HIV Disease, Drug Abuse, & Nutrient Therapy in Botswana

描述(申请人提供)：非洲博茨瓦纳是世界上艾滋病毒感染率最高的国家。此外，世界这一地区新出现的药物滥用问题可能会导致免疫抑制和营养状况下降，进而促进艾滋病毒疾病的发展。这一应用是基于我们的非洲研究，该研究表明，随着时间的推移，复合维生素补充剂显著增加了孕妇的CD4计数，我们的美国研究表明，硒是艾滋病毒死亡率的强大预测因子，补硒可以减缓艾滋病毒疾病的进展。这项应用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者成年艾滋病或死亡的时间。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计数和GT；350的参与者将被随机分成4组：多种维生素与硒的组合，或单独服用多种维生素，或单独服用硒，或服用安慰剂，为期24个月。这项建议的具体目的是1)研究在改善免疫功能方面，复合维生素和硒是否比单独使用复合维生素或单独使用硒更可取。2)研究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)探讨在改善免疫功能方面，硒是否优于安慰剂。4)评估药物滥用对艾滋病毒感染者的营养状况和艾滋病毒疾病进展的影响。这项拟议的调查将确定营养疗法在改善免疫功能和减缓博茨瓦纳艾滋病毒疾病进展方面的有效性。由于在非洲大多数国家，艾滋病毒感染者的成人并不容易获得抗逆转录病毒疗法，这项研究可能会提供另一种方法来延缓艾滋病毒的发展。

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.