Nutrition News for Africa

Abstract - February 15, 2007

An article entitled “Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy” was published by Drain et al, in the American Journal of Clinical Nutrition 2007;85:333-45.

Micronutrients deficiencies are commonly observed with advanced HIV disease. They have been associated with higher risks of HIV disease progression and mortality. In 1996, highly active antiretroviral therapy (HAART) became the new standard for HIV treatment. HAART regimens comprise 3 HIV medications. HAART restores immunologic function, but does not eliminate weight loss and wasting, which continue to be strong independent predictors of mortality. Because low micronutrient concentrations are caused by similar mechanisms and several micronutrient concentrations are lower among patients with HIV wasting syndrome, micronutrient deficiencies may also persist with HAART, and research on these deficiencies and the role of micronutrient supplementation of HIV-infected individuals receiving HAART has become a priority. Compared to HIV-negative persons, HIV-infected persons have lower serum concentrations of several micronutrients and more commonly have micronutrient deficiencies.

The authors reviewed published observational studies and trial evidence of micronutrients and HAART in HIV-positive persons to summarize the current literature and suggest future research priorities.

In summary, the review of observational studies reveals that some but not all micronutrients may increase after HAART initiation. Some of the intervention studies also reveal that certain micronutrients may be a beneficial adjunct to HAART. None of the observational studies adjusted micronutrient concentrations by inflammatory markers, which could alter serum concentrations of several micronutrients. The authors caution that they may not have captured all relevant articles, that there might be a publication bias favoring significant findings and that many of the studies had their own limitations, including small sample sizes.

With these limitations in mind, the authors recommend that future research include a longitudinal description of changes in micronutrient concentrations after HAART initiation, with adjustments for acute inflammatory markers. In addition, since no trials assessed the effect of micronutrient supplements on clinical disease progression or mortality in HIV-positive persons receiving HAART, they also recommend conducting large randomized placebo-controlled trials in HIV-positive persons receiving HAART. This would help determine the effects on clinical HIV-related outcomes and side effects of particular HIV medications.

The authors conclude that although micronutrient supplements have been shown to be beneficial in HIV-infected persons not receiving HAART, little data is available on supplementation of HIV-positive persons receiving HAART. They recommend future research efforts to focus on identifying which micronutrients might remain depleted after HAART initiation, and whether micronutrient supplements would be beneficial in HIV-positive persons receiving HAART.