A daily vitamin pill can delay the progress of AIDS in HIV-infected women, an eight-year study by Harvard researchers has found.
Vitamins are by no means a cure or a substitute for antiretroviral therapy, the researchers said. But for malnourished women in Africa or Asia with little hope of getting better drugs, vitamins are an inexpensive, safe way of giving them extra months of life and a little less misery before they die, the study suggested.
"The study is important for developing countries, especially for pregnant and post-partum women, who are a nutritionally vulnerable group," said Dr. Lynne Mofenson, chief of the pediatric and maternal AIDS branch of the National Institute of Child Health and Human Development, one of the National Institutes of Health.
Dr. Richard Marlinck, who helps run treatment programs in six African countries in his dual roles as director of the Harvard Aids Institute and scientific advisor to the Elizabeth Glaser Pediatric Aids Foundation, said the study would prompt him to recommend vitamins for patients in all six programs.
"This is exciting because it costs literally pennies and can ward off the time when you need to begin treatment with expensive and toxic drugs," he said.
The study, run by the Harvard School of Public Health and the medical school of Tanzania's Muhimbili University, followed 1,078 women in Dar es Salaam between 1995 and last year. The women were recruited when they were pregnant. Like millions of others in poor countries, they had no access to the drug therapy known as AIDS cocktails, so HIV infection meant a sentence of eventual death from tuberculosis, meningitis, pneumonia, Kaposi's sarcoma, diarrhea or another opportunistic infection.
About 6 million people in poor countries are already sick enough to need antiretroviral drugs, the World Health Organization estimates, and another 25 million or more will need them soon. Only about 400,000 are getting them.
Efforts to increase that number have gone slowly because of high drug prices, fights over patents, a lack of interest by donors, reluctance by African leaders to admit that their nations have epidemics and the inability of shattered health-care systems to muster enough doctors, nurses and laboratories to safely deliver the drugs.
Vitamins costing less than US$15 a year might prolong the lives of people waiting for rescue, the study concluded. The supplements do not attack the virus, but enhance the body's own immune system, allowing it to do so.
The vitamins were specially made for the study "but are quite easy to mass-produce," said its lead author, Wafaie Fawzi, a Harvard professor of nutrition and epidemiology. They contained about three times the recommended daily allowance of vitamin E and six to 10 times the allowance of C and B-complex vitamins.
The Tanzania study found that 30 percent fewer of the women who received the multivitamins died or progressed to full-blown AIDS during the study than a group of women receiving a placebo.
Nonetheless, vitamins were no cure-all. About a quarter of the women who received them still died or reached full-blown AIDS during the study and, without anti-retroviral treatment, virtually all can be expected to die in the next few years.
The study had to be changed twice in mid-stream for ethical reasons, Fawzi said.
Vitamin A was dropped from the supplements because researchers found evidence that it increased the risk that mothers would pass the infection to their babies.
Also, when the authors had early evidence that multivitamins prevented fetal death and premature births, they put all the women in the study on multivitamins until they delivered. After that, the mothers went back on their previous regimens.
The study confirms what researchers have suspected since the epidemic's early days, Marlink said.
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