title: Supplementation with multivitamins and vitamin A and incidence of malaria among HIV-infected Tanzanian women.
abstract: BACKGROUND
  HIV and malaria infections occur in the same individuals, particularly in sub-Saharan Africa. We examined whether daily multivitamin supplementation (vitamins B complex, C, and E) or vitamin A supplementation altered malaria incidence in HIV-infected women of reproductive age.
  
  
  METHODS
  HIV-infected pregnant Tanzanian women recruited into the study were randomly assigned to daily multivitamins (B complex, C, and E), vitamin A alone, both multivitamins and vitamin A, or placebo. Women received malaria prophylaxis during pregnancy and were followed monthly during the prenatal and postpartum periods. Malaria was defined in 2 ways: presumptive diagnosis based on a physician's or nurse's clinical judgment, which in many cases led to laboratory investigations, and periodic examination of blood smears for malaria parasites.
  
  
  RESULTS
  Multivitamin supplementation compared with no multivitamins significantly lowered women's risk of presumptively diagnosed clinical malaria (relative risk: 0.78, 95% confidence interval: 0.67 to 0.92), although multivitamins increased their risk of any malaria parasitemia (relative risk: 1.24, 95% confidence interval: 1.02 to 1.50). Vitamin A supplementation did not change malaria incidence during the study.
  
  
  CONCLUSIONS
  Multivitamin supplements have been previously shown to reduce HIV disease progression among HIV-infected women, and consistent with that, these supplements protected against development of symptomatic malaria. The clinical significance of increased risk of malaria parasitemia among supplemented women deserves further research, however. Preventive measures for malaria are warranted as part of an integrated approach to the care of HIV-infected individuals exposed to malaria.
authors.affiliation: Departments of *Global Health and Population; †Epidemiology; ‡Nutrition; §Biostatistics, Harvard School of Public Health, Boston, MA; ‖Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; ¶Division of Gastroenterology and Nutrition, Children's Hospital, Boston, MA; and #Harvard Medical School, Boston, MA.
authors.forename: Ibironke O
authors.initials: IO
authors.lastname: Olofin
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Goodarz
authors.initials: G
authors.lastname: Danaei
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000293:Adolescent; D000328:Adult; D001205:Ascorbic Acid / Q000627:therapeutic use*; D015897:Comorbidity; D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011295:Prenatal Care / Q000379:methods; D013636:Tanzania / Q000453:epidemiology; D014801:Vitamin A / Q000627:therapeutic use*; D014803:Vitamin B Complex / Q000627:therapeutic use*; D014810:Vitamin E / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014801:Vitamin A; D014803:Vitamin B Complex; D014810:Vitamin E; D001205:Ascorbic Acid