HIV Disease, Drug Abuse, & Nutrient Therapy in Botswana

简介（由申请人提供）：非洲国家博茨瓦纳是世界上艾滋病感染率最高的国家。此外，世界这一地区新出现的药物滥用问题可能导致免疫抑制和营养状况下降，从而促进艾滋病毒疾病的进展。这一应用是基于我们在非洲的研究，该研究表明，随着时间的推移，补充多种维生素可以显著增加孕妇的CD4计数，而我们在美国的研究表明，硒是HIV死亡率的有力预测指标，硒的补充可以减缓HIV疾病的进展。这项应用的总体目标是确定补充复合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人的艾滋病时间或死亡率。我们将从合作的哈佛艾滋病研究所管理的博茨瓦纳筛查诊所招募828名参与者。CD4计数为bb0 350的参与者将被随机分为四组：复合维生素与硒的组合，或单独复合维生素，或单独硒，或安慰剂，为期24个月。本研究的具体目的是：1)研究在提高免疫功能方面，复合维生素和硒的组合是否优于单独使用复合维生素或单独使用硒。2)探讨复合维生素补充剂在改善免疫功能方面是否优于安慰剂。3)探讨硒在改善免疫功能方面是否优于安慰剂。4)评估药物滥用如何影响艾滋病毒感染者的营养状况和艾滋病毒疾病进展。这项拟议的调查将确定营养疗法在博茨瓦纳改善免疫功能和减缓艾滋病毒疾病进展方面的功效。由于在非洲大多数国家，艾滋病毒感染的成年人不容易获得抗逆转录病毒治疗，因此这项研究可能提供一种延缓艾滋病毒进展的替代方法。

DESCRIPTION (provided by applicant): 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.