better outline the nutritional
and metabolic course of HIV disease before clinical deterioration and in
absence of antiretroviral therapy. The article addresses topics such as
diarrhoea and HIV infection, antioxidants, vitamins and other micronutrients,
fatty acid metabolism and obesity and HIV infection.
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Fawzi WW et al. A randomized trial of multivitamin supplements and HIV
disease progression and mortality. New England Journal of Medicine, 2004,
351(1):23-32.
The authors compared supplementation consisting of multivitamins alone,
vitamin A alone, or both with placebo. They found that women who were randomly
assigned to receive multivitamin supplementation were less likely to have
progression to advanced stages of HIV disease, had better preservation of CD4+
T-cell counts and lower viral loads, and had lower HIV-related morbidity and
mortality rates than women who received placebo. Vitamin A appeared to reduce
the effect of multivitamins and, when given alone, had some negative effects.
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Fawzi WW, Msamanga G. Micronutrients and adverse pregnancy outcomes in the
context of HIV infection. Nutrition Reviews, 2004, 62(7 Pt 1):269-275.
According to relevant literature, micronutrient (vitamins and trace elements)
status may affect the risk of vertical transmission. This article reviews
studies that explored the relationship between individual or multiple
micronutrients supply and pregnancy outcomes in an HIV context in developing
countries. Observational studies and randomized trials are scrutinized. First
the authors present the outcomes of observational and randomized studies on
vitamin A, B complex, C, E, selenium, and zinc supply, and then propose a
critical analysis of the studies themselves. In conclusion, the authors
underline the positive evidence of the use of multivitamins supply including
vitamin B complex, C, and E as a means to reduce low birth weight, prematurity,
and fetal death. The vitamin A supply in prenatal settings does not seem to be
efficient. Finally the authors calls for more research in the field of zinc and
selenium supply in randomized trials.
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Fawzi WW, Msamanga GI, Kupka R et al.
Multivitamin supplementation improves hematologic status in HIV-infected women
and their children in Tanzania. American Journal of Clinical Nutrition, 2007,
85(5): 1335-1343.
Anemia is a frequent complication among HIV-infected persons and is
associated with various adverse outcomes. Iron supplementation has been shown
to raise hemoglobin concentrations, and treatment and prevention of infections
are other important intervention to control anemia. Despite the widespread
implementation of these interventions, anemia remains a major problem.
According to the authors no study have yet assessed the efficacy of
multivitamins alone in African settings where HIV infection, malaria and other
infectious diseases are prevalent. This study aims to examine the efficacy of
maternal supplementation during pregnancy and after delivery on hemoglobin
concentrations and the risk of anemia among the women and their children.1078
HIV-infected pregnant women from Dar es Salaam in Tanzania were enrolled in a
double-blind placebo-controlled trial. Participants were not receiving
antiretroviral treatment and received daily either vitamin A alone,
multivitamins (b-complex, vitamin C and E but excluding vitamin A),
multivitamin plus vitamin A or placebo. All women received iron and folate
supplement only during pregnancy according to local standard of care.
Hemoglobin measurement and investigation and treatment for parasites occurred
every 6 months. 906 women had at least 2 measurement and therefore were
included in the analysis. Median follow-up time for hemoglobin measurement for
mothers was 57,3 months (28,6-66,8) and for children it was 28 months
(5,3-41,7). The different arms of the trial were not significantly different
according to mean age and gestational age at enrollment. Other baseline
characteristics were also similar. Compared with placebo, multivitamin
supplementation resulted among women in a hemoglobin increase of 0,59 g/dL
during the first 2 years after enrollment (p=.0002). Compared to placebo
group, the children born to mothers who received multivitamins had a 63%
reduced risk of anemia (RR=0,37, 95% CI: 0,18, 0,79, p=.01). Multivitamin
supplementation provided during pregnancy and in the postpartum period
resulted in significant improvements in hemoglobin status among HIV-infected
women and their children.
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Fawzi WW et al. Studies of vitamins and
minerals and HIV transmission and diseases progression. Journal of Nutrition,
2005, 135:938-944.
This article is part of a symposium that took place in April 2004 in
Washington, DC. It presents a review of evidence about the effects of
micronutrients (vitamins and minerals) supply on HIV transmission and
progression. It reviews trials that have been undertaken in resource limited
setting and in developed countries, and reviews separately vitamins and minerals
(merely selenium and zinc). Finally, the authors provide some comments on the
studies, classifying them in different sections: vitamin A among children,
vitamin A among adults, and multivitamin supplement during pregnancy and
lactation. Authors warn about the use of micronutrient supplementation as an
alternative treatment, instead recommend micronutrient supplementation as a
complementary intervention to antiretroviral therapy (ART). They finish with a
call for further research in the field of other micronutrient supplementation
among adults who are advanced in their disease and are receiving ART therapy and
among children.
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Fawzi WW et al. Trial of zinc
supplements in relation to pregnancy outcomes, hematologic indicators, and T
cell counts among HIV-1-infected women in Tanzania. American Journal of Clinical
Nutrition, 2005, 81(1):161-167.
The outcomes of zinc supplementation among pregnant HIV-infected women is not
clear. Therefore, this randomized trial examined the effects of zinc supply in
relation to different issues, such as birth outcomes, hematologic indicators,
and counts of T lymphocyte. Besides a multivitamin supplement, 400 HIV-infected
pregnant women received either 25 mg of zinc or a placebo. The authors observed
no significant differences in birth weight, duration of gestation, or fetal and
neonatal mortality between both groups. According to the trial there is no
compelling evidence to support the addition of zinc to prenatal supplements
intended for pregnant HIV-infected women.
