Micronutrient supplementation in adults with HIV infection

Abstract

Background Micronutrient deficiencies are common among adults living with HIV disease, particularly in low‐income settings where the diet may be low in essential vitamins and minerals. Some micronutrients play critical roles in maintenance of the immune system, and routine supplementation could therefore be beneficial. This is an update of a Cochrane Review previously published in 2010. Objectives To assess whether micronutrient supplements are effective and safe in reducing mortality and HIV‐related morbidity of HIV‐positive adults (excluding pregnant women). Search methods We performed literature searches from January 2010 to 18 November 2016 for new randomized controlled trials (RCTs) of micronutrient supplements since the previous review included all trials identified from searches prior to 2010. We searched the CENTRAL (the Cochrane Library), Embase, and PubMed databases. Also we checked the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and the ClinicalTrials.gov trials registers. We also checked the reference lists of all new included trials. Selection criteria We included RCTs that compared supplements that contained either single, dual, or multiple micronutrients with placebo, no treatment, or other supplements. We excluded studies that were primarily designed to investigate the role of micronutrients for the treatment of HIV‐positive participants with metabolic morbidity related to highly active antiretroviral therapy (HAART). Primary outcomes included all‐cause mortality, morbidity, and disease progression. Data collection and analysis Two review authors independently selected trials for inclusion, and appraised trial quality for risk of bias. Where possible, we presented results as risk ratios (RR) for dichotomous variables, as hazard ratios (HRs) for time‐to‐event data, and as mean differences (MD) for continuous variables, each with 95% confidence intervals (CIs). Since we were often unable to pool the outcome data, we tabulated it for each comparison. We assessed the certainty of the evidence using the GRADE approach. Main results We included 33 trials with 10,325 participants, of which 17 trials were new trials. Ten trials compared a daily multiple micronutrient supplement to placebo in doses up to 20 times the dietary reference intake, and one trial compared a daily standard dose with a high daily dose of multivitamins. Nineteen trials compared supplementation with single or dual micronutrients (such as vitamins A and D, zinc, and selenium) to placebo, and three trials compared different dosages or combinations of micronutrients. Multiple micronutrients We conducted analyses across antiretroviral therapy (ART)‐naive adults (3 trials, 1448 participants), adults on antiretroviral therapy (ART) (1 trial, 400 participants), and ART‐naive adults with concurrent active tuber...

Nutritional support to reduce mortality in patients with HIV?

“…treatment outcomes including mortality, but many have shown no effects or only modest beneficial effects. 3,4 In The Lancet HIV, Jane Mallewa and colleagues 5 report the results of a large multicentre clinical trial in HIV clinics in Kenya, Malawi, Uganda, and Zimbabwe in which the researchers tested whether ready-touse supplementary food (RUSF) reduced mortality in severely immunocompromised patients with HIV starting ART. The investigators randomly assigned 897 adults and children aged at least 5 years to peanutbased RUSF (1000 kcal per day) and 908 to no-RUSF (control) for 12 weeks and followed up for 48 weeks.…”

“…The effect of maraviroc intensification has also been modest and variable, with several trials showing no change in HIV persistence measures. 4,[11][12][13] It is difficult to compare these intensification studies. Many had small sample sizes or had varying participant demographics, ART regimens and timing, or DNA and RNA quantification methods.…”

Nutritional status and dietary diversity of school-age children living with HIV: a cross sectional study in Phnom Penh, Cambodia

“…Progressive stunting is considered the most common abnormality in children who were infected with HIV perinatally. Deficiencies of several micronutrients such as Vitamin A have been identified as an important factor negatively associated with growth [4,8].…”

Micronutrient Supplementation in Adults with HIV Infection: Cochrane Nursing Care Field – Cochrane Review Summary

“…Micronutrient deficiencies are common in people with HIV (Visser et al, 2017), particularly in low income countries where diets may be low in essential vitamins and minerals. Micronutrient deficiencies may be more pronounced in people with advanced HIV as a result of reduced dietary intake, opportunistic infections, diarrhoea and parasitic infections (Visser et al, 2017).…”

“…It is possible that vitamin and/or mineral supplementation may benefit people living with HIV by strengthening their immune system and helping them to recover from infections more quickly (Visser et al, 2017). However, a robust evidence base is needed to guide healthcare policy and practice.…”