title: Multivitamin supplementation improves hematologic status in HIV-infected women and their children in Tanzania.
abstract: BACKGROUND
  Anemia is a frequent complication among HIV-infected persons and is associated with faster disease progression and mortality.
  
  
  OBJECTIVE
  We examined the effect of multivitamin supplementation on hemoglobin concentrations and the risk of anemia among HIV-infected pregnant women and their children.
  
  
  METHODS
  HIV-1-infected pregnant women (n = 1078) from Dar es Salaam, Tanzania, were enrolled in a double-blind trial and provided daily supplements of preformed vitamin A and beta-carotene, multivitamins (vitamins B, C, and E), preformed vitamin A and beta-carotene + multivitamins, or placebo. All women received iron and folate supplements only during pregnancy according to local standard of care. The median follow-up time for hemoglobin measurement for mothers was 57.3 mo [interquartile range (IQR): 28.6-66.8] and for children it was 28.0 mo (IQR: 5.3-41.7).
  
  
  RESULTS
  During the whole period, hemoglobin concentrations among women who received multivitamins were 0.33 g/dL higher than among women who did not receive multivitamins (P=0.07). Compared with placebo, multivitamin supplementation resulted in a hemoglobin increase of 0.59 g/dL during the first 2 y after enrollment (P=0.0002). Compared with placebo, the children born to mothers who received multivitamins had a reduced risk of anemia. In this group, the risk of macrocytic anemia was 63% lower than in the placebo group (relative risk: 0.37: 95% CI: 0.18, 0.79; P=0.01).
  
  
  CONCLUSIONS
  Multivitamin supplementation provided during pregnancy and in the postpartum period resulted in significant improvements in hematologic status among HIV-infected women and their children, which provides further support for the value of multivitamin supplementation in HIV-infected adults.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA. mina@hsph.harvard.edu
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
authors.forename: Gernard I
authors.initials: GI
authors.lastname: Msamanga
authors.forename: Roland
authors.initials: R
authors.lastname: Kupka
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villamor
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mugusi
authors.forename: Ruilan
authors.initials: R
authors.lastname: Wei
authors.forename: David
authors.initials: D
authors.lastname: Hunter
mesh_terms: D000328:Adult; D000740:Anemia / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood* / Q000150:complications; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood*; D011256:Pregnancy Outcome; D012307:Risk Factors; D013636:Tanzania; D014801:Vitamin A / Q000097:blood / Q000627:therapeutic use; D014810:Vitamin E / Q000097:blood / Q000627:therapeutic use; D014815:Vitamins / Q000097:blood* / Q000627:therapeutic use*; D019207:beta Carotene / Q000097:blood / Q000627:therapeutic use
chemical_list: D006454:Hemoglobins; D014815:Vitamins; D019207:beta Carotene; D014801:Vitamin A; D014810:Vitamin E