Impact of Micronutrient Supplementation on Mortality

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Dear FORUM

" Multiple micronutrient supplementation may enhance the survival of HIV-infected

individuals with CD4 cell counts <200 X 106/l. This could have important public

health implications in the developing world where access to antiretrovirals

remains poor "

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" A Randomized Trial of the Impact of Multiple Micronutrient Supplementation on

Mortality Among HIV-Infected Individuals Living in Bangkok "

AIDS (11.21.03)::Sukhum Jiamton; Jacques Pepin; Reungpung Suttent; Suzanne

Filteau; Bussakorn Mahakkanukrauh; Wanna Hanshaoworakul; Pongsakdi

Chaisilwattana; Puan Suthipinittharm; Prakash Shetty; Shabbar Jaffar

To examine the impact of high-dose multiple micronutrient supplementation on

survival and disease-progression among HIV-infected patients in Thailand, the

authors conducted a randomized placebo-controlled trial of commercially

available micronutrients on 481 men and women with CD4 cell counts ranging from

50 X 106 - 550 X 106/l. Based on observational studies that micronutrient

deficiencies among HIV-1 patients are associated strongly with a faster

progression to disease and death, the investigators hypothesized that

micronutrient supplementation might provide clinical benefit and reduce death

rates. Since micronutrients are inexpensive and easily tolerated, their effect

on the progression of HIV is an important public health question, the study

stated.

The participants received micronutrients rich in antioxidants - or a placebo -

for 48 weeks, were examined at 12-week intervals and were tested for CD4 cell

count at 24-week intervals. The micronutrients comprised a comprehensive mix of

vitamins and minerals in amounts higher than recommended daily allowances (RDA)

for healthy individuals. The mix 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. Seventy-nine trial participants (16

percent) were lost to follow-up and 23 (5 percent) died.

The researchers found the death rate was lower in the arm of the study taking

multiple micronutrient supplementation than in the placebo arm. Statistically

significant differences occurred among those whose CD4 cell counts at

recruitment were <200 x 106 or <100 X 106/l, with 63 percent and 74 percent

lower mortality respectively compared to placebo. Mortality rates were similar

between the two arms of the trial among those with higher CD4 cell counts at

enrollment, " although the power for this comparison was very low, " the authors

noted.

" Multiple micronutrient supplementation may enhance the survival of HIV-infected

individuals with CD4 cell counts <200 X 106/l. This could have important public

health implications in the developing world where access to antiretrovirals

remains poor.

The clinical findings need to reproduced in other settings and

the mechanism, which appears to be independent of change in CD4

cell count, merits further investigation, " the researchers

concluded.