Hiv Nutritional Supplements Articles & Resources

In this controlled trial conducted in Tanzania, 1075 HIV-infected pregnant women between 12 and 27 weeks' gestation were randomly assigned to receive vitamin A supplements, multivitamins without vitamin A, both supplements, or placebo for the remainder of their pregnancies. Vitamin A was singled out because previous studies of HIV-infected women had shown particularly high frequencies of biochemical deficiency of this vitamin. The vitamin A supplement contained 30 mg [Beta]-carotene plus 5000 IU preformed vitamin A. The multivitamin contained 20 mg thiamin, 20 mg riboflavin, 25 mg vitamin [.6] 100 mg niacin, 50 [micro] g vitamin [.12], 500 mg vitamin C, 30 mg vitamin E, and mg folic acid.

Among those women whose pregnancy outcome was known, fetal death, low birth weight, severe preterm birth, and small size for gestational age at birth were all significantly more common among women who did not receive multivitamins than among those who did. For each of these outcomes, the risk was decreased by at least one-third by multivitamin supplementation. Vitamin A supplementation had no significant effect on any of these outcomes. Multivitamin (but not vitamin A supplementation) resulted in significant increases in the mothers' CD4, CD8, and CD3 counts. The effect of supplementation on transmission of HIV from mother to child was not assessed.

These findings indicate that multivitamin supplementation may improve pregnancy outcomes and clinical status among HIV-infected pregnant women, at least in developing countries. The beneficial effect of multivitamins may be mediated through improvement in the mothers' immune status and hematological status or through increased placental weight. How the individual vitamins produce these effects is not understood, however. The authors suggest that poor absorption and increased vitamin A requirements among HIV-infected pregnant women might have explained the lack of effect of vitamin A. Higher doses of vitamin A might have a beneficial effect, but the possibility of teratogenicity from high-dose vitamin A supplementation must also be taken into consideration.

Vitamin supplementation is one of the few potential treatments for HIV-infected pregnant women that is sufficiently inexpensive for use in low-income populations. The results of this study suggest that this treatment may be of substantial benefit, although its effects on vertical transmission and clinical progression of HIV disease have not yet been determined.

Wafaie W. Fawzi, Gernard I. Msamanga, Donna Spiegelman et al, for the Tanzania Vitamin and HIV Infection Trial Team, Randomised Trial of Effects of Vitamin Supplements on Pregnancy Outcomes and T Cell Counts in HIV-1-Infected Women in Tanzania, Lancet 35](9114):1477-1482 (May 16,1998) [Correspondence: Dr Wafaie Fawzi, Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115]