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Multivitamin supplementation improves hematologic status in HIV-infected women and their children in Tanzania ^1,2,3

¹ From the Departments of Nutrition (WWF, RK, EV, RW, and DH), Epidemiology (WWF, DS, and DH), and Biostatistics (DS), Harvard School of Public Health, Boston, MA, and the Departments of Community Health (GIM) and Internal Medicine (FM), Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania

Background: Anemia is a frequent complication among HIV-infected persons and is associated with faster disease progression and mortality.

Objective: We examined the effect of multivitamin supplementation on hemoglobin concentrations and the risk of anemia among HIV-infected pregnant women and their children.

Design: HIV-1–infected pregnant women (n = 1078) from Dar es Salaam, Tanzania, were enrolled in a double-blind trial and provided daily supplements of preformed vitamin A and ß-carotene, multivitamins (vitamins B, C, and E), preformed vitamin A and ß-carotene + multivitamins, or placebo. All women received iron and folate supplements only during pregnancy according to local standard of care. The median follow-up time for hemoglobin measurement for mothers was 57.3 mo [interquartile range (IQR): 28.6–66.8] and for children it was 28.0 mo (IQR: 5.3–41.7).

Results: During the whole period, hemoglobin concentrations among women who received multivitamins were 0.33 g/dL higher than among women who did not receive multivitamins (P = 0.07). Compared with placebo, multivitamin supplementation resulted in a hemoglobin increase of 0.59 g/dL during the first 2 y after enrollment (P = 0.0002). Compared with placebo, the children born to mothers who received multivitamins had a reduced risk of anemia. In this group, the risk of macrocytic anemia was 63% lower than in the placebo group (relative risk: 0.37: 95% CI: 0.18, 0.79; P = 0.01).

Conclusion: Multivitamin supplementation provided during pregnancy and in the postpartum period resulted in significant improvements in hematologic status among HIV-infected women and their children, which provides further support for the value of multivitamin supplementation in HIV-infected adults.

Key Words: Anemia • HIV infection • hemoglobin • vitamins • Tanzania