HIV Disease, Drug Abuse, & Nutrient Therapy in Botswana

非洲的博茨瓦纳是世界上艾滋病毒感染率最高的国家。此外，一个新兴的 世界这一地区的药物滥用问题可能导致免疫抑制和 营养状况，这反过来又促进了艾滋病毒疾病的进展。此应用程序基于我们的非洲 研究表明，补充多种维生素可显著增加孕妇的CD4计数， 随着时间的推移，我们在美国的研究表明，硒是艾滋病死亡率的一个强有力的预测因子， 补充硒可减缓HIV疾病的进展。此应用程序的总体目标是 确定补充多种维生素和硒是否可以改善免疫功能， 延长博茨瓦纳艾滋病毒感染成年人的艾滋病发病时间或死亡率。我们将招募828名参与者， 博茨瓦纳筛查诊所由合作的哈佛艾滋病研究所管理。CD4受试者 计数> 350将被随机分为4组的析因设计： 硒，或单独的多种维生素，或单独的硒，或安慰剂，持续24个月。具体目标是 建议是1）研究复合维生素和硒的组合是否优于 单独的多种维生素或单独的硒在改善免疫功能方面的作用。2)探讨 就改善免疫功能而言，补充多种维生素是否优于安慰剂。 3)研究硒在改善免疫功能方面是否优于安慰剂。四、 评估药物滥用如何影响HIV感染男性的营养状况和HIV疾病进展， 妇女这项拟议的调查将确定营养疗法对提高免疫力的功效。 功能和减缓艾滋病毒疾病的进展。由于抗逆转录病毒疗法并不容易 在非洲大多数国家，艾滋病毒感染的成年人都可以使用，这项研究可能提供一种替代方法， 来延缓艾滋病的发展

The country of Botswana, Africa, has the highest rates of HIV infection in the world. Moreover, an emerging drug abuse problem in this part of the world may contribute to immune suppression and to the decline of nutritional status, which in turn facilitates HIV disease progression. This application is based on our African studies indicating that multivitamin supplementation significantly increased CD4 count in pregnant women over time, and our US studies showing that selenium is a powerful predictor of HIV mortality and that selenium supplementation slows HIV disease progression. The overall goal of this application is to determine whether supplementation with multivitamins and selenium can improve immune function and prolong time to AIDS or mortality in HIV infected adults in Botswana. We will recruit 828 participants from the Botswana screening clinics managed by the collaborating Harvard AIDS Institute. Participants with CD4 count > 350 will be randomized into a factorial design with 4 groups: combination of multivitamins with selenium, or multivitamins alone, or selenium alone, or placebo, for 24 months. The specific aims of this proposal are 1) To investigate whether the combination of multivitamins and selenium is preferable to either multivitamins alone or selenium alone with respect to improving immune function. 2) To investigate whether multivitamin supplementation is preferable to placebo with respect to improving immune function. 3) To investigate whether selenium is preferable to placebo with respect to improving immune function. 4) To assess how drug abuse affects nutritional status and HIV disease progression in HIV infected men and women. This proposed investigation will determine the efficacy of nutrient therapy to improve immune function and slow HIV disease progression in Botswana. Since antiretroviral therapies are not readily available to HIV infected adults in most countries in Africa, this study may provide an alternative approach to retard HIV progression.