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Fields-Gardner C, Fergusson P. Position of the American Dietetic
Association and Dietitians of Canada: nutrition intervention in the care of
persons with human immunodeficiency virus infection. Journal of the American
Dietetic Association, 2004, 104(9):1425-1441.
This complete document is intended for dietetic professionals and other
health-care workers, and covers the entire field of the relation between
HIV/AIDS and nutrition, and its impact on domestic and global health. It
describes, briefly, the impact of HIV/AIDS on nutritional status, including
malabsorption, wasting, drug interactions, and metabolic abnormalities. A
special section focusing on pediatric issues is included, because of children's
particular needs and vulnerability to the pandemic. A list of selected resources
for professionals and other educational materials relating nutrition and HIV
infection is provided. The document ends with information for the nutritional
and non-nutritional management of HIV/AIDS-infected individuals.
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Friis H. Micronutrient interventions and
HIV infection: a review of evidence. Tropical Medicine and International Health,
2006, 11(12): 1849-1857.
This review aims to discuss available evidence concerning micronutrient
supplementation in HIV transmission and progression. HIV-positive persons with
no apparent symptoms seem to have reduced micronutrients status, probably due
to impaired absorption. With advancing disease, micronutrients status becomes
increasingly impaired following reduced intake, increased loss and
utilization. This article focuses on the impact of micronutrient interventions
on mother-to-child transmission, sexual transmission, progression and
morbidity, and on viral load.
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Friis H. Micronutrients and HIV
infection : a review of current evidence. Consultation on Nutrition and HIV/AIDS
in Africa: Evidence, lessons and recommendations for action. Durban, South
Africa, 10-13 April 2005. Geneva, World Health Organization, 2005.
This paper presents evidence-based of present knowledge of the 2 way
complex relationship between micronutrients and HIV infection. Data reviewed
here confirm that micronutrients play an important role in HIV infection. Like
other infections, HIV infection seems to impair micronutrient status, and
micronutrient intake and status may affect HIV transmission, progression and
morbidity. However, conclusive evidence is lacking, some data suggest that the
positive and negative effects of some micronutrients have been well etablished
in specific circumstances. Moreover, the effect of a given micronutrient
intervention will depend on the background dietary status and intake in the
study population. The review also proposes current evidence of a range of
micronutrients taken individually on their effects on HIV progression and
transmission, and ends with proposals for further research areas.
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Gerrior JL, Neff LM. Nutrition
assessment in HIV infection. Nutrition in Clinical Care, 2005, 8(1): 6-15.
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Gil L et al. Effect of increase of dietary micronutrient intake on
oxidative stress indicators in HIV/AIDS patients. International Journal for
Vitamin and Nutrition Research, 2005, 75(1): 19-27.
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NEW! Hendricks MK, Eley B, Bourne LT. Nutrition and HIV/AIDS in infants and
children in South Africa: Implications for food-based dietary guidelines.
Maternal Children Nutrition. 2007, 3(4): 322-333.
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Heredia A, Davis C, Amoroso A. et al. In
vitro suppression of latent HIV-1 activation by vitamin E: potential clinical
implications: research letter. AIDS. 2005, 19(8): 836-837.
This research letter provides data showing the role vitamin E could play in
reducing the risk of the emergence of drug resistant HIV-1 variants in
patients undergoing antiretroviral treatment interruption.
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Humphrey JH, Iliff PJ, Marinda ET et al.
Effects of a Single Large Dose of Vitamin A, Given during the Postpartum Period
to HIV-Positive Women and Their Infants, on Child HIV Infection, HIV-Free
Survival, and Mortality. The Journal of Infectious Diseases, 2006, 193: 860-871.
The data presented here are issued from the ZWITAMBO study and the research
aimed to investigate the effect that single large dose maternal/neonatal
vitamin A supplementation has on mother to child transmission (MTCT), HIV free
survival, and mortality in HIV-exposed infants. This randomized controlled
trial included 14,110 mother-infant pairs. In addition to a control, three
different vitamin A regimen were proposed: both mother and infant, mother
only, infant only. The majority of the infants were breastfed and a total of
4495 infants were born to HIV-positive women and included in the analysis.
Vitamin A supplementation appears not to affect significantly postnatal MTCT
or mortality during the 24 first months of life. For infants who were
polymerase chain reaction (PCR)-negative for HIV at baseline and PCR-positive
at 6 weeks, neonatal supplementation reduced significantly mortality by 28%.
Maternal supplementation had no notable effect. Any kind of vitamin A
supplementation in infants PCR-negative at 6 weeks was associated with 2 fold
higher mortality. In conclusion, the authors figure out that adequate vitamin
A supplementation of HIV-positive children extends their survival, but post-partum
maternal and neonatal vitamin A supplementation may accelerate progression to
death in breastfed children who are PCR-negative at 6 weeks. This study shows
data that questions universal maternal or neonatal vitamin A supplementation
in high HIV prevalence areas.
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Irlam JH, ME Visser, N Rollins et
al. Micronutrient supplementation in children and adults with HIV infection. The
Cochrane Database of Systematic Reviews, 2005, Issue 4, Art. No.: CD003650. DOI:
10.1002/14651858.CD003650.pub2.
This systematic review studied the impact of micronutients supplements in
adults and in children infected by HIV. The review included fifteen randomised
controlled trials issued from both developing and developed countries. The
supplement studied in this review include vitamins, trace elements, and
combinations of those. Because of the heterogeneity between studies, a
meta-analysis was not found to be appropriate for the review. The primary
outcomes considered were mortality, morbidity, hospital admissions, and
pregnancy outcomes. Secondary outcomes were viral load, markers of immune
response, serum levels of micronutrients, anthropometric measures, quality of
life, and adverse effects. Among HIV infected adults there seems to be no
conclusive data to show that micronutrient supplementation significantly
reduces morbidity and mortality. The authors propose to follow the current WHO
recommendations to promote and support adequate dietary intake of
micronutrients at RDA level wherever possible. Concerning children, it seems
that vitamin A shows some benefit, but further research is needed to
investigate long term clinical benefit, adverse effects, and optimal
formulation.
