HIV This Week

Drain PK, Kupka R, Mugusi F, Fawzi WW. Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy. Am J Clin Nutr 2007;85:333-45.

In HIV-infected persons, low serum concentrations of vitamins and minerals, termed micronutrients, are associated with an increased risk of HIV disease progression and mortality. Micronutrient supplements can delay HIV disease progression and reduce mortality in HIV-positive persons not receiving highly active antiretroviral therapy. With the transition to more universal access to antiretroviral therapy, a better understanding of micronutrient deficiencies and the role of micronutrient supplements in HIV-positive persons receiving antiretroviral therapy has become a priority. The provision of simple, inexpensive micronutrient supplements as an adjunct to antiretroviral therapy may have several cellular and clinical benefits, such as a reduction in mitochondrial toxicity and oxidative stress and an improvement in immune reconstitution. Drain and colleagues reviewed observational and trial evidence on micronutrients in HIV-positive persons receiving antiretroviral therapy to summarize the current literature and to suggest future research priorities. A small number of observational studies have suggested that some, but not all, micronutrients may become replete after antiretroviral therapy initiation, and few intervention studies have found that certain micronutrients may be a beneficial adjunct to antiretroviral therapy. However, most of these studies had some major limitations, including a small sample size, a short duration of follow-up, a lack of adjustment for inflammatory markers, and an inadequate assessment of HIV-related outcomes. Therefore, few data are available to determine whether antiretroviral therapy ameliorates micronutrient deficiencies or to recommend or refute the benefit of providing micronutrient supplements to HIV-positive persons receiving antiretroviral therapy. Because micronutrient supplementation may cause harm, randomized placebo-controlled trials are needed. Future research should determine whether antiretroviral therapy initiation restores micronutrient concentrations, independent of inflammatory markers, and whether micronutrient supplements affect HIV-related outcomes in HIV-positive persons receiving antiretroviral therapy.

Editors’ note: There is no doubt that nutrition is important in optimizing health status but, as this review suggests, it has not been demonstrated that micronutrient supplements provide benefit to people living with HIV, whether or not they are on antiretroviral treatment.