Skip to main content
Top
Published in: BMC Infectious Diseases 1/2012

Open Access 01-12-2012 | Study protocol

Multivitamin supplementation in HIV infected adults initiating antiretroviral therapy in Uganda: the protocol for a randomized double blinded placebo controlled efficacy trial

Authors: David Guwatudde, Amara E Ezeamama, Danstan Bagenda, Rachel Kyeyune, Fred Wabwire-Mangen, Henry Wamani, Ferdinand Mugusi, Donna Spiegelman, Molin Wang, Yukari C Manabe, Wafaie W Fawzi

Published in: BMC Infectious Diseases | Issue 1/2012

Login to get access

Abstract

Background

Use of multivitamin supplements during the pre-HAART era has been found to reduce viral load, enhance immune response, and generally improve clinical outcomes among HIV-infected adults. However, immune reconstitution is incomplete and significant mortality and opportunistic infections occur in spite of HAART. There is insufficient research information on whether multivitamin supplementation may be beneficial as adjunct therapy for HIV-infected individuals taking HAART. We propose to evaluate the efficacy of a single recommended daily allowance (RDA) of micronutrients (including vitamins B-complex, C, and E) in slowing disease progression among HIV-infected adults receiving HAART in Uganda.

Methods/Design

We are using a randomized, double-blind, placebo-controlled trial study design. Eligible patients are HIV-positive adults aged at least 18 years, and are randomized to receive either a placebo; or multivitamins that include a single RDA of the following vitamins: 1.4 mg B1, 1.4 mg B2, 1.9 mg B6, 2.6 mcg B12, 18 mg niacin, 70 mg C, 10 mg E, and 0.4 mg folic acid. Participants are followed for up to 18 months with evaluations at baseline, 6, 12 and 18 months. The study is primarily powered to examine the effects on immune reconstitution, weight gain, and quality of life. In addition, we will examine the effects on other secondary outcomes including the risks of development of new or recurrent disease progression event, including all-cause mortality; ARV regimen change from first- to second-line therapy; and other adverse events as indicated by incident peripheral neuropathy, severe anemia, or diarrhea.

Discussions

The conduct of this trial provides an opportunity to evaluate the potential benefits of this affordable adjunct therapy (multivitamin supplementation) among HIV-infected adults receiving HAART in a developing country setting.

