Effect of micronutrient supplementation on disease progression in asymptomatic, antiretroviral-naive, HIV-infected adults in Botswana: a randomized clinical trial.
Effect of micronutrient supplementation on disease progression in asymptomatic, antiretroviral-naive, HIV-infected adults in Botswana: a randomized clinical trial.
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DOI：
10.1001/jama.2013.280923
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发表时间：
2013-11-27
影响因子：
120.7
通讯作者：
Marlink, Richard
中科院分区：
文献类型：
--
作者：
Baum, Marianna K.;Campa, Adriana;Lai, Shenghan;Martinez, Sabrina Sales;Tsalaile, Lesedi;Burns, Patricia;Farahani, Mansour;Li, Yinghui;van Widenfelt, Erik;Page, John Bryan;Bussmann, Hermann;Fawzi, Wafaie W.;Moyo, Sikhulele;Makhema, Joseph;Thior, Ibou;Essex, Myron;Marlink, Richard
Micronutrient deficiencies occur early in human immunodeficiency virus (HIV) infection, and supplementation with micronutrients may be beneficial; however, its effectiveness has not been investigated early in HIV disease among adults who are antiretroviral therapy (ART) naive. To investigate whether long-term micronutrient supplementation is effective and safe in delaying disease progression when implemented early in adults infected with HIV subtype C who are ART-naive. Randomized clinical trial of supplementation with either daily multivitamins (B vitamins and vitamins C and E), seleniumalone, or multivitamins with selenium vs placebo inafactorial design for 24 months. The study was conducted in 878 patients infected with HIV subtype C with a CD4 cell count greater than 350/μL who were not receiving ART at Princess Marina Hospital in Gaborone, Botswana, between December 2004 and July 2009. Daily oral supplements of B vitamins and vitamins C and E, selenium alone, or multivitamins plus selenium, compared with placebo. Reaching a CD4 cell count less than 200/μL until May 2008; after this date, reaching a CD4 cell count of 250/μL or less, consistent with the standard of care in Botswana for initiation of ART at the time of the study. There were 878 participants enrolled and randomized into the study. All participants were ART-naive throughout the study. In intent-to-treat analysis, participants receiving the combined supplement of multivitamins plus selenium had a significantly lower risk vs placebo of reaching CD4 cell count 250/μL or less (adjusted hazard ratio [HR], 0.46; 95% CI, 0.25-0.85; P = .01; absolute event rate [AER], 4.79/100 person-years; censoring rate, 0.92; 17 events; placebo AER, 9.22/100 person-years; censoring rate, 0.85; 32 events). Multivitamins plus selenium in a single supplement, vs placebo, also reduced the risk of secondary events of combined outcomes for disease progression (CD4 cell count ≤250/μL, AIDS-defining conditions, or AIDS-related death, whichever occurred earlier [adjusted HR, 0.56; 95% CI, 0.33-0.95; P = .03; AER, 6.48/100 person-years; censoring rate, 0.90; 23 events]). There was no effect of supplementation on HIV viral load. Multivitamins alone and selenium supplementation alone were not statistically different from placebo for any end point. Reported adverse events were adjudicated as unlikely to be related to the intervention, and there were no notable differences in incidence of HIV-related and health-related events among study groups. In ART-naive HIV-infected adults, 24-month supplementation with a single supplement containing multivitamins and selenium was safe and significantly
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影响因子：
3.8
作者：
BAUM, MK;SHORPOSNER, G;HENNEKENS, CH
通讯作者：
HENNEKENS, CH
DOI：
10.1056/nejmra1201533
发表时间：
2013-06-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
Piot P;Quinn TC
通讯作者：
Quinn TC
DOI：
10.1097/00126334-200412150-00021
发表时间：
2004-12-15
影响因子：
3.6
作者：
McClelland, RS;Baeten, JM;Kreiss, JK
通讯作者：
Kreiss, JK
影响因子：
7.1
作者：
JACOB, RA;KELLEY, DS;PETERS, JH
通讯作者：
PETERS, JH
影响因子：
3.8
作者：
Jiamton, S;Pepin, J;Jaffar, S
通讯作者：
Jaffar, S