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Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania.
Lancet. 1998 May 16; 351(9114):1477-82.Lct

Abstract

BACKGROUND

In HIV-1-infected women, poor micronutrient status has been associated with faster progression of HIV-1 disease and adverse birth outcomes. We assessed the effects of vitamin A and multivitamins on birth outcomes in such women.

METHODS

In Tanzania, 1075 HIV-1-infected pregnant women at between 12 and 27 weeks' gestation received placebo (n=267), vitamin A (n=269), multivitamins excluding vitamin A (n=269), or multivitamins including vitamin A (n=270) in a randomised, double-blind, placebo-controlled trial with a 2x2 factorial design. We measured the effects of multivitamins and vitamin A on birth outcomes and counts of T lymphocyte subsets. We did analyses by intention to treat.

RESULTS

30 fetal deaths occurred among women assigned multivitamins compared with 49 among those not on multivitamins (relative risk 0.61 [95% CI 0.39-0.94] p=0.02). Multivitamin supplementation decreased the risk of low birthweight (<2500 g) by 44% (0.56 [0.38-0.82] p=0.003), severe preterm birth (<34 weeks of gestation) by 39% (0.61 [0.38-0.96] p=0.03), and small size for gestational age at birth by 43% (0.57 [0.39-0.82] p=0.002). Vitamin A supplementation had no significant effect on these variables. Multivitamins, but not vitamin A, resulted in a significant increase in CD4, CD8, and CD3 counts.

INTERPRETATION

Multivitamin supplementation is a low-cost way of substantially decreasing adverse pregnancy outcomes and increasing T-cell counts in HIV-1-infected women. The clinical relevance of our findings for vertical transmission and clinical progression of HIV-1 disease is yet to be ascertained.

Authors+Show Affiliations

Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

9605804

Citation

Fawzi, W W., et al. "Randomised Trial of Effects of Vitamin Supplements On Pregnancy Outcomes and T Cell Counts in HIV-1-infected Women in Tanzania." Lancet (London, England), vol. 351, no. 9114, 1998, pp. 1477-82.
Fawzi WW, Msamanga GI, Spiegelman D, et al. Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet. 1998;351(9114):1477-82.
Fawzi, W. W., Msamanga, G. I., Spiegelman, D., Urassa, E. J., McGrath, N., Mwakagile, D., Antelman, G., Mbise, R., Herrera, G., Kapiga, S., Willett, W., & Hunter, D. J. (1998). Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet (London, England), 351(9114), 1477-82.
Fawzi WW, et al. Randomised Trial of Effects of Vitamin Supplements On Pregnancy Outcomes and T Cell Counts in HIV-1-infected Women in Tanzania. Lancet. 1998 May 16;351(9114):1477-82. PubMed PMID: 9605804.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. AU - Fawzi,W W, AU - Msamanga,G I, AU - Spiegelman,D, AU - Urassa,E J, AU - McGrath,N, AU - Mwakagile,D, AU - Antelman,G, AU - Mbise,R, AU - Herrera,G, AU - Kapiga,S, AU - Willett,W, AU - Hunter,D J, PY - 1998/5/30/pubmed PY - 1998/5/30/medline PY - 1998/5/30/entrez KW - Acquired Immunodeficiency Syndrome--women KW - Africa KW - Africa South Of The Sahara KW - Biology KW - Birth Weight KW - Body Weight KW - Correlation Studies KW - Delivery Of Health Care KW - Demographic Factors KW - Developing Countries KW - Diseases KW - Eastern Africa KW - English Speaking Africa KW - Fetal Death KW - Food Supplementation KW - Health KW - Health Services KW - Hiv Infections--women KW - Low Birth Weight KW - Mortality KW - Nutrition Programs KW - Physiology KW - Population KW - Population Characteristics KW - Population Dynamics KW - Pregnancy KW - Pregnancy Outcomes KW - Pregnant Women KW - Premature Birth KW - Primary Health Care KW - Reproduction KW - Research Methodology KW - Research Report KW - Statistical Studies KW - Studies KW - Tanzania KW - Viral Diseases KW - Vitamin A KW - Vitamins SP - 1477 EP - 82 JF - Lancet (London, England) JO - Lancet VL - 351 IS - 9114 N2 - BACKGROUND: In HIV-1-infected women, poor micronutrient status has been associated with faster progression of HIV-1 disease and adverse birth outcomes. We assessed the effects of vitamin A and multivitamins on birth outcomes in such women. METHODS: In Tanzania, 1075 HIV-1-infected pregnant women at between 12 and 27 weeks' gestation received placebo (n=267), vitamin A (n=269), multivitamins excluding vitamin A (n=269), or multivitamins including vitamin A (n=270) in a randomised, double-blind, placebo-controlled trial with a 2x2 factorial design. We measured the effects of multivitamins and vitamin A on birth outcomes and counts of T lymphocyte subsets. We did analyses by intention to treat. RESULTS: 30 fetal deaths occurred among women assigned multivitamins compared with 49 among those not on multivitamins (relative risk 0.61 [95% CI 0.39-0.94] p=0.02). Multivitamin supplementation decreased the risk of low birthweight (<2500 g) by 44% (0.56 [0.38-0.82] p=0.003), severe preterm birth (<34 weeks of gestation) by 39% (0.61 [0.38-0.96] p=0.03), and small size for gestational age at birth by 43% (0.57 [0.39-0.82] p=0.002). Vitamin A supplementation had no significant effect on these variables. Multivitamins, but not vitamin A, resulted in a significant increase in CD4, CD8, and CD3 counts. INTERPRETATION: Multivitamin supplementation is a low-cost way of substantially decreasing adverse pregnancy outcomes and increasing T-cell counts in HIV-1-infected women. The clinical relevance of our findings for vertical transmission and clinical progression of HIV-1 disease is yet to be ascertained. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/9605804/Randomised_trial_of_effects_of_vitamin_supplements_on_pregnancy_outcomes_and_T_cell_counts_in_HIV_1_infected_women_in_Tanzania_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S014067369804197X DB - PRIME DP - Unbound Medicine ER -