Trial registration

Clinical Trial Registration-URL: http://​www.​clinicaltrials.​gov. Unique identifier: NCT01228578
Appendix
Available only for authorised users
Literature
1.
go back to reference Coyne-Meyers K, Trombley LE: A review of nutrition in human immunodeficiency virus infection in the era of highly active antiretroviral therapy. Nutr Clin Pract. 2004, 19 (4): 340-355. 10.1177/0115426504019004340.CrossRefPubMed Coyne-Meyers K, Trombley LE: A review of nutrition in human immunodeficiency virus infection in the era of highly active antiretroviral therapy. Nutr Clin Pract. 2004, 19 (4): 340-355. 10.1177/0115426504019004340.CrossRefPubMed
2.
go back to reference Beisel WR: Single nutrients and immunity. Am J Clin Nutr. 1982, 35 (2 Suppl): 417-468.PubMed Beisel WR: Single nutrients and immunity. Am J Clin Nutr. 1982, 35 (2 Suppl): 417-468.PubMed
3.
go back to reference Dreizen S: Nutrition and the immune response – a review. Int J Vitam Nutr Res. 1979, 49 (2): 220-228.PubMed Dreizen S: Nutrition and the immune response – a review. Int J Vitam Nutr Res. 1979, 49 (2): 220-228.PubMed
4.
go back to reference Jiamton S, et al: A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok. AIDS. 2003, 17 (17): 2461-2469. 10.1097/00002030-200311210-00008.CrossRefPubMed Jiamton S, et al: A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok. AIDS. 2003, 17 (17): 2461-2469. 10.1097/00002030-200311210-00008.CrossRefPubMed
5.
go back to reference Fawzi WW, et al: Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet. 1998, 351 (9114): 1477-1482. 10.1016/S0140-6736(98)04197-X.CrossRefPubMed Fawzi WW, et al: Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet. 1998, 351 (9114): 1477-1482. 10.1016/S0140-6736(98)04197-X.CrossRefPubMed
6.
go back to reference Allard JP, et al: Effects of vitamin E and C supplementation on oxidative stress and viral load in HIV-infected subjects. AIDS. 1998, 12 (13): 1653-1659. 10.1097/00002030-199813000-00013.CrossRefPubMed Allard JP, et al: Effects of vitamin E and C supplementation on oxidative stress and viral load in HIV-infected subjects. AIDS. 1998, 12 (13): 1653-1659. 10.1097/00002030-199813000-00013.CrossRefPubMed
7.
go back to reference McComsey G, et al: Effect of antioxidants on glucose metabolism and plasma lipids in HIV-infected subjects with lipoatrophy. J Acquir Immune Defic Syndr. 2003, 33 (5): 605-607. 10.1097/00126334-200308150-00009.CrossRefPubMed McComsey G, et al: Effect of antioxidants on glucose metabolism and plasma lipids in HIV-infected subjects with lipoatrophy. J Acquir Immune Defic Syndr. 2003, 33 (5): 605-607. 10.1097/00126334-200308150-00009.CrossRefPubMed
8.
go back to reference Batterham M, et al: A preliminary open label dose comparison using an antioxidant regimen to determine the effect on viral load and oxidative stress in men with HIV/AIDS. Eur J Clin Nutr. 2001, 55 (2): 107-114. 10.1038/sj.ejcn.1601124.CrossRefPubMed Batterham M, et al: A preliminary open label dose comparison using an antioxidant regimen to determine the effect on viral load and oxidative stress in men with HIV/AIDS. Eur J Clin Nutr. 2001, 55 (2): 107-114. 10.1038/sj.ejcn.1601124.CrossRefPubMed
9.
go back to reference Spada C, et al: An evaluation of antiretroviral therapy associated with alpha-tocopherol supplementation in HIV-infected patients. Clin Chem Lab Med. 2002, 40 (5): 456-459.PubMed Spada C, et al: An evaluation of antiretroviral therapy associated with alpha-tocopherol supplementation in HIV-infected patients. Clin Chem Lab Med. 2002, 40 (5): 456-459.PubMed
10.
go back to reference de Souza Junior O, et al: alpha-Tocopherol as an antiretroviral therapy supplement for HIV-1-infected patients for increased lymphocyte viability. Clin Chem Lab Med. 2005, 43 (4): 376-382.CrossRefPubMed de Souza Junior O, et al: alpha-Tocopherol as an antiretroviral therapy supplement for HIV-1-infected patients for increased lymphocyte viability. Clin Chem Lab Med. 2005, 43 (4): 376-382.CrossRefPubMed
11.
go back to reference Jaruga P, et al: Supplementation with antioxidant vitamins prevents oxidative modification of DNA in lymphocytes of HIV-infected patients. Free Radic Biol Med. 2002, 32 (5): 414-420. 10.1016/S0891-5849(01)00821-8.CrossRefPubMed Jaruga P, et al: Supplementation with antioxidant vitamins prevents oxidative modification of DNA in lymphocytes of HIV-infected patients. Free Radic Biol Med. 2002, 32 (5): 414-420. 10.1016/S0891-5849(01)00821-8.CrossRefPubMed
12.
go back to reference Kaiser JD, et al: Micronutrient supplementation increases CD4 count in HIV-infected individuals on highly active antiretroviral therapy: a prospective, double-blinded, placebo-controlled trial. J Acquir Immune Defic Syndr. 2006, 42 (5): 523-528. 10.1097/01.qai.0000230529.25083.42.CrossRefPubMed Kaiser JD, et al: Micronutrient supplementation increases CD4 count in HIV-infected individuals on highly active antiretroviral therapy: a prospective, double-blinded, placebo-controlled trial. J Acquir Immune Defic Syndr. 2006, 42 (5): 523-528. 10.1097/01.qai.0000230529.25083.42.CrossRefPubMed
