Aids: Multivitamin found to slow pace of HIV

AIDS researchers hailed the report in the New England Journal of Medicine as an important moment in the battle to control HIV in Africa. They hastened to emphasize, however, that vitamins are most beneficial for patients in the earliest phase of infection and should not serve as a substitute for initiatives to bring potent, but expensive, antiretroviral drugs to the developing world.

"It's a major advance and hopefully can have an impact on the lives of people who don't have access to other medications," said Dr. Wafaa El-Sadr, an HIV specialist at Columbia University's Mailman School of Public Health who was not involved in the study. "This is very exciting work."

The Harvard team began its work in 1995 in Tanzania, a nation where the burden of HIV is steep: In a population of 36 million, an estimated 2.5 million to 3 million have the AIDS virus. Believing that vitamins might strengthen the immune system's defenses against the virus, the researchers set out to test whether a daily dose of vitamins could keep pregnant women and their infants healthier and stave off common manifestations of the disease, including oral infections, nausea, and fatigue.

The researchers focused their study on pregnant women because they also wanted to examine health issues related to the transmission of HIV from mother to child, the subject of earlier reports.

The study's findings are bolstered by both the number of participants -- 1,078 women were enrolled -- and its duration, with women monitored on average for nearly six years. Women were given either a single pill containing vitamins B, C, and E; the multivitamin along with vitamin A; vitamin A alone; or a placebo, an inactive dummy pill.

Researchers found that the patients taking vitamins B, C, and E fared best of all: They were 30 percent less likely to progress to the latest stage of HIV infection or to die during the study than women who received the placebo. And they were substantially less likely to develop painful mouth inflammations, rashes, and fatigue.

Blood tests showed that women on the multivitamin had higher levels of vital disease-fighting cells and lower levels of the AIDS virus. 

A year's worth of multivitamins for an individual in Africa costs $15. An annual supply of antiretroviral medications in the developing world costs 20 times as much.

Studies from the World Health Organization have estimated that about 25 million people with HIV live in Africa, although the Globe reported last month that some authorities now believe those figures may be inflated.

"The results from the study clearly provide support for a recommendation of providing multivitamins as supportive care to those infected with HIV," said Dr. Wafaie W. Fawzi, the lead author of the study. "The multivitamins would be useful in earlier stages of HIV disease, in order to delay the time until these antiretroviral drugs are necessary."

That's important not just because of the cost difference, but because use of the vitamins allows doctors to keep in reserve the powerful antiretroviral drugs, which can cause side effects and require patients to be strictly compliant in taking their medication, said Fawzi, a specialist in international nutrition and epidemiology at the Harvard School of Public Health.

Researchers said that they don't know how long the salutary effect of multivitamins persists, but that they believe that in addition to helping prime the immune system of patients, the pills provide broader nutritional benefits.

"This study shows you buy time, but you don't cure HIV, and you don't stop it forever," said Dr. Calvin Cohen, research director for Community Research Initiative of New England, an HIV research organization. "You help the body fight back a little longer, which is a significant accomplishment."

Fawzi said this week that the Harvard researchers have begun sharing their findings with other medical units caring for AIDS patients in the developing world, in the hope that multivitamins can be incorporated routinely into treatment. Although the study was limited to pregnant women, AIDS specialists said they believe the findings demonstrate the importance of offering vitamins broadly to people infected with HIV in developing countries.

That's already happening in treatment campaigns presided over by Columbia's El-Sadr in Africa and Thailand, as well as in clinics in India where researchers from the Tufts University School of Medicine work.

Specialists said they are not prepared to recommend that patients in the West should begin taking extra vitamins. In part, that's because Western patients tend to get more vitamins from their diets and because many already take supplements.

The discovery regarding multivitamins was reported as other researchers are demonstrating that low-cost approaches can be as effective as pricey brand-name pills in treating common conditions such as heart disease. But conducting studies of inexpensive, generic treatments is a costly proposition and not typically undertaken by pharmaceutical companies more interested in the substantial profit that can be derived from creating blockbuster drugs that demand top dollar.

Instead, researchers hoping to evaluate fixtures of the medicine cabinet rely on financial support from government agencies, which was the case with the Harvard study, bolstered by a multimillion-dollar grant from the National Institutes of Health.

"Of course, we can't study every oddball idea that comes down the pike," said Dr. Sherwood Gorbach of Tufts, who studies the interaction between nutrition and HIV and is editor of the journal Clinical Infectious Diseases.

"But on the other hand," he said, "if you can develop some scientific rationale for investigating the efficacy of a treatment, then it should be put to the test."

Stephen Smith can be reached at stsmith@globe.com. 
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