title: Effect of periodic vitamin A supplementation on mortality and morbidity of human immunodeficiency virus-infected children in Uganda: A controlled clinical trial.
abstract: OBJECTIVE
  We investigated whether vitamin A supplementation would decrease mortality and morbidity rates in children infected with the human immunodeficiency virus (HIV).
  
  
  METHODS
  We conducted a randomized, double-blind, placebo-controlled clinical trial at Mulago Hospital, a large hospital that serves the urban and semiurban populations of Kampala, Uganda. One hundred eighty-one HIV-infected children were enrolled at 6 mo and randomized to receive vitamin A supplementation, 60 mg retinol equivalent, or placebo every 3 mo from ages 15 to 36 mo. Morbidity was assessed through a 7-d morbidity history every 3 mo, and vital events were measured. Children received daily trimethoprim-sulfamethoxazole prophylactic therapy.
  
  
  RESULTS
  After age 15 mo, children were followed for a median of 17.8 mo (interquartile range = 11.1 to 21.0 mo). The trial was stopped when there was a new policy to implement a program of mass supplementation of vitamin A in the country. Mortality rates among 87 children in the vitamin A group and 94 children in the control group were 20.6% and 32.9%, respectively, yielding a relative risk of 0.54 (95% confidence interval, 0.30 to 0.98; P = 0.044) after adjusting for baseline weight-for-height Z score. Children who received vitamin A had lower modified point prevalences of persistent cough (odds ratio, 0.47; 95% confidence interval, 0.23 to 0.96; P = 0.038) and chronic diarrhea (odds ratio, 0.48; 95% confidence interval, 0.19 to 1.18; P = 0.11) and a shorter duration of ear discharge (P = 0.03). Vitamin A supplementation had no significant effect on modified point prevalences of fever, ear discharge, bloody stools, or hospitalizations.
  
  
  CONCLUSIONS
  Vitamin A supplementation decreases mortality rate in HIV-infected children and should be considered in the care for these children in developing countries.
authors.affiliation: Department of Ophthalmology Johns Hopkins School of Medicine, Baltimore, MD, USA. rdsemba@jhmi.edu
authors.forename: Richard D
authors.initials: RD
authors.lastname: Semba
authors.forename: Christopher
authors.initials: C
authors.lastname: Ndugwa
authors.forename: Robert T
authors.initials: RT
authors.lastname: Perry
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Clark
authors.forename: J Brooks
authors.initials: JB
authors.lastname: Jackson
authors.forename: George
authors.initials: G
authors.lastname: Melikian
authors.forename: James
authors.initials: J
authors.lastname: Tielsch
authors.forename: Francis
authors.initials: F
authors.lastname: Mmiro
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage; D002675:Child, Preschool; D016001:Confidence Intervals; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity; D009752:Nutritional Status; D012307:Risk Factors; D012720:Severity of Illness Index; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D014454:Uganda / Q000453:epidemiology; D014801:Vitamin A / Q000008:administration & dosage* / Q000627:therapeutic use; D014802:Vitamin A Deficiency / Q000150:complications / Q000517:prevention & control*
chemical_list: D000890:Anti-Infective Agents; D014801:Vitamin A; D015662:Trimethoprim, Sulfamethoxazole Drug Combination