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Micronutrient supplementation in children and adults with HIV infection.
Cochrane Database Syst Rev 2005; (4):CD003650CD

Abstract

BACKGROUND

The scale and impact of the HIV/AIDS pandemic has made the search for simple, affordable, safe, and effective public health interventions all the more urgent. Micronutrient supplements hold the promise of meeting these criteria, but their widespread use needs to be based on sound scientific evidence of effectiveness and safety.

OBJECTIVES

To assess whether micronutrient supplements are effective in reducing morbidity and mortality in adults and children with HIV infection.

SEARCH STRATEGY

The Cochrane Library (CENTRAL), EMBASE, MEDLINE, AIDSearch, CINAHL, and conference proceedings were searched, and pharmaceutical manufacturers and researchers in the field were contacted to locate any ongoing or unpublished trials.

SELECTION CRITERIA

Randomised controlled trials comparing the effects of micronutrient supplements (vitamins, trace elements, and combinations of these) with placebo or no treatment on mortality and morbidity in HIV-infected individuals.

DATA COLLECTION AND ANALYSIS

Two reviewers independently appraised trial quality and extracted data. Study authors were contacted for additional data where necessary. A meta-analysis was not deemed appropriate due to significant heterogeneity between trials.

MAIN RESULTS

Fifteen trials were included. Six trials comparing vitamin A/beta-carotene with placebo in adults failed to show any effects on mortality, morbidity, CD4 and CD8 counts, or on viral load. Four trials of other micronutrients in adults did not affect overall mortality, although there was a reduction in mortality in a low CD4 subgroup. In a large Tanzanian trial in pregnant and lactating women, daily multivitamin supplementation was associated with a number of benefits to both mothers and children: a reduction in maternal mortality from AIDS-related causes; a reduced risk of progression to stage four disease; fewer adverse pregnancy outcomes; less diarrhoeal morbidity; and a reduction in early-child mortality among immunologically- and nutritionally-compromised women. Vitamin A alone reduced all-cause mortality and improved growth in a small sub-group of HIV-infected children in one hospital-based trial, and reduced diarrhoea-associated morbidity in a small HIV-infected sub-group of infants in another trial.

AUTHORS' CONCLUSIONS

There is no conclusive evidence at present to show that micronutrient supplementation effectively reduces morbidity and mortality among HIV-infected adults. It is reasonable to support the current WHO recommendations to promote and support adequate dietary intake of micronutrients at RDA levels wherever possible. There is evidence of benefit of vitamin A supplementation in children. The long-term clinical benefits, adverse effects, and optimal formulation of micronutrient supplements require further investigation.

Authors+Show Affiliations

University of Cape Town, Paediatrics and Child Health - Child Health Unit, 46 Sawkins Rd, Rondebosch, Cape Town, South Africa 7700. jirlam@cormack.uct.ac.zaNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

16235333

Citation

Irlam, J H., et al. "Micronutrient Supplementation in Children and Adults With HIV Infection." The Cochrane Database of Systematic Reviews, 2005, p. CD003650.
Irlam JH, Visser ME, Rollins N, et al. Micronutrient supplementation in children and adults with HIV infection. Cochrane Database Syst Rev. 2005.
Irlam, J. H., Visser, M. E., Rollins, N., & Siegfried, N. (2005). Micronutrient supplementation in children and adults with HIV infection. The Cochrane Database of Systematic Reviews, (4), p. CD003650.
Irlam JH, et al. Micronutrient Supplementation in Children and Adults With HIV Infection. Cochrane Database Syst Rev. 2005 Oct 19;(4)CD003650. PubMed PMID: 16235333.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Micronutrient supplementation in children and adults with HIV infection. AU - Irlam,J H, AU - Visser,M E, AU - Rollins,N, AU - Siegfried,N, Y1 - 2005/10/19/ PY - 2005/10/20/pubmed PY - 2006/2/25/medline PY - 2005/10/20/entrez SP - CD003650 EP - CD003650 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 4 N2 - BACKGROUND: The scale and impact of the HIV/AIDS pandemic has made the search for simple, affordable, safe, and effective public health interventions all the more urgent. Micronutrient supplements hold the promise of meeting these criteria, but their widespread use needs to be based on sound scientific evidence of effectiveness and safety. OBJECTIVES: To assess whether micronutrient supplements are effective in reducing morbidity and mortality in adults and children with HIV infection. SEARCH STRATEGY: The Cochrane Library (CENTRAL), EMBASE, MEDLINE, AIDSearch, CINAHL, and conference proceedings were searched, and pharmaceutical manufacturers and researchers in the field were contacted to locate any ongoing or unpublished trials. SELECTION CRITERIA: Randomised controlled trials comparing the effects of micronutrient supplements (vitamins, trace elements, and combinations of these) with placebo or no treatment on mortality and morbidity in HIV-infected individuals. DATA COLLECTION AND ANALYSIS: Two reviewers independently appraised trial quality and extracted data. Study authors were contacted for additional data where necessary. A meta-analysis was not deemed appropriate due to significant heterogeneity between trials. MAIN RESULTS: Fifteen trials were included. Six trials comparing vitamin A/beta-carotene with placebo in adults failed to show any effects on mortality, morbidity, CD4 and CD8 counts, or on viral load. Four trials of other micronutrients in adults did not affect overall mortality, although there was a reduction in mortality in a low CD4 subgroup. In a large Tanzanian trial in pregnant and lactating women, daily multivitamin supplementation was associated with a number of benefits to both mothers and children: a reduction in maternal mortality from AIDS-related causes; a reduced risk of progression to stage four disease; fewer adverse pregnancy outcomes; less diarrhoeal morbidity; and a reduction in early-child mortality among immunologically- and nutritionally-compromised women. Vitamin A alone reduced all-cause mortality and improved growth in a small sub-group of HIV-infected children in one hospital-based trial, and reduced diarrhoea-associated morbidity in a small HIV-infected sub-group of infants in another trial. AUTHORS' CONCLUSIONS: There is no conclusive evidence at present to show that micronutrient supplementation effectively reduces morbidity and mortality among HIV-infected adults. It is reasonable to support the current WHO recommendations to promote and support adequate dietary intake of micronutrients at RDA levels wherever possible. There is evidence of benefit of vitamin A supplementation in children. The long-term clinical benefits, adverse effects, and optimal formulation of micronutrient supplements require further investigation. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/16235333/Micronutrient_supplementation_in_children_and_adults_with_HIV_infection_ L2 - https://doi.org/10.1002/14651858.CD003650.pub2 DB - PRIME DP - Unbound Medicine ER -