Micronutrient supplements may enhance survival; research has implications for poor countries

Multiple micronutrient supplementation may enhance the survival of HIV-positive individuals with CD4 <200 cells/mm3 say researchers who conducted a randomised trial that enrolled 481 HIV-positive people in Thailand.

Sukhum Jiamton and colleagues in Bangkok, London and Quebec, conducted a randomised, placebo-controlled trial to examine the impact of high dose commercially available, multiple, micronutrient supplementation on survival and disease progression. Participants received either the supplement or a placebo for a period of 48 weeks, were examined clinically at 12-week intervals and CD4 counts were conducted at 24-week intervals. A subset had their plasma viral load recorded at 48 weeks.

Seventy-nine (16%) were lost to follow up and 23 (5%) died. The death rate was lower in the micronutrients arm with the mortality hazard ratios [95% confidence interval (CI)] of 0.53 (0.22-1.25; P = 0.1) overall and 0.37 (0.13-1.06; P = 0.052) and 0.26 (0.07-0.97; P = 0.03) among those with CD4 cell counts < 200 /mm3 and < 100 /mm3 respectively. The researchers report that there was no impact on CD4 cell count or plasma viral load.

The supplement used was a mix of vitamins and minerals in amounts higher than recommended daily allowances for healthy individuals, and consisted of vitamin A, betacarotene, vitamin D3, vitamin E, vitamin K, vitamin C, vitamin B1, vitamin B2, vitamin B6, vitamin B12, folacin, pantheothenic acid, iron, magnesium, manganese, zinc, iodine, copper, selenium, chromium and cystine.

The study said that since micronutrients are inexpensive and easily tolerated, their effect on the progression of HIV is an important public health question. The researchers concluded that the findings could have important public health implications in the developing world where access to antiretrovirals remains poor.

Jiamton S, Pepin J, Suttent R et al. A randomised trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok. AIDS. 2003 Nov 21;17(17):2461-2469.