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Cheap Multivitamins Slow HIV's Progress

Help delay onset of AIDS in Africans who can't afford drugs

WEDNESDAY, June 30, 2004 (HealthDayNews) -- Daily multivitamins helped HIV-positive African women stay healthier longer when they had no access to drugs to fight the virus, new research has found.

While vitamin supplements are no substitute for HIV-suppressing medications such as antiretroviral drugs, they may be a cheap, effective means of at least delaying the onset of AIDS, according to experts.

"Women who received multivitamins were less likely to progress to advanced stages of HIV disease. They were less likely to die during the study period, they had fewer symptoms of late-stage infections such as mouth infections, mouth ulcers or diarrheal diseases. They also had better immune status and less amount of virus in the blood," said study author Wafaie Fawzi, a nutritionist and epidemiologist at Harvard University School of Public Health.

The findings appear in the July 1 issue of the New England Journal of Medicine.

While antiretroviral drugs help HIV-positive individuals in affluent countries stay relatively healthy, most of the world's 40 million people living with HIV are not so lucky. Without access to these expensive medications, HIV wreaks havoc on the immune system, leading inevitably to death.

However, numerous studies have suggested that proper nutrition boosts the body's ability to stave off HIV-related illness.

In their study, the largest of its kind to date, Fawzi's team divided nearly 1,100 pregnant HIV-positive Tanzanian women into four groups: one received a daily vitamin A supplement; the second got a multivitamin containing the B-complex vitamins plus vitamins C, E, and folic acid; the third received vitamin A plus the multivitamin; and the fourth group received a placebo.

The researchers then observed the health of each of the women over the next four years.

Overall, 299 of the women in the study either succumbed to AIDS or were in end-stage disease by the end of the study. According to the researchers, women receiving the multivitamin alone fared best overall, with just 24.7 percent dying or progressing to late-stage AIDS within the four-year period, compared to 31.1 percent of women taking placebo. Overall, women taking the daily multivitamin appeared less prone to illnesses characteristic of HIV infection.

Even their offspring fared better: Compared to mothers who didn't get supplements, mothers receiving the multivitamin "were less likely to have babies that were of low birth weight, and the multivitamin also protected against fetal death and the risk of severe premature birth," Fawzi said.

Although it did not affect rates of mother-to-child transmission of HIV, multivitamin use by the mother did seem to help prevent transmission of the virus via breast milk, he said.

Vitamins keep HIV-infected individuals healthier "mostly by boosting their immune status," Fawzi speculated. As happens in healthy individuals, proper nutrition helps the body fight off enemies, preventing all kinds of pathogens from gaining a foothold.

According to Fawzi, many African nations already provide vitamins to pregnant women, "irrespective of their HIV status," as part of standard antenatal care. "It's been reasonably successful in sub-Saharan Africa and many developing countries," he said.

The study is "an interesting observation that needs to be confirmed in a larger trial," said Dr. Sandra Lehrman, director of the Therapeutics Research Program in the Division of AIDS at the National Institute of Allergy and Infectious Diseases.

And while she believes that multivitamins can only bring benefit to undernourished populations everywhere, Lehrman stressed that HIV/AIDS "is a viral disease, and we can't lose our focus on treating the virus."

"We need to treat HIV disease with antiretroviral drugs that have been shown to have a lot of benefit," Lehrman said. Programs that distribute multivitamins could be a valuable adjunct to that treatment, however, just as other initiatives are proving helpful in keeping AIDS at bay in poor countries. "There's been a lot of work done in Uganda, looking at safe drinking water, which decreases diarrhea," Lehrman pointed out, "or using [insecticide] impregnated mosquito nets, which decreases child illness."

Fawzi agreed. "One of the benefits of multivitamins is clearly that by delaying HIV disease progression, you can delay the time at which antiretroviral drugs are necessary," he said. "I hope these findings would encourage the use of multivitamins among HIV-infected individuals. It would be a low-cost means of delaying the initiation of drug therapy."

More information

Learn more about the AIDS crisis in Africa at UNAIDS.

SOURCES: Wafaie Fawzi, M.B., B.S., Dr.P.H., associate professor, international nutrition and epidemiology, Harvard University School of Public Health, Boston; Sandra Lehrman, M.D., director, Therapeutics Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Md.; July 1, 2004, New England Journal of Medicine
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