Micronutrients in HIV: A Bayesian Meta-Analysis

Abstract

BackgroundApproximately 28.5 million people living with HIV are eligible for treatment (CD4<500), but currently have no access to antiretroviral therapy. Reduced serum level of micronutrients is common in HIV disease. Micronutrient supplementation (MNS) may mitigate disease progression and mortality.ObjectivesWe synthesized evidence on the effect of micronutrient supplementation on mortality and rate of disease progression in HIV disease.MethodsWe searched MEDLINE, EMBASE, the Cochrane Central, AMED and CINAHL databases through December 2014, without language restriction, for studies of greater than 3 micronutrients versus any or no comparator. We built a hierarchical Bayesian random effects model to synthesize results. Inferences are based on the posterior distribution of the population effects; posterior distributions were approximated by Markov chain Monte Carlo in OpenBugs.Principal FindingsFrom 2166 initial references, we selected 49 studies for full review and identified eight reporting on disease progression and/or mortality. Bayesian synthesis of data from 2,249 adults in three studies estimated the relative risk of disease progression in subjects on MNS vs. control as 0.62 (95% credible interval, 0.37, 0.96). Median number needed to treat is 8.4 (4.8, 29.9) and the Bayes Factor 53.4. Based on data reporting on 4,095 adults reporting mortality in 7 randomized controlled studies, the RR was 0.84 (0.38, 1.85), NNT is 25 (4.3, ∞).ConclusionsMNS significantly and substantially slows disease progression in HIV+ adults not on ARV, and possibly reduces mortality. Micronutrient supplements are effective in reducing progression with a posterior probability of 97.9%. Considering MNS low cost and lack of adverse effects, MNS should be standard of care for HIV+ adults not yet on ARV.

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“…We found in previous systematic reviews and meta-analyses (Andreae 2012; Andreae 2015; Carter 2015) that studies that are otherwise homogeneous enough to justify their synthesis may report their outcome of interest slightly differently, which may preclude simple data synthesis with RevMan (RevMan 5.3) (e.g. reporting pain outcomes as continuous outcomes in one study, but as dichotomous outcomes in another).…”

“…reporting pain outcomes as continuous outcomes in one study, but as dichotomous outcomes in another). If outcome reporting is too disparate and varied for pooling of aggregated data in a classic meta-analysis using RevMan (RevMan 5.3), we will consider alternative statistical approaches, including IPD meta-analysis (Stewart 2011) and Bayesian evidence synthesis (Carter 2015; Sutton 2000), or a combination thereof (Andreae 2015; Young 2008). In particular, we may estimate the SMD from dichotomous published data or outcomes in different cognitive domains when relevant data are not available from primary study authors and will feed these study level estimates into a comprehensive hierarchical model to estimate the overall pooled effect, for example, in the update of Andreae 2012, as often, study authors were not able to provide individual data for all studies, precluding a meta-analysis based only on IPD from all studies.…”

Genetic Analysis of HIV-1 in Japan: a Comprehensive Analysis of Donated Blood

“…Although diagnostic testing and combined antiretroviral therapy (cART) for human immunodeficiency virus (HIV)-1 infections have improved considerably (1,2), the prevention of future HIV-1 infection remains a global concern, and substantial effort has been focused on reducing infection rates (3)(4)(5)(6)(7)(8). To develop effective preventive measures against HIV-1 epidemics, it is important to understand regional circulation of these viruses.…”

Las deficiencias más significativas de macro y micro nutrientes en adolescentes que viven con el VIH/sida en terapia anti-retroviral

“…Carter et al (26) in a meta-analysis on the micronutrients in HIV noted that studies report that those micronutrients are supplemented in the diet, providing no information on their intake as food. Our work is among the pioneers in the approach to those micronutrients in food intake.…”