Vitamin and mineral supplements are easily the most popular complementary therapyA broad range of healing philosophies, approaches, and therapies that Western (conventional) medicine does not commonly use to promote well-being or treat health conditions. Examples include acupuncture, herbs, Traditional Chinese Medicine, etc. (CT) used by people with HIV in Australia. In 2001, the Futures 3 survey of HIV-positive Australians found that 73% of people using CT were taking these supplements.
Doubtless for some, taking vitamin pills just seems like good ‘insurance’ but mounting studies are finding that many nutritional deficiencies are associated with faster deterioration with HIV and earlier death[1-5].
For example, a 1992 American study found that people who had a deficiency of vitamin A in addition to having HIV were more than six times more likely to die, in the two year study period, than if they had enough vitamin A6.
In another study where 310 people with HIV were followed up for nine years, AIDS developed around four years earlier among people with vitamin B12 deficiency than among people with adequate B127.
A deficiency of the trace element selenium may be even more serious. A 1997 study at the University of Miami followed up 125 people with HIV for over 3?? years and found that those people who didn’t have enough selenium were 11 times more likely to die than people with good selenium levels8.
Despite these alarming findings, there seems to be little research interest in finding out if taking nutritional supplements might make a difference. However, a trial just reported from Thailand shows that taking vitamin pills can make a big difference in people who have low CD4 counts but can’t access treatment9. In fact, for some people, a nutritional supplement turned out to be a matter of life and death.
The trial, conducted at the Siriraj Hospital at Mahidol University in Bangkok, Thailand, was the first double-blindA clinical trial design in which neither the participating individuals nor the study staff knows which participants are receiving the experimental drug and which are receiving a placebo (or another therapy). Double-blind trials are thought to produce objective results, since the expectations of the doctor and the participant about the experimental drug do not affect the outcome; also called double-masked study. clinical studyA clinical trial is a research study to answer specific questions about vaccines or new therapies or new ways of using known treatments. Clinical trials are used to determine whether new drugs or treatments are both safe and effective. Carefully conducted clinical trials are the fastest and safest way to find treatments that work in people. Trials are in four phases: Phase I tests a new drug or treatment in a small group; Phase II expands the study to a larger group of people; Phase III expands the study to an even larger group of people; and Phase IV takes place after the drug or treatment has been licensed and marketed. to look at the effect of vitamins and minerals on HIV/AIDS. Researchers enrolledThe act of signing up participants into a study. Generally this process involves evaluating a participant with respect to the eligibility criteria of the study and going through the informed consent process. 481 HIV-positive men and women who were not on antiretroviralA medication or other substance which is active against retroviruses such as HIV. treatment; participants took either a high-selenium nutritional supplement for 48 weeks or they took an identical looking placeboA dummy medical treatment, designed to have no pharmacological effect, administered to the control group of a clinical trial. pill. Nobody knew till the end of the trial who was getting the real vitamins.
Despite their advanced HIV disease, most of the people on the trial were relatively well to start with — although 5 percent had an opportunistic infection on the day they enrolled in the trial and 25 percent had been taking Bactrim in the month before the trial to prevent PCP. Around 40 percent had a CD4 count under 200. Ten people took some anti-HIV drugs during the trial but they were evenly split between those taking the placebo and those on the real vitamins.
At 48 weeks the researchers began sorting out the results. At first, it looked like the vitamins hadn’t done anything. Changes in CD4 counts and viral loads were the same whether people took the vitamins or the placebo. Admissions to hospital were also the same for both groups.
However, when researchers looked at the number of people who had died in each group, there was a clear benefit for people getting the extra nutrition. And it showed up most in people with low CD4 counts.
Those who started the trial with CD4 counts under 200 and took the supplement had a death rate 63 percent lower than for those with similar CD4s who were taking placebo (p=.05). For people with CD4s under 100 there was even greater benefit — their death rate was 74 percent lower than the matched placebo group (p=.03).
The researchers pointed out that if they had only looked for changes in CD4s or viral load that they wouldn’t have seen any benefits. “Our study highlights the need to measure impact against clinicalPertaining to or founded on observation and treatment of participants, as distinguished from theoretical or basic science. endpoints [death, illness, hospital admissions etc] rather than on surrogate markers [such as CD4 count and viral load] as the beneficial effect would have been missed if only surrogate markers had been measured,” the researchers said.
The researchers suggested that the improvement in survival was due to “a novel mechanism independent of CD4 T-lymphocyte numbers.” That is, CD4 count and viral load weren’t the only things that affected how well people did. Clearly, nutrition had an effect over and above these measures.
What supplements were people using? People took their vitamins twice a day after food. The vitamin pill contained vitamins A, B1, B2, B6, B12, C, D3, E and K, betacarotene, folacin, panthothenic acid, iron, magnesium, manganese, zinc, iodine, copper, selenium, chromium and cystine.
References
1 Samba RD, Tang AM. Micronutrients and the pathogenesis of human immunodeficiency virusA small infective organism which is incapable of reproducing outside a host cell. infection. Br J Nutr 1999,81:181-189.
2 Friis H, Goma E, Michaelson. Micronutrient interventions and the HIV pandemic. In Micronutrients and HIV infection. Edited by Friis H. London: CRC Press; 2002:219-246.
3 Baum MK, et al. High risk of HIV-related mortality is associated with selenium deficiency. J Acquir Immune Defic Syndr Hum Retrovirol 1997, 15:370-374.
4 Tang AM, et al. Effects of micronutrient intake on survival in human immunodeficiency virus type 1 infection. Am J Epidemiol 1996, 143:1244-1256.
5 Kupka R, Fawzi W. Zinc nutrition and HIV infection. Nutr Rev 2002, 60:69-79.
6 Semba RD; Increased mortality associated with vitamin A deficiency during human immunodeficiency virus type 1 infection. Arch Intern Med 1993 Sep 27;153(18):2149-54
7 Tang AM; et al. Low serum vitamin B-12 concentrations are associated with faster human immunodeficiency virus type 1 (HIV-1One of two distinct HIV species, HIV-1 is the predominant type in Australia and around the world.) disease progression. J Nutr. 1997 Feb;127(2):345-51.
8 Baum MK; et al. High risk of HIV-related mortality is associated with selenium deficiency. J Acquir Immune Defic Syndr Hum Retrovirol, 15(5):370-4 1997 Aug 15
9 Jiamton S. et al. A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok. AIDS 2003, 17:2461-2469
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