Title: Multivitamins, nutrition, and antiretroviral therapy for HIV disease in Africa.

POPLINE Document Number: 194595

Author(s):

Marston B
De Cock KM

Source citation:

New England Journal of Medicine, 2004 Jul 1;351(1):78-80.

Abstract:

Readers could be forgiven for being confused by the literature on micronutrients and the pathogenesis of human immunodeficiency virus (HIV) disease. Micronutrients play important roles in maintaining immune function and neutralizing the reactive oxygen intermediates produced by activated macrophages and neutrophils in their response to microorganisms. Serum and plasma measurements of vitamins and trace elements, which are imperfect indicators of body stores, have shown that deficiencies are common among HIV infected persons, especially those who are underprivileged, such as women in developing countries, and injection-drug users. A vicious cycle has been envisaged in which undernourished HIV infected persons have micronutrient deficiencies, leading to further immunosuppression and oxidative stress and subsequent acceleration of HIV replication and CD4+ T-cell depletion. 1 It has been difficult, however, to show causal associations between specific deficiencies and adverse clinical outcomes in HIV-infected persons, and data linking replacement or supplementation of specific micronutrients with a clinical benefit have been sparse and inconsistent. In this issue of the Journal, Fawzi and colleagues report the results of a controlled trial of multivitamin supplementation among HIV-infected pregnant women in Tanzania. 2 Their report prompts important questions about the plausibility of the findings but also raises broader issues concerning the role of nutrition in the public health response to HIV infection and AIDS in Africa in this era of increasing access to antiretroviral therapy. (excerpt)

Keywords:

Africa
Africa, Sub Saharan
Africa, North
Critique
Recommendations
Evaluation
HIV Positive Persons
Vitamins and Minerals
HIV Infections
AIDS Prevention
Antiretroviral Therapy
Nutrition
Food Supplementation
Developing Countries
Viral Diseases
Diseases
Physiology
Biology
AIDS
HIV
Health
Nutrition Programs
Primary Health Care
Health Services
Delivery of Health Care