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Jacobson DL, Spiegelman D, Duggan C et
al. Predictor of bone mineral density in human immunodeficiency virus-1 infected
children. Journal of Pediatric Gastroenterology and Nutrition, 2005, 41:
339-346.
This article aims to compare bone mineral density in HIV-infected children
with population norms and to define predictors of bone mineral density in this
vulnerable population. At baseline the authors measured bone mineral density
by dual x-ray absorptiometry in 37 US HIV-infected children and 9 sibling
controls. Age and gender-adjusted z-score were calculated for bone mineral
density and body mass index. All results were adjusted for Tanner stages for
puberty development. After adjusting for height and weight, the authors found
that HIV-infected children had significantly lower bone mineral density than
their siblings. Among HIV infected children, lower bone mineral density was
associated with lower weight z-scores (P<.0001), lower height (P<.01),
advanced HIV stage (P=.01) and ages older than 8 years (P<.001). Dietary
intakes of calcium and vitamin D were not associated with bone loss, but both
intakes were suboptimal in this group of children. In the same model, using
multivitamin supplementation and being of African American ethnicity were
associated with better bone mineral density z-scores. Neviparine use showed a
borderline effect (P=.06). According to these results, it seems that
HIV-infected children, compared with population norms, had lower than expected
bone mass for their age and gender that could be attributable to delays in
growth, sexual maturity, length of infection, ethnicity and disease severity.
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Jiamto S, Chaisilwattana P, Pepin J et
al. A randomized placebo-controlled trial of the impact of multiple
micronutrient supplementation on HIV-1 genital shedding among Thai subjects.
Journal of Acquired Immune Deficiency Syndrome. 2004, 37(1): 1216-1218.
This randomized placebo controlled trial aimed to investigate the impact of
multiple micronutrients supplementation on HIV genital shedding among men and
women. Participants were engaged in a bigger cohort study. The authors
recruited 140 consecutive participants from the main study, all of them were
antiretroviral naive, and had CD4 cells count between 50-550 cells/mm³. The
subjects were randomly allocated to multiple micronutrients supplements (n=71)
or placebo (n=69). Baseline characteristics were similar between the two arms.
Genital, cervicovaginal and plasma HIV viral load was tested. Plasma viral
load was correlated with seminal viral load (r=0.44; p.0003, n=65) but not
with cervicovaginal secretions (r=0.18; p=.01, n=71). After 48 weeks of
follow-up, the median CD4 cell count, mean log viral load in plasma, semen and
cervicoaginal secretions did not differ significantly between patients in both
group (p>.4 for each comparison). The percentage changes from baseline to end
of follow-up did not differ between the 2 groups. It seems that multiple
micronutrient supplementation have no impact on viral load in seminal or
cervicovaginal secretions.
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Jones CY, Tang AM, Forrester JE et al.
Micronutrient levels and HIV disease status in HIV-infected patients on highly
active antiretroviral therapy in the Nutrition for Healthy Living cohort.
Journal of Acquired Immune Deficiency Syndrome. 2006, 43(4): 475-482.
Before the introduction of higly active antiretroviral therapy (HAART), low
serum micronutrients levels were common. These deficiencies have been
associated with adverse outcomes. This cross sectional study intended to
investigate in HIV-infected persons on HAART the prevalence of low serum
levels of retinol, alpha-tocopherol, zinc, and selenium; whether low levels of
these micronutrients are associated with worse HIV disease status; and also to
understand if supplementation is associated with better HIV disease status.
Blood samples from 117 HIV-infected women and 171 men from the Nutrition for
Healthy Living (NFLH) study were analysed. CD4 cell counts, CD4 count <200
cells/mm, viral load, and undetecteble viral load were assessed. Except mainly
for zinc there was a low prevalence of micronutrient deficiency. Women in the
upper quartiles of zinc had significantly lower log viral load levels than
those in the lowest quartile. The same trend was observed for women and men
for selenium. Women in the upper quartiles of retinol had higher log viral
loads than those in the lowest quartile. There was no statistical association
of any micronutrient with CD4 cell count or likelihood of CD4 count <200
cells/mm. Among men with CD4 counts >350 cells/mm, those with higher retinol
had higher log viral loads compared with the lowest quartile, whereas it was
the opposite for men with CD4 counts <350 cells/mm. It appears that low
retinol, alpha-tocopherol and selenium are uncommon in HIV-infected adults on
HAART. Zinc deficiency seems to be more common. Decreased serum retinol levels
in women and in men with CD4 counts >350 cells/mm as well as increased serum
zinc levels in both genders were associated with improved virologic control.
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Kaiser JD, Campa AM, Ondercin JP et al.
Micronutrient supplementation increases CD4 count in HIV-infected individuals on
highly active antiretroviral therapy: A prospective, double-blinded,
placebo-controlled trial. Journal of Acquired Immune Deficiency Syndrome, 2006,
42 (5): 523-528.
This prospective double blind placebo controlled trial aims to investigate
the effects of micronutrient supplementation among HIV-positive person
receiving Highly Active Antiretroviral Therapy (HAART). 40 HIV-infected
persons under a stavudine and/or didanosine based HAART treatment were
randomized to receive micronutrients or placebo twice daily for 12 weeks.
