Multivitamin supplementation improves hematologic status in HIV-infected women and their children in Tanzania

• Published in: The American journal of clinical nutrition 2007-05, Vol.85 (5), p.1335-1343
• Main Authors: Fawzi, Wafaie W, Msamanga, Gernard I, Kupka, Roland, Spiegelman, Donna, Villamor, Eduardo, Mugusi, Ferdinand, Wei, Ruilan, Hunter, David
• Format: Article
• Language: English
• Subjects: Adult; anemia (disease); Anemia - blood; Anemia - drug therapy; Anemia - epidemiology; Anemia - etiology; Anemia, Iron-Deficiency - blood; Anemia, Iron-Deficiency - drug therapy; Anemia, Iron-Deficiency - epidemiology; Anemia, Iron-Deficiency - etiology; ascorbic acid; beta Carotene - blood; beta Carotene - therapeutic use; beta-carotene; Biological and medical sciences; blood chemistry; Child Nutritional Physiological Phenomena; Child, Preschool; children; deficiency diseases; Dietary Supplements; disease course; Double-Blind Method; Feeding. Feeding behavior; Female; folic acid; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; hemoglobin; Hemoglobins - analysis; HIV infections; HIV Infections - blood; HIV Infections - complications; Human immunodeficiency virus; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; iron; Male; Maternal Nutritional Physiological Phenomena; mortality; multivitamin supplements; nutritional status; postpartum period; Pregnancy; Pregnancy Complications, Infectious - blood; Pregnancy Outcome; pregnant women; Risk Factors; Tanzania; temporal variation; Vertebrates: anatomy and physiology, studies on body, several organs or systems; vitamin A; Vitamin A - blood; Vitamin A - therapeutic use; vitamin B complex; vitamin E; Vitamin E - blood; Vitamin E - therapeutic use; Vitamins - blood; Vitamins - therapeutic use; women
• ISSN: 0002-9165; 1938-3207
• DOI: 10.1093/ajcn/85.5.1335

BACKGROUND: Anemia is a frequent complication among HIV-infected persons and is associated with faster disease progression and mortality. OBJECTIVE: We examined the effect of multivitamin supplementation on hemoglobin concentrations and the risk of anemia among HIV-infected pregnant women and their children. DESIGN: HIV-1-infected pregnant women (n = 1078) from Dar es Salaam, Tanzania, were enrolled in a double-blind trial and provided daily supplements of preformed vitamin A and β-carotene, multivitamins (vitamins B, C, and E), preformed vitamin A and β-carotene + multivitamins, or placebo. All women received iron and folate supplements only during pregnancy according to local standard of care. The median follow-up time for hemoglobin measurement for mothers was 57.3 mo [interquartile range (IQR): 28.6-66.8] and for children it was 28.0 mo (IQR: 5.3-41.7). RESULTS: During the whole period, hemoglobin concentrations among women who received multivitamins were 0.33 g/dL higher than among women who did not receive multivitamins (P = 0.07). Compared with placebo, multivitamin supplementation resulted in a hemoglobin increase of 0.59 g/dL during the first 2 y after enrollment (P = 0.0002). Compared with placebo, the children born to mothers who received multivitamins had a reduced risk of anemia. In this group, the risk of macrocytic anemia was 63% lower than in the placebo group (relative risk: 0.37: 95% CI: 0.18, 0.79; P = 0.01). CONCLUSION: Multivitamin supplementation provided during pregnancy and in the postpartum period resulted in significant improvements in hematologic status among HIV-infected women and their children, which provides further support for the value of multivitamin supplementation in HIV-infected adults.