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Micronutrient supplementation in children and adults with HIV infection (Review)

Primary Health Care Directorate, University of Cape Town, E47 OMB, Groote Schuur Hospital, Cape Town, Western Cape, South Africa, 7925.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 01/2010; 12(12):CD003650. DOI: 10.1002/14651858.CD003650.pub3
Source: PubMed

ABSTRACT Micronutrient deficiencies are widespread and compound the effects of HIV disease; micronutrient supplements may be effective and safe in reducing this burden.
To assess whether micronutrient supplements are effective and safe in reducing mortality and morbidity in adults and children with HIV infection.
The CENTRAL, EMBASE, PubMed, and GATEWAY databases were searched for randomised controlled trials of micronutrient supplements using the search methods of the Cochrane HIV/AIDS Group.
Randomised controlled trials were selected that compared the effects of micronutrient supplements (vitamins, trace elements, and combinations of these) with other supplements, placebo or no treatment on mortality, morbidity, pregnancy outcomes, immunologic indicators, and anthropometric measures in HIV-infected adults and children. Any adverse effects of supplementation were recorded.
Two reviewers independently selected trials, appraised trial quality for risk of bias using standardised criteria, and extracted data using standardised forms.
Sixteen additional trials are included in this update to the original Cochrane review (Irlam 2005). Overall, 30 trials involving 22 120 participants are reviewed: 20 trials of single supplements (vitamin A, vitamin D, zinc, selenium) and 10 of multiple micronutrients. Eight trials were undertaken in child populations.None of the six trials of vitamin A or beta-carotene supplementation in adults demonstrated any significant reduction in HIV disease progression. Vitamin A halved all-cause mortality in a meta-analysis of three trials in African children, had inconsistent impacts on diarrhoeal and respiratory morbidity, and improved short-term growth in one trial. No significant adverse effects of vitamin A in adults or children have been reported.Zinc supplements reduced diarrhoeal morbidity and had no adverse effects on disease progression in a single safety trial in South African children. No significant clinical benefits were found from zinc supplementation of pregnant Tanzanian women or Peruvian adults with persistent diarrhoea.Selenium reduced diarrhoeal morbidity in pregnant women in Tanzania, and reduced viral load in two separate small trials in American adults.Single trials of vitamin D supplements in adults, and in adolescents and children, demonstrated safety but no clinical benefits.Multiple micronutrient supplements conferred multiple clinical benefits to pregnant women and their offspring in a large Tanzanian trial. Supplementation in another Tanzanian trial reduced the recurrence of pulmonary TB and increased weight gain in co-infected patients. No significant adverse effects were reported.
Multiple micronutrient supplements reduced morbidity and mortality in HIV-infected pregnant women and their offspring and also improved early child growth in one large randomised controlled trial in Africa. Additional research is needed to determine if these are generalisable findings. Vitamin A supplementation is beneficial and safe in HIV-infected children, but further evidence is needed to establish if supplementation confers similar benefits in HIV-infected adults. Zinc is safe in HIV-infected adults and children. It may have similar benefits in HIV-infected children and adults, and uninfected children with diarrhoea, as it does in HIV-uninfected children.Further trials of single supplements (vitamin D, zinc, and selenium) are required to build the evidence base. The long-term clinical benefits, adverse effects, and optimal formulation of multiple micronutrient supplements require further investigation in individuals with diverse disease status.

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    • "In order to assess whether micronutrient supplements are effective and safe in reducing mortality and morbidity in adults and children with HIV-1 infection, 30 randomized controlled trials were selected that compared the effects of micronutrient supplements (vitamins, trace elements, and combinations of these) with other supplements, placebo or no treatment on mortality, morbidity, pregnancy outcomes, immunologic indicators, and anthropometric measures in HIV-1 infected adults and children (Irlam et al, 2005, 2010). Any adverse effects of supplementation were recorded in 30 trials involving 22,120 participants: 20 trials of single supplements (vitamin A, vitamin D, zinc, selenium) and 10 of multiple micronutrients. "
    HIV and AIDS - Updates on Biology, Immunology, Epidemiology and Treatment Strategies, 10/2011; , ISBN: 978-953-307-665-2
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    Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2008; 28(5):479-82. · 1.44 Impact Factor
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    ABSTRACT: To determine daily intakes of selected nutrients and factors associated with the suboptimal intakes of these nutrients among young HIV-positive (HIV+) pregnant women. Eighty-five young HIV+ pregnant women were recruited from three hospitals in Ghana and were interviewed after informed consent. Dietary intake was quantified using the 24-hour recall technique. Total intake, calculated based on dietary recall, and adequacy of intake, calculated based on intake levels compared to the RDA, were assessed. Factors potentially associated with intake were tested using the Mann Whitney U test. The median daily intakes of the nutrients of interest were as follows: Protein (63.1 g), Vitamin C (106 mg), Zinc (11.7 mg), Iron (22.2 mg), and Selenium (1.4 μg). The prevalence of inadequacy of these nutrients were: Vitamin C (35.3%), Protein (39.7%), Iron (72.9%), Selenium (97.6%), and Zinc (100%). HIV + women with nausea, vomiting, and oral lesions had significantly lower intakes of Protein, Iron and Zinc (p < 0.05). Inadequacy of dietary intake is very prevalent among this group of pregnant women particularly among those with nausea, vomiting, and oral lesions. These conditions could be significant contributors to the burden of nutrient deficiencies among women infected with HIV in this setting. Since deficiencies of these nutrients during pregnancy could lead to adverse pregnancy outcomes, emphasis on the dietary sources of these nutrients such as fish, peas, nuts, kontomire, whole grain cereals, seafood, onions, milk, garlic, alfalfa, mushrooms, and banana should be made during antenatal counseling.
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