13.
go back to reference Lopez O, et al: Could antioxidant supplementation reduce antiretroviral therapy-induced chronic stable hyperlactatemia?. Biomed Pharmacother. 2003, 57 (3–4): 113-116.CrossRefPubMed Lopez O, et al: Could antioxidant supplementation reduce antiretroviral therapy-induced chronic stable hyperlactatemia?. Biomed Pharmacother. 2003, 57 (3–4): 113-116.CrossRefPubMed
14.
go back to reference Mast TC, et al: Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, Uganda. AIDS Care. 2004, 16 (1): 81-94. 10.1080/09540120310001633994.CrossRefPubMed Mast TC, et al: Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, Uganda. AIDS Care. 2004, 16 (1): 81-94. 10.1080/09540120310001633994.CrossRefPubMed
15.
go back to reference Grinsztejn B, et al: Comparison of clinical response to initial highly active antiretroviral therapy in the patients in clinical care in the United States and Brazil. J Acquir Immune Defic Syndr. 2007, 45 (5): 515-520. 10.1097/QAI.0b013e3180decb6a.CrossRefPubMed Grinsztejn B, et al: Comparison of clinical response to initial highly active antiretroviral therapy in the patients in clinical care in the United States and Brazil. J Acquir Immune Defic Syndr. 2007, 45 (5): 515-520. 10.1097/QAI.0b013e3180decb6a.CrossRefPubMed
16.
go back to reference Coetzee D, et al: Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa. AIDS. 2004, 18 (6): 887-895. 10.1097/00002030-200404090-00006.CrossRefPubMed Coetzee D, et al: Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa. AIDS. 2004, 18 (6): 887-895. 10.1097/00002030-200404090-00006.CrossRefPubMed
17.
go back to reference Kamya MR, et al: Predictors of long-term viral failure among ugandan children and adults treated with antiretroviral therapy. J Acquir Immune Defic Syndr. 2007, 46 (2): 187-193. 10.1097/QAI.0b013e31814278c0.CrossRefPubMed Kamya MR, et al: Predictors of long-term viral failure among ugandan children and adults treated with antiretroviral therapy. J Acquir Immune Defic Syndr. 2007, 46 (2): 187-193. 10.1097/QAI.0b013e31814278c0.CrossRefPubMed
18.
go back to reference Seyler C, et al: Medium-term survival, morbidity and immunovirological evolution in HIV-infected adults receiving antiretroviral therapy, Abidjan, Cote d'Ivoire. Antivir Ther. 2003, 8 (5): 385-393.PubMed Seyler C, et al: Medium-term survival, morbidity and immunovirological evolution in HIV-infected adults receiving antiretroviral therapy, Abidjan, Cote d'Ivoire. Antivir Ther. 2003, 8 (5): 385-393.PubMed
19.
go back to reference Stangl AL, et al: Trends and predictors of quality of life among HIV-infected adults taking highly active antiretroviral therapy in rural Uganda. AIDS Care. 2007, 19 (5): 626-636. 10.1080/09540120701203915.CrossRefPubMed Stangl AL, et al: Trends and predictors of quality of life among HIV-infected adults taking highly active antiretroviral therapy in rural Uganda. AIDS Care. 2007, 19 (5): 626-636. 10.1080/09540120701203915.CrossRefPubMed
20.
go back to reference Rosner B: Fundamentals of Biostatistics. 2000, Pacific Grove: Duxbury Press, 5 Rosner B: Fundamentals of Biostatistics. 2000, Pacific Grove: Duxbury Press, 5
21.
go back to reference Drain PK, et al: Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy. Am J Clin Nutr. 2007, 85 (2): 333-345.PubMed Drain PK, et al: Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy. Am J Clin Nutr. 2007, 85 (2): 333-345.PubMed
22.
go back to reference Isanaka S, et al: Effect of high-dose vs standard-dose multivitamin supplementation at the initiation of HAART on HIV disease progression and mortality in Tanzania: a randomized controlled trial. JAMA. 2012, 308 (15): 1535-1544. 10.1001/jama.2012.13083.CrossRefPubMed Isanaka S, et al: Effect of high-dose vs standard-dose multivitamin supplementation at the initiation of HAART on HIV disease progression and mortality in Tanzania: a randomized controlled trial. JAMA. 2012, 308 (15): 1535-1544. 10.1001/jama.2012.13083.CrossRefPubMed
Metadata
Title
Multivitamin supplementation in HIV infected adults initiating antiretroviral therapy in Uganda: the protocol for a randomized double blinded placebo controlled efficacy trial
Authors
David Guwatudde
Amara E Ezeamama
Danstan Bagenda
Rachel Kyeyune
Fred Wabwire-Mangen
Henry Wamani
Ferdinand Mugusi
Donna Spiegelman
Molin Wang
Yukari C Manabe
Wafaie W Fawzi
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2012
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-12-304

Other articles of this Issue 1/2012

BMC Infectious Diseases 1/2012 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.