Table 2.
Randomized controlled trials on vitamin B, C, D, E and folic acid, and HIV progression.
| Reference | Population, in- and exclusion criteria. | Intervention and follow-up | Primary outcomes | Major findings | Conclusions |
|---|---|---|---|---|---|
| Allard 1998 [35] | Canada, 49 individuals receiving ART. | Daily vit. E (800 IU) and C (1000mg) for 3 months. | HIV viral load, oxidative stress | Trend towards reduction in viral load. Significant reduction of oxidative stress. | Vit. E and C may reduce viral load and reduces oxidative stress. |
| Kelly 1999 [34] | Zambia, 141 ART naïve patients admitted with diarrhea. | Daily vit. A (10.500 IU), C (300 mg), E (300 mg) Selenium (300 μg) and Zinc (200 mg) for two weeks. | Diarrhea, mortality, serum A and E, CD4 count. | No difference in length of diarrheal episodes, mortality or CD4 count after 6 weeks. | No additional value of multivitamin to treatment of diarrhea among HIV patients. |
| Fawzi 1998.[22,24,43] | Tanzania, 1078 ART naïve pregnant women. | Multifactorial design with Vit. B, C, E and folic acid1. | MTCT, Mortality, CD4 count and viral load. | No effect on MTCT, Reduced mortality, delayed HIV progression, increased CD4, CD8 count and decreased viral load for the multivitamin. | Multivitamin does not reduce MTCT but reduces HIV progression and mortality among children and pregnant women. |
| Jiamton 2003 [44] | Bangkok, 481 ART naïve individuals with CD4 count 50 - 500 cells/μL. | Daily vit. A, B, C, D, E, K, zinc, selenium and various minerals2 for 48 weeks. | Mortality, CD4 count | Reduction of mortality with no differences in viral load and CD4 count. | Micronutrients reduce mortality among people living with HIV. |
| McClelland 2004 [36] | Kenya, 400 ART naïve women. | Daily vit. B, C, E, folic acid1 and selenium (200 mg) for 6 weeks. | HIV infectivity | Increase in HIV infectivity. Increase in CD4 and CD8 count and no difference in viral load. | Multivitamin may increase HIV infectivity. |
| Kaiser 2006 [38] | United states, 40 individuals receiving ART and signs of ART related neuropathy. | Twice daily vit. A, B, C, D, E, zinc, selenium, NAC and various minerals3 for 12 weeks. | CD4 count, viral load, neuropathy, safety parameters. | Intervention increased CD4 count with no effect on viral load or neuropathy. | Micronutrients and NAC increases CD4 count and was found to be safe. |
| Kelly 2008 [45] | Uganda, cluster randomized trial among 500 individuals of which 135 HIV infected and ART naïve. | Daily vit.A, B, C, D, E, folic acid, selenium, iron, zinc, copper, iodine4. | Diarrhea incidence, CD4 count, mortality. | Intervention did not reduce the incidence of diarrhea. No effect on CD4 count but decrease in mortality. | Low dose multivitamin may reduce mortality. |
| Wejse 2009 [42] | Guineau-Bassau, West Africa, 367 TB-infected, 131 co-infected with HIV and ART naïve. | Vitamin D 100,000 IU every 3 months for 12 months | Clinical severity score of TB and overall mortality at 12 months | No difference in clinical severity or mortality between vitamin D and control group. | Vit. D not effective at improving clinical outcomes of TB. |
MTCT = Mother to child transmission, TB = Tuberculosis
1. Micronutrient supplement included vitamin B1 20 mg , vitamin B2 20 mg, vitamin B6 25 mg, vitamin B3 100 mg, vitamin B12 50 μg, vitamin C 500 mg and folic acid 0.8 mg.
2. Micronutrient supplement included vitamin A 3,000 μg, beta-carotene 6 mg, vitamin D3 20 μ g, vitamin E 80 mg, vitamin K 180 μg, vitamin C 400 mg, vitamin B1 24 mg, vitamin B2 15 mg, vitamin B6 40 mg, vitamin B12 30 μg, folacin 100 μ g, panthothenic acid 40 mg, iron 10 mg, magnesium 200 mg, manganese 8 mg, zinc 30 mg, iodine 300 μg, copper 3 mg, selenium 400 μg, chromium 150 μg and cystine 66 mg.
3. Micronutrient supplement included N-acetyl cysteine 1,200 mg , acetyl L-carnitine 1,000 mg, α-lipoic acid 400 mg, β-carotene 20,000 IU, vitamin A 8,000 IU, vitamin C 1,800 mg, thiamine 60 mg , riboflavin 60 mg, pantothenic acid 60 mg, niacinamide 60 mg, inositol 60 mg, vitamin B6 260 mg, vitamin B12 2.5 mg, vitamin D 400 IU, vitamin E 800 IU, folic acid 800 μg, Ca 800 mg, Mg 400 mg, Se 200 μg, Iodine 150 μg, Zn 30 mg, Cu 2 mg, B 2 mg, K 99 mg, Fe 18 mg, Mn 10 mg, biotin 50 μg, Cr 100 μg, Mo 300 μg, choline 60 mg, bioflavonoid complex 300 mg, L-glutamine 100 mg, and betaine HCL 150 mg.
4. Micronutrient supplement included Vitamin A as β-carotene 4,8 mg, vitamin B1 1,4 mg , vitamin B2 1,4 mg, vitamin B6 1,6 mg, vitamin B12 2,6 μg, vitamin C 18 mg, vitamin D35 mg, vitamin E 10 mg, iron 30 mg, zinc 15 mg, copper 12 mg, selenium 65 μg iodine 150 μg and folic acid 400 μg.