Immunologic, metabolic and clinical measurement were collected monthly. Main
outcome consisted of immunologic parameters and secondary end points were
metabolic and clinical effects, and distal symmetrical polyneuropathy. At the
end of the follow up mean CD4 cells count increased in the supplementation
group versus the placebo group (+65 cells vs -6 cells, p=.029). The absolute
CD4 count increased by an average of 24% in the micronutrient group versus no
change in the other group (p=.01). Neuropthy scores improved in the
micronutrient group by 42% compared with a 33% improvement in the other arm,
but the difference was not significant. Serum parameters were not different
among both groups. Micronutrients supply as proposed here seems to improve CD4
cells count reconstitution in HIV-infected person taking HAART.
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Kupka R et al. Selenium status is associated with accelerated HIV disease
progression among HIV-1-infected pregnant women in Tanzania. Journal of
Nutrition, 2004, 134(10): 2556-2560.
Selenium state has been implicated in HIV disease progression and appears to
poorer survival among populations infected with HIV in developed countries. This
study examined these relations in a developing country, Tanzania. Among 949
HIV-infected pregnant women, the authors looked at the association between
plasma selenium levels and survival and CD4 counts over time. Over the 5.7-year
median follow-up time, 306 of 949 women died. In a Cox multivariate model, lower
plasma selenium levels were significantly associated with an increased risk of
mortality. Increased plasma selenium levels was related to a decreased risk of
mortality. Plasma selenium levels was not associated with time to progression to
CD4 cell count < 200 cells/mm, but were weakly and positively related to CD4
cell count in the first years of follow up. According to the authors, selenium
status seems to be important for clinical outcomes related to HIV disease in
Sub-Saharan Africa.
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Kupka R et al. Selenium levels in relation to morbidity and
mortality among children born to HIV-infected mothers. European Journal of
Clinical Nutrition, 2005, 59: 1250-1258.
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Lanzillotti JS, Tang AM. Micronutrients
and HIV disease: a review pre- and post-HAART. Nutrition in Clinical Care, 2005,
8(1): 16-23.
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McGrath N, Bellinger D, Robins J et al.
Effects 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: 216-225.
This article aims to determine the association between maternal
multivitamin supplementation and the mental and psychomotor development of
children born to HIV infected mothers in Dar es Salaam, Tanzania. This was
done by analysing supplements on vertical transmission and AIDS progression.
The authors assessed the effect of supplementation of vitamin A and
multivitamins (B, C and E) on a mental and a psychomotor score. Women between
12 and 27 weeks of gestation at the time of randomization and who had HIV
infection were eligible. Those who had already developed AIDS were excluded
(WHO classification). Antiretroviral therapy was not available to the majority
of Tanzanians, including those participating in the study. At each monthly
visit women received doses of vitamins corresponding to multiples of RDA
according to the hypothesis they require higher doses to reach adequate plasma
values. The supplements were taken once daily during pregnancy and continued
after delivery. Participants were allocated to receive either vitamin A,
multivitamin excluding vitamin A, or multivitamin including vitamin A. After
delivery and regardless of mother's regimen, children followed the Tanzanian
national guideline concerning vitamin A. Multivitamin supplementation was
associated with a mean increase in psychomotor development index score of 2.6
(95% confidence interval 0.1-5.1). It was also associated with significant
protection against the risk for development delay on the motor scale (RR: 0.4
with 95% confidence interval 0.2-0.7) but not on the mental development index.
Vitamin A had no significant effects on these outcomes. Maternal multivitamin
supplements seems to provide a low-cost intervention to reduce the risk for
developmental delays among infants who were born to HIV infected mothers in
developing countries without access to antiretroviral therapy.
Click here for Pubmed summary.
Mermin J, Bunnell R, Lule J et al.
Developing an evidence-based, preventive care package for persons with HIV in
Africa. Tropical Medicine & International Health. 2005, 10(10): 961-970.
Click here for Pubmed summary.
Mwanburi MD et al. Understanding the
role of HIV load in determining weight change in the era of highly active
antiretroviral therapy. Clinical Infectious Diseases, 2005, 40:167-173.
The aim of this study was to establish the relationship between HIV RNA load
and weight change among HIV infected individuals. This study is part of the
Nutrition for Healthy Living Study which investigates the role of nutrition in
HIV disease. 318 participants were included in this cohort based study. 54% of
the participants were under HAART at the time of enrollment and most were men
(81%). The authors found that in the absence of HAART, virus load strongly
influenced weight loss. They found that it was not the case for HAART-receiving
patients. The finding that change in virus load, rather than change in CD4 cells
counts, predict weight loss in patients who are not taking HAART implies that
virus load suppression is a necessary condition for control of weight loss.
Therefore the authors propose that patients who are losing weight and not taking
HAART should start taking HAART to prevent more weight loss. Finally they call
for further research in examining resting energy expenditure in patient taking
HAART and in those who are not receiving HAART.
Click here for the entire article.
O'Brien ME, Kupka R, Msamanga GI et al.
Anemia is an independent predictor of mortality and immunologic progression of
disease among women with HIV in Tanzania. Journal of Acquired Immune Deficiency
Syndrome. 2005, 40(2): 219-225.
Anemia is the most frequent hematologic complication during HIV, and the
prevalence of anemia among African women with HIV infection have been reported
to be approximately 70-80%. Given this and the fact that few studies have
examined the association of anemia with mortality and HIV progression among
women in sub Saharan Africa, the authors intended to examine this association
among a cohort of Tanzanian women. 1078 pregnant women with World Health
Organisation (WHO) clinical stage 1 or 2 disease were enrolled into the trial.
According to local guidelines, they received iron and folate for antenatal
care. They were randomized to receive one of the following regimen:
multivitamins (B complex, C and E), vitamin A plus beta-carotene,
multivitamins that included vitamin A plus beta carotene, or placebo.
