Research: FAWZI and colleagues,

Listed in Issue 35

Abstract

FAWZI and colleagues, Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA write that poor micronutrient status has been associated with faster progression of HIV-1 disease and adverse birth outcomes in HIV-1-infected women. The authors studied the effects of vitamin A and multivitamins upon birth outcomes in HIV-infected women.

Background

Methodology

The authors conducted a randomised, double-blind, placebo- controlled trial in which 1075 HIV-1-infected pregnant women, between 12-27 weeks gestation were assigned to one of the following groups: 1) placebo (n = 267); 2) vitamin A (n = 269); 3) multivitamins excluding vitamin A (n = 269); or 4) multivitamins including vitamin A (n = 270). Effects assessed were birth outcomes and T-lymphocyte subset counts.

Results

There were 30 foetal deaths among women in the multivitamin group compared to 49 in the group not given multivitamins (relative risk = 0.61). Multivitamin supplementation decreased the risk of low birthweight by 44%, severe preterm birth by 39%, and small size for gestational age at birth by 43% . Supplementation with vitamin A had no significant effect upon these variables. Multivitamins, but not vitamin A, resulted in a significant increase in CD4, CD8 and CD3 counts.

Conclusion

Supplementation with multivitamins is a low-cost way of substantially decreasing adverse pregnancy outcomes and increasing T-cell counts in HIV-1-infected women . The clinical relevance of these findings for vertical transmission and clinical progression of HIV-1 disease has yet to be determined.

References

Fawzi WW et al. Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet 351(9114): 1477-82. May 16 1998.

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