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Micronutrients in HIV: a Bayesian meta-analysis.
PLoS One 2015; 10(4):e0120113Plos

Abstract

BACKGROUND

Approximately 28.5 million people living with HIV are eligible for treatment (CD4<500), but currently have no access to antiretroviral therapy. Reduced serum level of micronutrients is common in HIV disease. Micronutrient supplementation (MNS) may mitigate disease progression and mortality.

OBJECTIVES

We synthesized evidence on the effect of micronutrient supplementation on mortality and rate of disease progression in HIV disease.

METHODS

We searched MEDLINE, EMBASE, the Cochrane Central, AMED and CINAHL databases through December 2014, without language restriction, for studies of greater than 3 micronutrients versus any or no comparator. We built a hierarchical Bayesian random effects model to synthesize results. Inferences are based on the posterior distribution of the population effects; posterior distributions were approximated by Markov chain Monte Carlo in OpenBugs.

PRINCIPAL FINDINGS

From 2166 initial references, we selected 49 studies for full review and identified eight reporting on disease progression and/or mortality. Bayesian synthesis of data from 2,249 adults in three studies estimated the relative risk of disease progression in subjects on MNS vs. control as 0.62 (95% credible interval, 0.37, 0.96). Median number needed to treat is 8.4 (4.8, 29.9) and the Bayes Factor 53.4. Based on data reporting on 4,095 adults reporting mortality in 7 randomized controlled studies, the RR was 0.84 (0.38, 1.85), NNT is 25 (4.3, ∞).

CONCLUSIONS

MNS significantly and substantially slows disease progression in HIV+ adults not on ARV, and possibly reduces mortality. Micronutrient supplements are effective in reducing progression with a posterior probability of 97.9%. Considering MNS low cost and lack of adverse effects, MNS should be standard of care for HIV+ adults not yet on ARV.

Authors+Show Affiliations

Foundation for Integrative AIDS Research, Brooklyn, NY, United States of America.Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.Teachers College, Columbia University, New York, NY, United States of America.Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, United States of America.Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25830916

Citation

Carter, George M., et al. "Micronutrients in HIV: a Bayesian Meta-analysis." PloS One, vol. 10, no. 4, 2015, pp. e0120113.
Carter GM, Indyk D, Johnson M, et al. Micronutrients in HIV: a Bayesian meta-analysis. PLoS ONE. 2015;10(4):e0120113.
Carter, G. M., Indyk, D., Johnson, M., Andreae, M., Suslov, K., Busani, S., ... Sacks, H. S. (2015). Micronutrients in HIV: a Bayesian meta-analysis. PloS One, 10(4), pp. e0120113. doi:10.1371/journal.pone.0120113.
Carter GM, et al. Micronutrients in HIV: a Bayesian Meta-analysis. PLoS ONE. 2015;10(4):e0120113. PubMed PMID: 25830916.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Micronutrients in HIV: a Bayesian meta-analysis. AU - Carter,George M, AU - Indyk,Debbie, AU - Johnson,Matthew, AU - Andreae,Michael, AU - Suslov,Kathryn, AU - Busani,Sudharani, AU - Esmaeili,Aryan, AU - Sacks,Henry S, Y1 - 2015/04/01/ PY - 2014/07/29/received PY - 2015/02/04/accepted PY - 2015/4/2/entrez PY - 2015/4/2/pubmed PY - 2015/12/24/medline SP - e0120113 EP - e0120113 JF - PloS one JO - PLoS ONE VL - 10 IS - 4 N2 - BACKGROUND: Approximately 28.5 million people living with HIV are eligible for treatment (CD4<500), but currently have no access to antiretroviral therapy. Reduced serum level of micronutrients is common in HIV disease. Micronutrient supplementation (MNS) may mitigate disease progression and mortality. OBJECTIVES: We synthesized evidence on the effect of micronutrient supplementation on mortality and rate of disease progression in HIV disease. METHODS: We searched MEDLINE, EMBASE, the Cochrane Central, AMED and CINAHL databases through December 2014, without language restriction, for studies of greater than 3 micronutrients versus any or no comparator. We built a hierarchical Bayesian random effects model to synthesize results. Inferences are based on the posterior distribution of the population effects; posterior distributions were approximated by Markov chain Monte Carlo in OpenBugs. PRINCIPAL FINDINGS: From 2166 initial references, we selected 49 studies for full review and identified eight reporting on disease progression and/or mortality. Bayesian synthesis of data from 2,249 adults in three studies estimated the relative risk of disease progression in subjects on MNS vs. control as 0.62 (95% credible interval, 0.37, 0.96). Median number needed to treat is 8.4 (4.8, 29.9) and the Bayes Factor 53.4. Based on data reporting on 4,095 adults reporting mortality in 7 randomized controlled studies, the RR was 0.84 (0.38, 1.85), NNT is 25 (4.3, ∞). CONCLUSIONS: MNS significantly and substantially slows disease progression in HIV+ adults not on ARV, and possibly reduces mortality. Micronutrient supplements are effective in reducing progression with a posterior probability of 97.9%. Considering MNS low cost and lack of adverse effects, MNS should be standard of care for HIV+ adults not yet on ARV. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/25830916/full_citation L2 - http://dx.plos.org/10.1371/journal.pone.0120113 DB - PRIME DP - Unbound Medicine ER -