The Effect of Multiple Micronutrient Supplementation on Mortality and Morbidity of HIV-Infected Adults: A Meta-Analysis of Randomized Controlled Trials

Abstract

Summary Numerous preclinical studies have suggested that micronutrient status is associated with the progression of human immunodeficiency virus (HIV) disease, but results from observational studies are still controversial. The objective was to systematically review the efficacy of multiple micronutrient supplementation on mortality and morbidity in HIVinfected adults. A comprehensive search of the PubMed/MEDLINE, EMBASE and Cochrane Library was performed. Six randomized controlled trials assessing the effect of multiple micronutrient supplementation on HIV-infected adults were included. Relative risk was used as an effect measure to compare the intervention and control groups with fixed-effects or random effects models. Sensitivity analyses were applied to further evaluate heterogeneity. Multiple micronutrient supplementation decreased the mortality and morbidity of HIVinfected adults nonstatistically significantly (RR ϭ 0.90; 95% CI, 0.80 to 1.02; p ϭ 0.09). Sensitivity analyses revealed that multiple micronutrient supplementation decreased the mortality and morbidity of adults infected with HIV alone statistically significantly (RR ϭ 0.75; 95% CI, 0.58 to 0.95; p ϭ 0.02), but not adults infected with both HIV and pulmonary tuberculosis (RR ϭ 0.97; 95% CI, 0.84 to 1.11; p ϭ 0.65). Multiple micronutrient consumption was correlated with reduction of the mortality and morbidity of HIV-infected adults, at least those in developing countries and infected with HIV alone, and should be prescribed by local doctors for those in earlier stages especially.

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

“…Our finding that programmatic provision of multivitamins reduces mortality and improves care outcomes for ART-naive patients aligns with the findings of multiple randomized placebo-controlled trials [7][8][9][10][11]. Most countries and programs in sub-Saharan Africa have shifted to a 'Test-and-Treat' strategy for ART initiation, including Tanzania in 2016.…”

“…Africa and are known to impact immune responses [5,6]. Randomized trials among ART-naïve populations have found that multivitamin supplements reduce mortality, disease progression, CD4 T-cell decline, and viral load [7][8][9][10]. A recent randomized trial conducted in Botswana determined pre-ART multivitamins containing vitamins B, C, E, and selenium approximately halved the risk of HIV progression or CD4 T-cell decline below the ART initiation threshold of 250 cells/µL [11].…”

Noncommunicable Diseases in HIV Infection in Low- and Middle-Income Countries

“…However, a recent meta-analysis 83 suggests that vitamin A reduces mortality in HIV-infected children and selenium has beneficial effects on CD4 counts; in addition a clinical trial in Zambia showed a beneficial effect of multiple micronutrients on mortality in adults 84 . The mortality benefit was more robust in another, more comprehensive review, which showed that multiple micronutrients significantly reduced mortality in patients without TB (RR 0.75; 95%CI 0.58-0.95) 85 . In addition to selenium, zinc supplementation may also have benefits for CD4 counts in adults 86 .…”

Micronutrients in HIV Infection Without HAART

“…A recent meta-analysis of six RCTs [10,[131][132][133][134][135] evaluated the impact of multiple micronutrient supplementation on mortality and morbidity of HIV-infected adults living in developing countries [136]. The authors found a nonsignificant reduction in mortality and morbidity in subjects receiving supplementation (RR, 0.9; 95% CI, 0.8-1.02).…”