It is thought to be the first randomised trial to show a clinical benefit - a reduction in deaths - from multiple micronutrient supplementation and suggests that multivitamins, both readily available and cost effective, could play an important role in the global fight against HIV/AIDS.
A report released this week by the World Health Organisation estimates that 5 million people became infected with HIV worldwide and 3 million died this year alone - the highest ever. Between 34 and 46 million people are living with HIV worldwide, including around 2.5 million children under the age of 15. And of the estimated 14,000 people infected with HIV daily during 2003, more than 95 per cent live in low- and middle-income countries.
The new study, published in the current issue of AIDS (17(17):2461-2469), used a vitamin supplement containing vitamins A, D, E, C, K and B complex, natural carotenoids, amino acids, and minerals including copper, iron, magnesium, manganese, and selenium.
A total of 481 HIV-infected men and women living in and around Bangkok in Thailand took part in the trial and were randomised to receive either the supplement Immunace, marketed by Vitabiotics in the UK, or a placebo. Participants were followed-up every 12 weeks for a total of 48 weeks.
The results at 48 weeks showed that the death rate among HIV-infected adults with CD4 counts below 200 who took the supplement was significantly lower than those who took placebo. The death rate for those in the micronutrients arm had a risk ratio of 0.53 overall and 0.37 among those with CD4 cell counts lower than 200. There was no impact on CD4 count or plasma viral load.
Previous studies have pointed to a link between micronutrient deficiencies in HIV-infected individuals and a faster progression to death but this study is the first to assess the effect of supplementation on death rates. The study also highlights the need to measure actual clinical benefits in individuals taking micronutrient supplements rather than simply looking for changes in biochemical markers.
Dr Shabbar Jaffar from The London School of Hygiene and Tropical Medicine who led the research team noted that more research is needed to establish the mechanism for increased survival with micronutrients.
But he added: "These results could have important implications for public health and the treatment and care of HIV-infected individuals in developing countries where nutritional deficiencies and access to potent antiretroviral combinations remain limited."
Immunace is formulated to help maintain resistance to infection and optimal cell defence, helping maintain long-term immune defence at the cellular level. It is available as a food supplement in health food stores and chemists in the UK.