Hematologic exams were provided at baseline, 6 weeks and 30 weeks postpartum,
and every month thereafter. Women were followed up either until they died or
were lost to follow-up or until the study closed. The median follow-up time
was 5,9 years. The authors investigated all cause death, AIDS related death,
and a 50% decrease in CD4 cell count. The analysis, conducted using adjusted
models, showed an association between anemia and an increased risk of all
cause mortality and AIDS-related mortality, independent of CD4 cell count, WHO
clinical stage, age, pregnancy, vitamin supplementation, and BMI. Anemia was
also associated with a more rapid decline to 50% of baseline CD4 counts. Iron
deficiency, defined by erythrocyte characteristics, was associated with
all-cause and AIDS-related death and a 50% decline in CD4 cell count. The
authors finally recommend that the screening, prevention and treatment of
anemia should be included in HIV care intervention, particularly to those
focusing on women.
Click here for Pubmed summary.
Olsen A, Mwaniki D, Krarup H et al.
Low-dose iron supplementation does not increase HIV-1 load. Journal of Acquired
Immune Deficiency Syndrome, 2004, 36: 637-638.
Iron supplementation may increase HIV replication and the rate of
progression of HIV-infection. This mechanism could interfere with the
international objective to combat iron deficiency. The author conducted a
retrospective study on data from 1994 concerning a randomized,
placebo-controlled, double-blind iron supplementation among adults in Kenya.
The aim of the study was to assess the effect of 60 mg of elemental iron given
twice a week during 4 months on HIV-1 viral load. Anonymous HIV testing was
performed on repository samples. Of the 181 participants, 45 were found to be
HIV-positive and 32 of these had serum data available. Compared to placebo, 60
mg of elemental iron twice a week for 4 months did not increase HIV load, but
the effect of higher doses of iron cannot be excluded.
Click here for Pubmed summary.
Papathakis PC, Rollins NC, Chantry CJ et
al. Micronutrient status during lactation in HIV-infected and HIV-uninfected
South African women during the first 6 mo after delivery. American Journal of
Clinical Nutrition, 2007, 85(1): 182-192.
Up to now few information is available on protein and micronutrient status
of HIV-infected breastfeeding women. Therefore this study aimed to compare
nutrient status of South African breastfeeding women by HIV status. Serum
albumin, prealbumin, vitamin B-12, folate, retinol, alpha-tocopherol,
hemoglobin, ferritin, and zinc concentrations were compared between
HIV-infected and HIV-negative mothers at 6, 14, and 24 weeks after delivery.
The authors also planned to control for acute phase response and therefore CRP
and alpha 1-acid glycoprotein were used as markers of an inflammatory process.
Data of 92 HIV-positive and 52 HIV-negative women were obtained. Mean albumin
and prealbumin were significantly lower in HIV-infected mothers, and a higher
proportion of these mothers had low albumin concentration (<35 g/L). Nearly
the half of all mothers were deficient in vitamin B12 or folate. Significantly
more HIV-positive than HIV-negative mothers had low vitamin B12 status
(p<.05), and mean folate concentrations were lower in HIV-infected mothers
(p=.05). After control for acute phase response mean serum retinol was
statistically lower among infected mothers. After 24 weeks alpha-tocopherol
deficiency was observed in a majority of women from both groups, but no
significant difference was noted by HIV status. Anemia was more prevalent
among HIV-infected women (p=.018), while 25% of all mothers had low serum
ferritin concentrations. Zinc deficiency was more common among infected women
(p=.05). This study brings biochemical evidence that multiple micronutrient
deficiencies are common among clinic attending South African breastfeeding
women between 6 and 24 weeks after delivery. This phenomen is observed
regardless of HIV status. Micronutrients deficiencies are associated with
disease progression, reduced CD4 cell counts, and increased morbidity and
mortality in HIV-positive persons. These data suggest that a multiple
micronutrient supplement is currently indicated for HIV-positive persons, at
least until an improved and diverse dietary intake is achievable.
Click here for Pubmed summary.
Semba RD, Ndugwa C, Perry RT et al. Effect of periodic vitamin A
supplementation on mortality and morbidity of human immunodeficiency
virus-infected children in Uganda: controlled clinical trial. Nutrition, 2005,
21: 25–31.
Click here for Pubmed summary.
Smith Fawzi MC, Kaaya SF, Mbwambo J et
al. Multivitamin supplementation in HIV-positive pregnant women: impact on
depression and quality of life in a resource-poor setting. HIV Medicine, 2007,
8(4): 203-212.
Major depression has been shown to be highly prevalent among HIV-positive
persons, and depressive symptoms or depression have been shown to be elevated
in HIV-positive and negative pregnant women attending prenatal, prevention of
mother-to-child transmission or other healthcare services. Therefore there is
a great need to identify strategies to improve the quality of life and related
psychosocial outcomes of those persons. According to cross-sectional studies
among HIV-negative population there is some evidence that micronutrients
(especially b-complex vitamins) could demonstrate a protective effect on
depression. The main objective of this study was to examine the effect of
vitamin supplementation on health-related quality of life and on the risk of
elevated depressive symptoms comparable to major depressive disorder in
HIV-positive pregnant women in Dar es Salaam, Tanzania. 1078 HIV-infected
pregnant women were enrolled in a double-blind, placebo-controlled trial. The
participants were not under antiretroviral treatment and received daily either
vitamin A alone, multivitamins excluding vitamin A, multivitamin plus vitamin
A or placebo. The effects of vitamin supplementation was assessed every 6-12
months. Depressive symptoms and health-related quality of life were measured
through validated questionnaires. Elevated depressive symptoms was observed
among 42% of the population. Multivitamin supplementation demonstrated a
protective effect on depression (RR=0.78, p=.005) and on some characteristcs
of quality of life. Vitamin A showed no effect on these outcomes. These
results could be explored further among patients who require antiretroviral
therapy.
