Advancing Sexual and Reproductive Health and Rights
 
International Family Planning Perspectives
Volume 30, Number 3, September 2004
DIGEST

Progression of HIV Disease in Pregnant Women Slowed by Daily Multivitamin Use

Pregnant women infected with HIV have a roughly one-third lower risk of developing AIDS or dying from AIDS-related causes if they take a daily multivitamin containing vitamin B complex, vitamin C and vitamin E, according to a randomized, double-blinded study in Tanzania.1 Compared with women taking a placebo, those taking the multivitamin also had reduced risks of HIV-related complications such as thrush and dysentery; in addition, they had more CD4+ immune cells and less virus in their blood. In contrast, women given vitamin A alone experienced few of these benefits, and women given vitamin A as well as the multivitamin had fewer and weaker benefits than their counterparts given only the multivitamin.

Between 1995 and 1997, researchers recruited pregnant women in the city of Dar es Salaam who had HIV disease of stages 1-3.* To assess the impact of micronutrient status on progression of the disease, they randomly assigned women to receive one of four daily oral supplements: a multivitamin excluding vitamin A (vitamins B1, B2, B6, B12, C and E), vitamin A (preformed vitamin A and beta carotene), the multivitamin plus vitamin A, or a placebo. Study participants in all four groups were also given folic acid and iron during pregnancy. The women had a physical examination and were questioned about symptoms every month, and blood samples were collected every six months.

On average, the 1,078 women included in the analyses were about 25 years old. Slightly more than three-fourths had had 5-8 years of education, and nearly 60% had had 1-3 prior pregnancies. Eight in 10 had stage 1 disease, and few, if any, were receiving antiretroviral therapy.

Pill counts revealed that women took 79% of the supplement pills as instructed during the study. The median duration of follow-up was nearly six years for assessment of death and five years for assessment of disease progression. The proportion of women who progressed to AIDS or died from AIDS-related causes was 25% in the multivitamin group, 26% in the multivitamin plus vitamin A group, 29% in the vitamin A group and 31% in the placebo group.

In regression analyses, compared with women in the placebo group, those in the multivitamin group had a significant reduction of nearly one-third in the risk of progression to AIDS or death from AIDS-related causes (relative risk, 0.7). In more-detailed analyses, women in this group had reduced risks of progression to AIDS (0.5) and of progression to disease of stage 3 or higher (0.7). These benefits were greatest in the first two years of multivitamin use.

In contrast, among women in the other two vitamin groups, the risk of progressing to AIDS or dying from AIDS-related causes was statistically indistinguishable from that in the placebo group. In more-detailed analyses, only the risk of progression to disease of stage 3 or higher for women who were given a multivitamin plus vitamin A was significantly reduced (relative risk, 0.8).

Compared with their counterparts in the placebo group, women in the multivitamin group had significantly reduced risks of a dozen HIV-related complications, including oral and gastrointestinal conditions such as thrush and dysentery (relative risks, 0.2-0.7); fatigue (0.6); rash (0.7); and acute upper respiratory tract infections (0.8). Women in the group given the multivitamin plus vitamin A had significant reductions in the risk of only five HIV-related complications (0.6-0.8), while women in the group given vitamin A alone did not have significant reductions in any.

On average, the concentration of CD4+ immune cells in blood was 11% higher in women taking a multivitamin and 9% higher in women taking a multivitamin plus vitamin A than in women taking a placebo. In addition, in a random subsample of 297 women, those in the multivitamin group had a viral load in their blood that was on average 4% lower than that among women in the placebo group, but viral load was not significantly altered in the other two vitamin groups.

Use of a multivitamin is an effective and inexpensive means of slowing the progression of HIV infection in women, the researchers contend, noting that a one-year supply of the multivitamin used in the study would have a retail cost of about $15 per person. They add that slowing progression in turn delays the need for antiretroviral therapy, which could save these drugs for later stages, avert drug-related side effects and reduce treatment costs. In conclusion, they recommend "that supplementation with the doses used in this trial be considered for HIV-infected persons before the initiation of antiretroviral therapy."

—S. London

REFERENCE

1. Fawzi WW et al., A randomized trial of multivitamin supplements and HIV disease progression and mortality. New England Journal of Medicine, 2004, 351(1):23-32.

*According to criteria of the World Health Organization, these stages are primary infection, clinically asymptomatic disease, symptomatic disease, and progression to AIDS.