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Multivitamins May Slow AIDS Onset

Vitamins -- Except Vitamin A -- Improve Immune System, Prolong AIDS-Free Period
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June 30, 2004 -- Multivitamin supplements slow, but do not stop, the relentless march of AIDS.

Only a combination of AIDS drugs can keep a person with HIV infection from dying of AIDS. But now it looks as though multivitamin supplements can prolong the AIDS-free period.

Why is this important? At the end of 2003, 40 million people were infected with HIV. Six million of these people are in dire need of AIDS drugs. Of these 6 million people facing death, more than 5.5 million can't get the drugs that would save their lives.

AIDS isn't the only specter haunting these people. Among other problems, they also face malnutrition. It's a vicious cycle. Malnutrition weakens the immune system. It also speeds the ability of the virus to eat away at the immune system, which in turn makes a person weaker and even more malnourished. No wonder many people in Africa call AIDS "slim disease."

Might vitamin supplements help? Wafaie W. Fawzi, DrPH, MD, of the Harvard School of Public Health and colleagues decided to find out. They went to Dar es Salaam, Tanzania, where they enrolled more than 1,000 pregnant, HIV-infected women in a study. The women received multivitamin supplements (vitamins B, C, and E), vitamin A alone, multivitamins plus vitamin A, or placebo.

Multivitamins cut the risk of death from AIDS by 27%. It slowed progression to AIDS by 50%. Women who took the multivitamins had far better immune systems -- and lower levels of HIV in their bodies -- than women who received placebo.

Vitamin A didn't do much by itself. And when added to the multivitamins, it reduced their effect. While more studies need to be done, it looks as though vitamin A is not helpful to people with HIV infection.

The effect of the multivitamins wasn't anything close to what AIDS drugs can do. But the supplements helped -- at a retail cost of only $15 per year. Given the difficulty of getting AIDS drugs to the people who need them, it's possible that multivitamin treatment can prolong the time before a person infected with HIV needs drug treatment. This might help spread too-thin resources a bit farther.

The findings appear in the July 1 issue of The New England Journal of Medicine. Published with them is an editorial by CDC researchers Barbara Marston, MD, and Kevin M. De Cock, MD. Marston and De Cock note that a clinical trial is needed to determine exactly how long multivitamins can delay AIDS therapy.

The researchers also note that other relatively simple measures -- such as providing mosquito-proof bed netting and point-of-use water chlorination -- make huge contributions to the health of people with HIV infection. And while multivitamins obviously will be helpful, Marston and De Cock note that HIV and AIDS treatment programs must address the need for food supplementation.

"As attractive and important as simple interventions are and as massive as the shortage of basic public health infrastructure is, the need for antiretroviral therapy in Africa is real and compelling," they conclude. "The international community must continue to expand its efforts to meet this need."

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