Click here for Pubmed summary.
Stehbens WE. Oxidative stress in viral hepatitis and AIDS. Experimental
and Molecular Pathology, 2004, 77(2):121-132.
Click here for PubMed summary.
Tang AM et al. Micronutrients: current
issues for HIV care providers. AIDS, 2005, 19 (9); 847-861.
Up to now it remained unknown if pharmacologic doses of micronutrients was
safe, favorable or contra-indicated. Therefore this editorial review presents
critical questions about micronutrients supply in HIV context that have already
been answered and questions that need further research. It tries to identify new
issues dealing with the role of micronutrients in the face of a changing
epidemic. The paper presents evidences in both pre-Highly Active Anti Retroviral
Therapy (HAART) and HAART contexts.
Click here for Pubmed reference.
van Lettow M, Harries AD, Kumwenda JJ et
al. Micronutrient malnutrition and wasting in adults with pulmonary tuberculosis
with and without HIV co-infection in Malawi. BMC Infectious Diseases, 2004, 4:
61.
This cross sectional study investigates the interaction between
tuberculosis, micronutrients malnutrition and HIV viral load. The authors
hypothesized that micronutrient malnutrition is associated with wasting and
higher plasma HIV viral load in adults with pulmonary tuberculosis. They
included 579 HIV-positive antiretroviral naive adults and 222 HIV-negative
under antiretroviral therapy adults with pulmonary tuberculosis in Malawi.
Body Mass Index (BMI), plasma micronutrients and plasma viral load were
assessed. BMI allowed wasting severity levels classification. The risk of
micronutrient deficiencies was therefore examined at different severity levels
of wasting. Plasma viral load was inversely associated to BMI, plasma retinol,
carotenoid and selenium concentration. Vitamin A, zinc and selenium deficiency
were common (61%, 85% and 87% respectively). Wasting defined as BMI<18,5 was
also frequent (59%) and independantly associated with a higher risk of low
carotenoids, and vitamin A and selenium deficiency. Severe wasting, defined as
BMI <16,0 showed the strongest associations with deficiencies in vitamins A,
selenium and plasma carotenoids. The present results suggest that
micronutrients malnutrition and wasting are more severe in adults with
pulmonary tuberculosis who have higher HIV load. Longitudinal studies are
however required to support these results.
Click here for the
entire article.
Villamor E, Kapiga SH, Fawzi WW. Vitamin
A serostatus and heterosexual transmission of HIV: case-control study in
Tanzania and review of the evidence. International Journal for Vitamin and
Nutrition Research. 2006, 76(2):81-85.
The role of vitamin A/beta-carotene supplementation among HIV-infected
pregnant and lactating women has been fairly studied. The potential role of
vitamin A on heterosexual HIV transmission has only raised limited interest.
In many resource limited settings where both vitamin A deficiency and HIV
infection are highly prevalent this question may be highly relevant. This
article presents a case control study (n=72) among a cohort of HIV-negative
women attending family planning clinics in Tanzania. The authors aimed to
examine whether low serum concentrations at baseline were associated with the
risk of seroconversion. No significant association was detected (OR=2.14, 95%
CI=0.54, 8.45). According to this and other works, it seems there is not
enough evidence to suggest an association between vitamin A and an eventual
higher heterosexual HIV transmission.
Click here for Pubmed summary.
Villamor A, Aboud S, Koulinska IN et al.
Zinc supplementation to HIV-1-infected pregnant women: effects on maternal
anthropometry, viral load, and early mother-to-child transmission. European
Journal of Clinical Nutrition, 2006, 60(7): 862-869.
This double blind placebo controlled randomized clinical trial aims to
investigate the effect of zinc supplementation among HIV-infected pregnant
women. The outcomes of interest are viral load, early mother-to-child
transmission of HIV (MTCT) and wasting. 400 Tanzanian HIV-infected pregnant
women were randomly assigned to receive daily doses of 25 mg zinc or placebo
from the day of the first prenatal visit until 6 weeks after delivery.
Anthropometric measures were performed monthly and HIV status of babies was
assessed at birth and 6 weeks postpartum. Viral load was controlled in a
random sample of 100 women at baseline and at the end of the research. The
supply had no effects on maternal viral load or early MTCT. Zinc supplement
was associated with an increased risk of wasting (RR=2,7, 95% CI=1.1, 6.4,
p=.03) and to a 4 mm decline in mid upper arm circumference during the second
trimester (p=.02). These findings suggest that zinc supplementation does not
provide any benefits on viral load or MTCT and the clinical relevance of its
impact on mid upper arm circumference needs to be ascertain. Therefore these
data do not support addition of zinc supplements to the standard care of
prenatal care among HIV-infected pregnant women.
Click here for Pubmed summary.
Villamor E et al. Vitamin
supplementation of HIV-infected women improves postnatal child growth. American
Journal of Clinical Nutrition, 2005, 81(4):880-888.
Children born to HIV-infected women are frequently affected by linear growth
retardation and wasting. This randomized placebo controlled trial was set up in
the context of finding inexpensive interventions that could improve the
postnatal growth of those children. Its aim was to study the effect of
supplementing HIV-infected women with multivitamins (thiamine, riboflavin,
vitamin B6, niacin, folic acid, vitamin B12, vitamin C, vitamin E) or vitamin A
and beta-carotene, during and after pregnancy, on the growth of their children
during the first 2 years of life. The trial includes 886 mother-infant pairs in
Tanzania. It seems that multivitamins have a significant positive effect on
weight, weight-for-age and weight-for-length. Vitamin A and beta-carotene seems
to reduce benefits of the multivitamin. In conclusion the authors note that
multivitamin supply during pregnancy and lactation may have a positive impact on
ponderal growth in children born to HIV-infected mothers.
