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Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania

Identifieur interne : 001229 ( Main/Exploration ); précédent : 001228; suivant : 001230

Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania

Auteurs : Wafaie W. Fawzi [États-Unis] ; Gernard I. Msamanga [Tanzanie] ; Donna Spiegelman [États-Unis] ; Ernest Jn Urassa [Tanzanie] ; Nuala Mcgrath [États-Unis] ; Davis Mwakagile [Tanzanie] ; Gretchen Antelman [États-Unis] ; Roger Mbise [Tanzanie] ; Saidi Kapiga [Tanzanie] ; Walter Willett [États-Unis] ; David J. Hunter [États-Unis] ; Guillermo Herrera

Source :

RBID : ISTEX:34DD655722595F4BE8D4E660AFCB5FF442F72C57

Descripteurs français

English descriptors

Abstract

Background In HIV-1-infected women, poor micronutrient status has been associated with faster progression of HIV-1 disease and adverse birth outcomes. We assessed the effects of vitamin A and multivitamins on birth outcomes in such women.Methods In Tanzania, 1075 HIV-1-infected pregnant women at between 12 and 27 weeks' gestation received placebo (n=267), vitamin A (n=269), multivitamins excluding vitamin A (n=269), or multivitamins including vitamin A (n=270) in a randomised, double-blind, placebo-controlled trial with a 22 factorial design. We measured the effects of multivitamins and vitamin A on birth outcomes and counts of T lymphocyte subsets. We did analyses by intention to treat.Results 30 fetal deaths occurred among women assigned multivitamins compared with 49 among those not on multivitamins (relative risk 061 [95 CI 039094] p=002). Multivitamin supplementation decreased the risk of low birthweight (<2500 g) by 44 (056 [038082] p=0003), severe preterm birth (<34 weeks of gestation) by 39 (061 [038096] p=003), and small size for gestational age at birth by 43 (057 [039082] p=0002). Vitamin A supplementation had no significant effect on these variables. Multivitamins, but not vitamin A, resulted in a significant increase in CD4, CD8, and CD3 counts.Interpretation Multivitamin supplementation is a low-cost way of substantially decreasing adverse pregnancy outcomes and increasing T-cell counts in HIV-1-infected women. The clinical relevance of our findings for vertical transmission and clinical progression of HIV-1 disease is yet to be ascertained.

Url:
DOI: 10.1016/S0140-6736(98)04197-X


Affiliations:


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<div type="abstract">Background In HIV-1-infected women, poor micronutrient status has been associated with faster progression of HIV-1 disease and adverse birth outcomes. We assessed the effects of vitamin A and multivitamins on birth outcomes in such women.Methods In Tanzania, 1075 HIV-1-infected pregnant women at between 12 and 27 weeks' gestation received placebo (n=267), vitamin A (n=269), multivitamins excluding vitamin A (n=269), or multivitamins including vitamin A (n=270) in a randomised, double-blind, placebo-controlled trial with a 22 factorial design. We measured the effects of multivitamins and vitamin A on birth outcomes and counts of T lymphocyte subsets. We did analyses by intention to treat.Results 30 fetal deaths occurred among women assigned multivitamins compared with 49 among those not on multivitamins (relative risk 061 [95 CI 039094] p=002). Multivitamin supplementation decreased the risk of low birthweight (<2500 g) by 44 (056 [038082] p=0003), severe preterm birth (<34 weeks of gestation) by 39 (061 [038096] p=003), and small size for gestational age at birth by 43 (057 [039082] p=0002). Vitamin A supplementation had no significant effect on these variables. Multivitamins, but not vitamin A, resulted in a significant increase in CD4, CD8, and CD3 counts.Interpretation Multivitamin supplementation is a low-cost way of substantially decreasing adverse pregnancy outcomes and increasing T-cell counts in HIV-1-infected women. The clinical relevance of our findings for vertical transmission and clinical progression of HIV-1 disease is yet to be ascertained.</div>
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