title: Micronutrients in HIV: a Bayesian meta-analysis.
abstract: BACKGROUND
  Approximately 28.5 million people living with HIV are eligible for treatment (CD4<500), but currently have no access to antiretroviral therapy. Reduced serum level of micronutrients is common in HIV disease. Micronutrient supplementation (MNS) may mitigate disease progression and mortality.
  
  
  OBJECTIVE
  We synthesized evidence on the effect of micronutrient supplementation on mortality and rate of disease progression in HIV disease.
  
  
  METHODS
  We searched MEDLINE, EMBASE, the Cochrane Central, AMED and CINAHL databases through December 2014, without language restriction, for studies of greater than 3 micronutrients versus any or no comparator. We built a hierarchical Bayesian random effects model to synthesize results. Inferences are based on the posterior distribution of the population effects; posterior distributions were approximated by Markov chain Monte Carlo in OpenBugs.
  
  
  RESULTS
  From 2166 initial references, we selected 49 studies for full review and identified eight reporting on disease progression and/or mortality. Bayesian synthesis of data from 2,249 adults in three studies estimated the relative risk of disease progression in subjects on MNS vs. control as 0.62 (95% credible interval, 0.37, 0.96). Median number needed to treat is 8.4 (4.8, 29.9) and the Bayes Factor 53.4. Based on data reporting on 4,095 adults reporting mortality in 7 randomized controlled studies, the RR was 0.84 (0.38, 1.85), NNT is 25 (4.3, ∞).
  
  
  CONCLUSIONS
  MNS significantly and substantially slows disease progression in HIV+ adults not on ARV, and possibly reduces mortality. Micronutrient supplements are effective in reducing progression with a posterior probability of 97.9%. Considering MNS low cost and lack of adverse effects, MNS should be standard of care for HIV+ adults not yet on ARV.
authors.affiliation: Foundation for Integrative AIDS Research, Brooklyn, NY, United States of America.
authors.forename: George M
authors.initials: GM
authors.lastname: Carter
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
authors.forename: Debbie
authors.initials: D
authors.lastname: Indyk
authors.affiliation: Teachers College, Columbia University, New York, NY, United States of America.
authors.forename: Matthew
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Andreae
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Suslov
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
authors.forename: Sudharani
authors.initials: S
authors.lastname: Busani
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
authors.forename: Aryan
authors.initials: A
authors.lastname: Esmaeili
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
authors.forename: Henry S
authors.initials: HS
authors.lastname: Sacks
mesh_terms: D001499:Bayes Theorem; D019587:Dietary Supplements / Q000009:adverse effects; D018450:Disease Progression; D015658:HIV Infections / Q000178:diet therapy* / Q000401:mortality; D006801:Humans; D018977:Micronutrients / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D018977:Micronutrients
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