Click here for Pubmed summary.
Villamor E, Saathoff E, Manji K et al.
Vitamin supplements, socioeconomic status, and morbidity events as predictors of
wasting in HIV-infected women from Tanzania. American Journal of Clinical
Nutrition, 2005, 82(4): 857-865.
The effect of wasting in HIV-infected persons are diffcult to inverse, and
wasting has been described to be a strong predictor of mortality in those
persons. The exact sequence of events leading to wasting has not yet been
completely described. Vitamin supplements, a low cost means, have been
proposed to prevent disease progression. This randomized placebo controlled
trial aimed at investigating the effect of different daily oral multivitamin
regimens on wasting in HIV-infected women and to assess the effects of
sociodemographics characteristics, morbidity events, and immunologic
progression on the risk of wasting. 1078 Tanzanian HIV-infected women were
included to receive: multivitamins (B complex, C and E), vitamin A plus
beta-carotene, multivitamins that included vitamin A plus beta carotene, or
placebo. Endpoints included first episode of midupper arm circumference <22cm
or a BMI <18 and the incidence of weight loss episodes dring an average of 5
years of follow-up. Analysis was based on intention to treat. It occurs that
multivitamins alone significantly reduced the risk of a first episode of a low
mid-upper arm circumference. The age, education level and heigth were
inversely related to the incidence of wasting. Some morbidity characteristics,
such as diarrhea, nausea or vomiting, lower respiratory tract infections, oral
ulcers, thrush, severe anemia, and low CD4+ were related to a higher risk of
wasting. It seems that vitamin B and vitamins C and E reduce the risk of
wasting. The authors end with a call for further research analysing if
supplementation with doses resembling to the recommended dietary allowance
have the same benefit effects as the doses used in this study.
Click here for Pubmed Summary.
NEW! Webb AL, Aboud S, Furtado J et al.
Effect of vitamin supplementation on breast milk concentrations of retinol,
carotenoids and tocopherols in HIV-infected Tanzanian women. European Journal of
Clinical Nutrition, 2007, advanced online publication.
Click here for Pubmed summary.
WHO. Nutrition and HIV/AIDS. Geneva,
World Health Organization, 2005.
The Health Assembly, in resolution WHA57.14, called for integration of
nutrition into a comprehensive response to HIV/AIDS. This document is the
statement of the WHO consultation on nutrition and HIV/AIDS in Africa that took
place in Durban in April 2005. It proposes guidance for different nutrition
topics such as: macronutrients, micronutrients, pregnancy and lactation, infant
and young child feeding, interaction between nutrition and antiretroviral
therapy. It ends with recommendations for action, and stresses on nutrition as
an integral part of the response to HIV/AIDS in Africa.
Click
here for the entire article.
The goal of the consultation is available here.
Wiysonge CS, Shey MS, Sterne JAC et al.
Vitamin A supplementation for reducing the risk of mother-to-child transmission
of HIV infection. The Cochrane Database of Systematic Reviews 2005, Issue 4.
Art. No.: CD003648.pub2. DOI: 10.1002/14651858.CD003648.pub2.
This systematic review studied the effects of antenatal and intrapartum
vitamin A supplementation on the risk of mother to child transmission of HIV
infection. It also assesses the impact on infant and maternal mortality and
morbidity, and the tolerability of the supplement. The review included four
randomised controlled trials which enrolled 3033 HIV infected pregnant women.
The effect of vitamin A supplement on mother to child transmission of HIV
seems to be contradictory between studies. Two of them showed no different
effects compared to placebo and one showed significant negative effects.
Globally it seems that there was no evidence of an effect of vitamin A
supplementation on mother-to-child transmission (OR 1.14, 95% CI 0.93 to
1.38). On the other hand, there is evidence that vitamin A supplementation
significantly improved birth weight, but the effect on stillbirths, preterm
births, death by 24 months among live births, postpartum CD4 levels, and
maternal death remain not statistically different that from placebo. An
upcoming trial in Harare (Zimbabwe Vitamin A for Mothers and Babies Project),
including 4495 HIV infected pregnant women, will help to clarify the effect of
vitamin A supplementation on mother to child transmission of HIV. The authors
conclude that current available evidence does not support the use of vitamin A
supplementation in HIV-infected pregnant women to reduce MTCT of HIV, although
there is an indication that vitamin A supplementation improves birth weight.
Click here for Pubmed summary.
In this section you will find relevant documents older than 2004:
Batterham MJ et al. Calculating energy requirements in men with HIV/AIDS
in the era of highly active antiretroviral therapy. European Journal of Clinical
Nutrition, 2003, 57:209–17.
This cross sectional study had three aims. The first was to determine if the
energy expenditure adjusted for body composition is increased among HIV-infected
males under Highly Active Antiretroviral Therapy (HAART) when compared with non
HIV-positive. Secondly, to examine the precision of usual energy predicting
equations in the context of HIV. Thirdly, to determine if resting energy
expenditure adjusted with body composition was significantly different in
subgroups of HIV-infected individuals and healthy individuals. 70 HIV positive
and 16 control individuals were followed. The authors measure resting energy
expenditure by indirect calorimetry, and body composition by bioelectrical
impedance analysis. The authors find out that the energy expenditure adjusted
for body composition was increased among HIV-positive individuals compared to
controls. The equations used occurs not to be satisfactory, therefore the
authors developed an equation based on their subjects to account for body
composition abnormalities. They finally proposes when measuring resting energy
expenditure in HIV-positive males to adjust it to fat-free and fat mass.
Click here for the Pubmed summary.
