Multivitamins During Pregnancy and
After Birth Delay Progression of HIV In Women
Multivitamin supplements containing high doses of the vitamin
B complex, as well as vitamins C and E, given to HIV-infected
women during pregnancy and for more than 5 years after they
gave birth reduced the symptoms of AIDS, according to a
study of Tanzanian women supported by the National Institute
of Child Health and Human Development (NICHD) and the John
E. Fogarty International Center (FIC) for Advanced Study
in the Health Sciences, both of the National Institutes
of Health. The supplements also bolstered counts of disease-fighting
immune cells, and modestly lowered HIV levels in the blood.
The study appears in the July 1 New
England Journal of Medicine.
"This study provides evidence
that multivitamin supplements may allow women in developing
countries who are infected with the AIDS virus to go for
longer than they otherwise would before needing anti-AIDS
drugs," said NICHD Director Duane Alexander, M.D.
"By keeping women healthier longer,
multivitamin therapy can help to assure that anti-HIV drugs
can be directed to those who need them most," said
FIC Acting Director Sharon Hrynkow, Ph.D.
The first author of the study was
Wafaie Fawzi, associate professor of nutrition and epidemiology
at the Harvard School of Public Health. Other authors of
the study also were from the Harvard School of Public Health
as well as from the Muhimbili University College of Health
Sciences in Dar es Salaam, Tanzania.
The authors conducted the study from
1995 to 2003, a time when the antiretroviral drugs were
not available to most women in Tanzania, including those
who took part in the study.
The researchers enrolled 1,078 HIV-infected
pregnant women in Dar es Salaam, Tanzania. Women were assigned
to one of four groups and received either a placebo, vitamin
A, vitamin A in combination with a multivitamin preparation
or a multivitamin preparation alone. The women took the
vitamins during pregnancy and continued taking them for
as long as they participated in the study-more than 5 years,
in many cases. The multivitamin preparation contained high
doses of vitamins C, E, and folic acid, as well as the vitamins
in the B complex group (B1, B2, B6, B12, and niacin). All
of the women received folic acid and an iron supplement
during pregnancy, whether they were in the placebo group
or the vitamin groups.
All the women received periodic checkups
for at least 4 years after giving birth, and about half
of the women received checkups for more than 5 years after
giving birth. The researchers charted the women's progress
to determine whether the supplements had an effect on the
progression of HIV disease to severe symptoms, to AIDS,
or death; or on the levels of certain immune cells (CD4+
and CD8+ cells); and on levels of HIV in the blood.
In all, 18 of 271 (7 percent) of the
women who took multivitamins progressed to AIDS during the
course of the study, compared with 31 among 267 (12 percent)
of the women in the placebo group, a 50 percent reduction
in the risk of progression to AIDS. Of the 271, 52 (19 percent)
of the women who took multivitamins died, compared with
66 of 267 women (25 percent) in the placebo group. Although
the number of deaths were lower in women receiving multivitamins,
this was not a statistically significant difference. The
effect of multivitamins was strongest in the first 2 years
The women taking multivitamins also
had fewer symptoms of later stage HIV infection, such as
mouth infections, mouth ulcers, or diarrheal diseases, than
did women in the other group. Similarly, the women in the
multivitamin group also had significantly higher CD4+ cell
counts than did women in the other groups: overall, the
average CD4+ cell count was 48 cells higher in women who
received multivitamins compared to those who received placebo.
The HIV virus level in the blood was also modestly but significantly
lower in women who received multivitamins.
The women who took vitamin A alone
did not show any pronounced differences from the women in
the placebo group, and adding vitamin A to the multivitamin
preparation did not appear to offer any significant added
benefit compared with multivitamins alone.
The benefits noted in the Tanzania
trial are modest compared to the effects of combination
antiretroviral therapy, the authors wrote. In the United
States, physicians routinely prescribe multivitamins to
pregnant women. Moreover, in developed countries like the
United States, pregnant women infected with HIV are routinely
given a combination of three or more anti-HIV drugs during
pregnancy to prevent the spread of the virus to their infants.
However, in developing countries,
vitamin supplementation during pregnancy is not routine
and is not provided following pregnancy, explained Lynne
Mofenson, M.D., Chief of NICHD's Pediatric, Adolescent and
Maternal AIDS branch, which provided funding for the study.
"These results suggest that use
of multivitamins by HIV-infected women during and after
pregnancy can slow the course of HIV disease, and could
provide a low-cost treatment to prolong the time before
they need antiretroviral therapy," Dr. Mofenson said.
She added that multivitamin therapy could result in significant
cost savings for developing countries.
The researchers wrote that the retail
costs of a year's supply of the multivitamins used in this
trial is about $15, and that wholesale prices are substantially
lower. "Our findings should encourage the use of multivitamin
supplements as supportive care to those infected with HIV
in developing countries," Dr. Fawzi said.
Dr. Mofenson noted that more studies
are needed to define the minimum dose of multivitamins needed
to produce a health benefit and to determine whether the
multivitamins might provide similar benefits if given to
persons already receiving antiretroviral therapy.