Abstract
Poor growth, micronutrient deficiencies and episodes of diarrhea and respiratory infections occur frequently in HIV-infected children. We investigated whether multi-micronutrient supplementation would improve the growth performance and reduce the number of episodes of diarrhea and/or of respiratory symptoms in HIV-infected children. In a double-blind randomized trial, HIV-infected South African children aged 4–24 months (n = 201) were assigned to receive multi-micronutrient supplements or placebo daily for six months. The children were assessed for respiratory symptoms or diarrhea bi-weekly; weights and heights were measured monthly. In total, 121 children completed the six month follow up study period (60%). A total of 43 children died; 27 of them had received supplements. This difference in mortality was not statistically significant (p = 0.12). Weight-for-height Z-scores improved significantly (p < 0.05) among children given supplements compared with those given placebo (0.40 (0.09–0.71)) versus −0.04 (−0.39–0.31) (mean (95% CI)). Height-for-age Z-scores did not improve in both treatment groups. The number of monthly episodes of diarrhea in the placebo group (0.36 (0.26–0.46)) was higher (p = 0.09) than in the supplement group (0.25 (0.17–0.33)) and the number of monthly episodes of respiratory symptoms was significantly higher (p < 0.05) among children on placebos (1.01 (0.83–1.79)) than those on supplements (0.66 (0.52–0.80)). Multi-micronutrient supplements significantly improved wasting and reduced the number of episodes of diarrhea and respiratory symptoms.
Highlights
In 2011, there were 330,000 children younger than 15 years worldwide who were newly infected with HIV and 90% of them were in Sub-Saharan Africa [1]
The aim of the present study was to test the hypothesis that daily multi-micronutrient supplementation for six months would improve the weight-for-height and height-for-age Z-scores by 30% compared to placebo in HIV-infected young South African children who are not yet on antiretroviral therapy (ART)
HIV-infected children aged 4–24 months who had been previously admitted to the pediatric wards of the hospital with pneumonia or diarrhea were enrolled into the study, on discharge from the wards or from the pediatric outpatient department from November 2005 to November 2006
Summary
In 2011, there were 330,000 children younger than 15 years worldwide who were newly infected with HIV and 90% of them were in Sub-Saharan Africa [1]. Children who are infected with HIV are known to be at high risk for poor nutritional status, infections and poor growth performance [2,3,4]. Growth failure in HIV-infected children is associated with an increased risk of mortality [5,6]. Deficiencies of micronutrients, especially of vitamin A and zinc have been associated with diarrhea and respiratory diseases [7,8]. Deficiencies of zinc and of iron have been associated with impaired growth [9,10]. Vitamin A and carotenoid status were demonstrated to be independent predictors of growth failure in HIV-infected Malawian children [11]
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