Effectiveness of a multivitamin supplementation program among HIV-infected adults in Tanzania

Abstract

Objective: The objective of this study was to assess the effectiveness of a routine multivitamin supplementation program for adults living with HIV in Tanzania. Design: We conducted a retrospective cohort study of 67,707 adults enrolled in the Dar es Salaam HIV care and treatment program during 2004-2012. Methods: The Dar es Salaam HIV care and treatment program intended to provide all adult patients with multivitamin supplements (vitamins B-complex, C, and E) free of charge; however, intermittent stockouts and other implementation issues did not afford universal coverage. We use Cox proportional hazard models to assess the time-varying association of multivitamin supplementation with mortality and clinical outcomes. Results: The study cohort contributed 41,540 and 129,315 person-years of follow-up time to the ART-naïve and ART-experienced analyses, respectively. Among 48,207 ART-naïve adults, provision of multivitamins reduced the risk of mortality (adjusted hazard ratio (aHR): 0.69; 95%

Prescription of nutritional interventions to HIV patients in Dar es Salaam, Tanzania

“…Only 13% said they did not prescribe the previous week. Randomized trials and observational studies among ART-naïve and ART-experienced individuals have demonstrated that MMS reduces the risk of mortality, HIV disease progression, incident tuberculosis and immunologic failure (13; 38; 39; 40) . Micronutrient deficiencies are very common among PLHIV; often with multiple concurrent micronutrient deficiencies (41; 42) .…”

“…RCTs (21; 22; 23; 24) that have examined the impact of iron supplement use have tended to have small sample sizes, but have reported significant reduction in anemia and iron deficiency (23) , improvement in immunologic status (23) , but no effect on viral load (22) . In the pre-ART era, large randomized trials demonstrated that multivitamin supplementation improved the risk of hematologic outcomes, disease progression and death (13; 25) , and a recent prospective cohort study among PLHIV on HAART also found that multivitamin supplementation may be protective (26) .…”

Risk Factors for Alanine Aminotransferase Elevations in a Prospective Cohort of HIV-Infected Tanzanian Adults Initiating Antiretroviral Therapy

“…A recent implementation evaluation of a routine multivitamin supplementation program for adults enrolled in Dar es Salaam HIV care and treatment program determined that single-dose RDA multivitamins for adults on ART and multiple RDA multivitamins for ART-naïve patients were both associated with decreased risk of ALT elevations >40 IU/L. 34 Patients with varying degrees of liver dysfunction have increased oxidative stress, and it has been postulated that supplementation with vitamins E and C may counteract oxidative stress. 35,36 Nevertheless, there have been some reports that suggested higher rates of liver toxicity with higher doses of vitamin B, particularly niacin (vitamin B 3 ) that was used for treatment of various conditions such as hypercholesterolemia and skin diseases.…”

The dawn of repurposing vitamins as potential novel antimicrobial agents: A call for global emergency response amidst AMR crisis

“…There are limited studies on the potential antimicrobial role of vitamins in treatment of viral and parasitic infection especially of resistant strains. Nevertheless, several studies have supported the fact that vitamins A, B, C, D, and E might act synergistically or independently with both immunomodulatory and antimicrobial effect in treatment of both viral and parasitic infections like HIV/AIDs and Malaria 39–51 . One study specifically shown that vitamin C can inhibit blood stage plasmodium significantly via oxidative stress and suggested that this vitamin is effective enough in inhibiting even chloroquine or artemisinin‐resistant parasites 45 .…”

“…Nevertheless, several studies have supported the fact that vitamins A, B, C, D, and E might act synergistically or independently with both immunomodulatory and antimicrobial effect in treatment of both viral and parasitic infections like HIV/AIDs and Malaria. 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 One study specifically shown that vitamin C can inhibit blood stage plasmodium significantly via oxidative stress and suggested that this vitamin is effective enough in inhibiting even chloroquine or artemisinin‐resistant parasites. 45 Vitamin B3 also was found to have specific antimicrobial effect towards HIV 52 and Plasmodium falciparum , 53 African Trypanosomes 54 and showed antileshimanial activity in vitro.…”