title: Micronutrients in HIV/AIDS: is there evidence to change the WHO 2003 recommendations?
abstract: To establish whether there is new evidence to inform changes to WHO 2003 recommendations for micronutrient intake in persons with HIV/AIDS, we conducted a narrative review of the literature published from 2003 to 2010. Although the review focused on new randomized controlled trials of multiple micronutrients in HIV-infected adults, including pregnant and lactating women, we also considered randomized trials of single micronutrients. The review found that there are few published randomized controlled trials of micronutrients in HIV-infected persons and that most trials used high-dose multiple micronutrient supplementation. The trials were heterogeneous with respect to the composition and dose of micronutrients used and the target population studied. Despite this heterogeneity, 5 of 6 trials that used high-dose multiple micronutrients showed benefits in terms of either improved CD4 cell counts or survival. However, many of these trials were small and of short duration, and therefore the long-term risks and benefits of high-dose multiple micronutrients are not established. The current WHO recommendation for an intake of micronutrients at Recommended Dietary Allowance amounts continues to be a reasonable target for persons with clinically stable HIV infection. In light of new data that show adverse effects of high-dose vitamin A, the current recommendation for a single high dose of vitamin A in HIV-infected women within 6 wk of delivery should be reviewed.
authors.affiliation: Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA. janet.forrester@tufts.edu
authors.forename: Janet E
authors.initials: JE
authors.lastname: Forrester
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Sztam
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D000328:Adult; D018791:CD4 Lymphocyte Count; D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007774:Lactation; D018977:Micronutrients / Q000008:administration & dosage / Q000627:therapeutic use*; D018673:Nutrition Policy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000401:mortality; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage / Q000009:adverse effects; D014944:World Health Organization
chemical_list: D018977:Micronutrients; D014801:Vitamin A
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