No benefit from high-dose multivitamins seen for HIV patients receiving antiretroviral therapy

October 16, 2012, Harvard School of Public Health

A new study by Harvard School of Public Health (HSPH) researchers suggests that, for HIV patients receiving highly active antiretroviral therapy (HAART) to treat HIV, there is no benefit from high- vs. standard-dose micronutrient supplementation—and that, in fact, high-dose supplements may cause harm. The study is the first large randomized trial to look at how high-dose multivitamin supplementation affects clinical outcomes among people on HAART.

The study appears in the October 17, 2012 issue of the (JAMA).

Previous studies have shown that high doses of supplemental micronutrients help that are not receiving HAART reduce disease progression and death, thus prolonging the time before HAART initiation is needed. The HSPH researchers wanted to know if high-dose multivitamin supplementation would provide a similar benefit for HIV patients on HAART; although HAART undoubtedly has major benefits, recovery of the immune system is incomplete, and the risks of mortality and remain high especially in the first few months after HAART initiation.

The researchers, including lead author Sheila Isanaka, research fellow in the HSPH Department of Nutrition, and senior author Wafaie Fawzi, professor of nutrition, epidemiology, and global health and chair of the Department of Global Health and Population at HSPH, studied a group of 3,418 patients with HIV who started HAART between November 2006 and November 2008 in seven clinics in Dar es Salaam, Tanzania. Half of the patients received high doses of supplements including vitamin B complex, vitamin C, and vitamin E; the other half received standard doses at the recommended dietary allowance level for a median duration of 15 months.

The results showed that high-dose supplementation had no effect on several key measures that reveal HIV disease progression—CD4 count, plasma , , or concentration—and did not reduce death or disease progression risks for HIV-infected patients. In addition, the researchers found that high doses of multivitamins increased patients' risk of having elevated levels of ALT, an enzyme associated with liver problems and other serious conditions.

"Although the provision of high-dose vitamin supplements has been found safe and efficacious among HIV-infected patients not receiving HAART, the results from this study show that the safety and efficacy of nutritional interventions in the context of potent combination therapies such as HAART need to be further examined," said Fawzi.

"This study provides no clear evidence of a benefit of high-dose micronutrient supplementation compared to standard-dose supplementation in adults receiving HAART, but it highlights the need for further research on how micronutrient supplements can be better positioned alongside antiretroviral drugs to reduce morbidity and mortality due to HIV," said Isanaka.

Micronutrients are key factors in maintaining immune function and neutralizing oxidative stress, and future studies could examine whether micronutrient supplements might be of benefit if they are offered with food, or given in lower doses, or given only after HIV patients have acclimated to HAART therapy, she said.

Explore further: HIV treatment use increases in the US

More information: "Effect of High-Dose vs Standard-Dose Multivitamin Supplementation at the Initiation of HAART on HIV Disease Progression and Mortality in Tanzania: A Randomized Controlled Trial," Sheila Isanaka, Ferdinand Mugusi, Claudia Hawkins, Donna Spiegelman, James Okuma, Said Aboud, Chalamilla Guerino, and Wafaie Fawzi, JAMA, October 17, 2012, Vol. 208, No. 15

Related Stories

HIV treatment use increases in the US

September 3, 2012
Between 2000 and 2008, the proportion of HIV-infected patients in the U.S. receiving effective treatment known as highly active antiretroviral therapy (HAART) increased, and HIV-infected patients appeared to be less infectious ...

New study adds further guidance on when to start antiretroviral therapy for HIV

September 26, 2011
One of the key decisions faced by people living with HIV, and by their health-care providers, is when to start treatment.

Study finds HIV-infected men at risk for spreading HIV despite taking HAART

March 27, 2012
Researchers from Boston University School of Medicine (BUSM) and Fenway Health have found that highly active antiretroviral therapy (HAART) does not completely suppress HIV in the semen of sexually active HIV-infected men ...

Recommended for you

HIV-1 genetic diversity is higher in vaginal tract than in blood during early infection

January 18, 2018
A first-of-its-kind study has found that the genetic diversity of human immunodeficiency virus type 1 (HIV-1) is higher in the vaginal tract than in the blood stream during early infection. This finding, published in PLOS ...

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

Usage remains low for pill that can prevent HIV infection

January 8, 2018
From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which—in their view—remains woefully ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.