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Vitamin supplements, socioeconomic status, and morbidity events as predictors of wasting in HIV-infected women from Tanzania^1,2,3

¹ From the Departments of Nutrition (EV, ES, DJH, and WWF) and Epidemiology (DJH and WWF), Harvard School of Public Health, Boston, MA, and the Departments of Pediatrics and Child Health (KM) and Community Health (GM), Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania

Background: Wasting is a strong independent predictor of mortality in HIV-infected persons. Vitamin supplements delay the disease progression, but their effect on wasting is not known. Data are lacking on the risk factors for wasting in African HIV-infected persons.

Objectives: The objectives were to examine the effect of vitamin supplements on wasting in HIV-infected women and to assess the effects of sociodemographic characteristics, morbidity events, and immunologic progression on the risk of wasting.

Design: HIV-infected women (n = 1078) from Tanzania were randomly assigned to receive 1 of 4 daily oral regimens: multivitamins (B complex, C, and E), vitamin A plus ß-carotene, multivitamins that included vitamin A plus ß-carotene, or placebo. The endpoints of the study included first episodes of a midupper arm circumference <22 cm or a body mass index (BMI; in kg/m²) <18 and the incidence of weight loss episodes during a median 5.3 y of follow-up.

Results: Multivitamins alone significantly reduced the risk of a first episode of a midupper arm circumference <22 cm (relative risk: 0.66; 95% CI: 0.47, 0.94; P = 0.02). In multivariate-adjusted Cox models, the woman’s age, education level, and height were inversely related to the incidence of wasting. Episodes of diarrhea, nausea or vomiting, lower respiratory tract infections, oral ulcers, thrush, severe anemia, and low CD4⁺ cell counts were each significantly related to an increased risk of wasting.

Conclusions: Vitamins C and E and the vitamin B complex have a protective effect on wasting in HIV-infected women. Prevention of diarrhea, severe respiratory tract infections, and anemia are likely to decrease the burden of wasting.

Key Words: Wasting • HIV infection • multivitamins • vitamin A • diarrhea • anemia

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