Fawzi WW et al. Effect of providing vitamin supplements to human
immunodeficiency virus-infected, lactating mothers on the child's morbidity and
CD4+ cell counts. Clinical Infectious Diseases, 2003, 36(8):1053-1062.
In developing countries, where the prevalence of HIV/AIDS is high, mortality
and morbidity of children is an important public health problem, with diarrheal
and respiratory diseases being important causes. According to past studies,
these children seem to be at risk of micronutrients deficiency. Particularly
vulnerable are children born to HIV-infected women, regardless of whether the
children are themselves infected. The aim of this randomized placebo-controlled
trial was to examine the effect of supplementation of vitamin A (preformed
vitamin A and beta-carotene) and/or multivitamins (vitamins B, C and E) on
vertical transmission of HIV-1 and other health outcomes among women and
children. It occurs that children in the multivitamin arms seems to have a lower
risk of acute or watery diarrhea. Mothers receiving vitamin A implied a
significant decrease in the risk that the child would have a cough with a rapid
respiratory rate and thereafter pneumonia. The trial concluded that a
multivitamin supplement to HIV-infected women is a low cost means to improve
their children's health.
Click here for the entire article.
Fawzi WW. Micronutrients and human immunodeficiency virus type 1 disease
progression among adults and children. Clinical Infectious Diseases, 2003,
37(S2):112-116.
Nowadays trials have shown positive effect of vitamins B, C and E supplements
on the immune status of HIV-infected persons. This article examines, according
to observational and randomized trial data, the potential roles of
micronutrients in slowing HIV-1 disease progression. Relationships between
micronutrients status and HIV disease progression among adults and children are
presented in a clear table. The authors call for larger trials to examine the
efficacy of micronutrient supply on clinical outcomes and to find out if the
benefits are sustained after the first weeks of the trial. More data are as well
needed to justify the effect of trace elements like selenium and zinc, among
HIV- infected persons.
Click here for the entire article.
Jiamton S et al. A randomized trial of the impact of multiple
micronutrient supplementation on mortality among HIV-infected individuals living
in Bangkok. AIDS, 2003, 17(17):2461-2469.
The objective of this randomized placebo-controlled trial held in Bangkok was
to evaluate the impact of commercially available micronutrients on survival and
disease progression in HIV infected people. The authors considered this question
as a high public health importance because micronutrients are cheap and easily
tolerated. After analysis the authors found there was a lower death rate in the
micronutrient arm of the study, and it was statistically significant. On the
other hand there was no impact on CD4 cell count or plasma viral load. If the
clinical findings of this trial are confirmed by other studies, it may have
important public health implications in the developing world where access to
antiretroviral therapy remains poor.
Click here for the entire article.
Kupka R, Fawzi W. Zinc nutrition and HIV infection. Nutrition Reviews,
2002, 60(3): 69-79.
Click here for Pubmed summary.
McDermid JM et al. Associations between dietary antioxidant intake and
oxidative stress in HIV-seropositive and HIV-seronegative men and women. Journal
of Acquired Immune Deficiency Syndromes, 2002, 29(2): 158-164.
Click here for Pubmed summary.
Siberry GK, Ruff AJ, Black R. Zinc and human immunodeficiency virus
infection. Nutrition Research, 2002, 22(4):527-538.
Far less is known about the interactions between zinc and HIV/AIDS. Zinc
deficiency produces reversible immune dysfunction, particularly of
T-lymphocyte cell-mediated immunity. In developing countries where zinc
deficiency is prevalent, zinc supplementation has been shown to reduce
morbidity from respiratory and diarrheal illnesses. The relationship between
zinc and HIV infection has not been well delineated. Malabsorption, repeated
concurrent infections and increased losses probably increase zinc requirements
in HIV infection. Up to 2002, no randomized, placebo-controlled study of
moderate zinc supplementation in HIV infection has been published, and
therefore the authors call for a trial with a moderate zinc supplementation in
a population setting of high HIV prevalence and endemic zinc deficiency.
Click here
for a summary.
Singhal N, Austin J. A clinical review of micronutrients in HIV infection.
Journal of the International Association of Physicians in AIDS Care (Chicago,
Ill. : 2002), 2002, 1(2): 63-75.
This article reviews current literature on the role of micronutrients in
HIV infection. The reason for micronutrients deficiencies in HIV-infected
people are multiple: malabsorption, altered metabolism, gut infection, and
altered gut barrier function. There is an association of deficiencies of
micronutrients in HIV-infection with immune deficiency, rapid disease
progression, and mortality. Micronutrients research have been animated this
last few years, and it is possible that some micronutrients may be key factors
in maintaining health in HIV, and in reducing mortality. Clinical benefit of
supplementation with some micronutrients may be measurable in the presence of
pre-existing deficiency. Apart from improved general nutrition, the impact of
micronutrient supplements on health and their optimal use in HIV infection is
controversial because there are so few clinical controlled trials. The authors
support the fact that according to current knowledge the use of routine
multivitamin and trace element supplementation as adjuvant to conventional
antiretroviral drug treatment and as a relatively low-cost intervention may be
useful. The authors call for further research to elucidate the role of
micronutrient deficiencies on the course of HIV infection, and the preventive
and therapeutic role of supplementation in its clinical management.
Click here for
Pubmed summary.
WHO. Nutrient requirements for people living with HIV/AIDS: report of a
technical consultation. Geneva, World Health Organization, 2003.
This technical consultation reviews the relationship between nutrition and
HIV/AIDS infection, and the scientific evidence on the role of nutrition in HIV
transmission, disease progression, and morbidity. It provides recommendations
for nutritional requirements for people living with HIV/AIDS, and identifies
research priorities to support improved policies and programmes.
Click here
for the entire article. This publication can be ordered at:
bookorders@who.int
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