Symposium: Women’s Voices, Women’s Choices:
The Challenge of Nutrition and HIV/AIDS
Studies of Vitamins and Minerals and HIV Transmission and Disease
Wafaie Fawzi,*†3Gernard Msamanga,‡Donna Spiegelman,†** and David J. Hunter*†
Departments of *Nutrition,†Epidemiology, and **Biostatistics, Harvard School of Public Health, Boston, MA, and
‡Department of Community Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
HIV-related adverse health outcomes contribute to a vicious cycle that may be slowed down by using nutritional
interventions, including vitamins and minerals. Among children, periodic supplementation with vitamin A starting at
6 mo of age has been shown to be beneficial in reducing mortality and morbidity among both HIV-infected and
uninfected children. Limited data exist on the role of other nutrient supplements among children. Among HIV-
infected adults, the safety and the efficacy of vitamin A supplements need further study, although adequate dietary
intake of this essential nutrient is recommended. Multivitamin supplements were efficacious in reducing adverse
pregnancy outcomes and early childhood infections, and is currently provided to pregnant HIV-infected pregnant
women in many programs. The efficacy of such supplements among HIV-negative pregnant women needs further
study. Daily multivitamin supplements were found to reduce HIV disease progression among men and women in
several observational studies and randomized trials, and to provide an important low-cost intervention that could
be provided to adults in early stages of HIV disease to prolong the time before antiretroviral therapy is recom-
mended. Next, research priorities include examining the roles of minerals, including selenium, in HIV infection, as
well as determining the safety and the efficacy of micronutrient supplements among individuals who are advanced
in their disease and who are receiving antiretroviral therapy.
HIV-1 infection is having a devastating impact on people in developing countries. Poor nutrition and
J. Nutr. 135: 938–944, 2005.
● HIV infection ● vitamins ● zinc ● selenium ● mortality
HIV-1 infection is having a devastating impact on many
developing countries. As of the end of 2003, ?38 million people
were living with HIV/AIDS (1). New infections totaled 5
million in 2003, and 3 million HIV-related deaths occurred in
the same year; ?20 million people have died since the begin-
ning of the epidemic in 1981. The most heavily affected
geographical region is sub-Saharan Africa, which is home to
about 66% (or ?25 million) of the world’s total number of
persons with HIV/AIDS. Over 80% of women living with
HIV/AIDS worldwide reside in sub-Saharan Africa. Mother-
to-child transmission of HIV-1 occurs in 30–45% of cases in
the region. Further, sub-Saharan Africa accounted for ?90%
of the children orphaned by AIDS. The epidemic is expanding
rapidly in Asia, particularly in south/southeast Asia; the region
hosts about 7 million people with HIV/AIDS.
Poor nutrition and HIV disease progression are part of a
vicious cycle that contributes to further deterioration of the
health of patients and that ultimately leads to mortality. It is
established that HIV infection can lead to undernutrition,
including micronutrient deficiencies and lean body mass de-
pletion through decreased food intake, malabsorption, and
increased utilization and excretion of nutrients (2). In this
paper, key evidence from epidemiologic studies that support
the prospective associations between micronutrient status and
immunologic and clinical outcomes will be reviewed. Com-
prehensive reviews on the subject were published (3,4), hence,
the latest findings on the role of vitamins and minerals among
HIV-infected individuals in developing countries will be pro-
vided in the context of a brief overview of the literature.
Vitamins and HIV disease progression
Lower plasma levels of vitamin A (5), vitamin E (6), and
vitamin B-12 (7) were related to faster disease progression.
1Presented as part of the symposium “Women’s Voices, Women’s Choices:
The Challenge of Nutrition and HIV/AIDS” given at the 2004 Experimental Biology
meeting on April 20, 2004, Washington, DC. The symposium was sponsored by
the American Society for Nutritional Sciences and in part by the Society for
International Nutrition Research. The proceedings are published as a supplement
to The Journal of Nutrition. This supplement is the responsibility of the Guest
Editors to whom the Editor of The Journal of Nutrition has delegated supervision
of both technical conformity to the published regulations of The Journal of
Nutrition and general oversight of the scientific merit of each article. The opinions
expressed in this publication are those of the authors and are not attributable to
the sponsors or the publisher, editor, or editorial board of The Journal of Nutrition.
The Guest Editors for the symposium publication are Margaret E. Bentley, Uni-
versity of North Carolina, Chapel Hill, NC, and Ellen Piwoz, Academy for Educa-
tional Development, Washington, DC.
2This work is supported in part by the National Institute of Child Health and
Human Development (R01 HD32257), the National Institute of Allergy and Infec-
tious Diseases (U01 AI45441) and the Fogarty International Center (D43
3To whom correspondence should be addressed.
0022-3166/05 $8.00 © 2005 American Society for Nutritional Sciences.
by on November 17, 2006
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by on November 17, 2006