Multivitamin-selenium combo may delay ill health, mortality from AIDS


December 4, 2013 — A new study co-authored by researchers from Harvard School of Public Health (HSPH) suggests that a special multivitamin preparation that includes selenium can significantly slow the progression to ill health or death in people with HIV infection.

The study appears in the November 27, 2013 issue of the Journal of the American Medical Association (JAMA).

“The results are potentially groundbreaking. If we can slow the progression to AIDS with a special multivitamin preparation, it could save a lot of lives for a small price,” said [[Richard Marlink]], executive director of the Harvard School of Public Health AIDS Initiative (HAI) and the Bruce A. Beal, Robert L. Beal, and Alexander S. Beal Professor of the Practice of Public Health at HSPH. “We now also need to figure out the exact reasons why this preparation works. In doing so, we may learn a lot more as to how to slow HIV’s destruction of patient’s immune systems.”

Marlink noted that such a multivitamin—very safe to take, with no side effects—would be particularly helpful in African countries, which often are unable to provide antiretroviral therapy (ART) to HIV-infected individuals at earlier stages of the disease, as would be done in resource-rich countries.

The HSPH researchers decided to study the effect of multivitamins on the health of HIV-infected individuals because it’s known that they tend to have deficiencies in micronutrients—such as B vitamins, vitamins C and E, and thiamin, riboflavin, niacin, and folic acid—and that these deficiencies may accelerate disease progression. In addition, it’s known that the trace element selenium helps maintain a responsive immune system.

The researchers also wanted to follow up on a 2004 Tanzanian study led by HSPH’s [[Wafaie Fawzi]], chair of HSPH’s Department of Global Health and Population; Richard Saltonstall Professor of Population Sciences; and a co-author on the current paper. The 2004 study suggested that HIV-positive pregnant women taking a specific multivitamin were more likely to stay healthier longer than those who didn’t. In that study, the women were at various stages of disease, prior to ART being available in Tanzania. The new study was different in that it focused on HIV-infected patients not yet eligible for ART—both women who weren’t pregnant and men—in the early stages of the disease.

For the current randomized controlled study conducted from 2004 to 2009 in Botswana, the researchers divided 878 HIV-infected adults, who had never received ART, into four groups. Individuals in each group were given either a multivitamin alone, selenium alone, a combination of multivitamins plus selenium, or a placebo.

The results showed that those who took daily multivitamins with selenium had a roughly 50% reduced risk of progressing to either ill health or death due to AIDS over a 24-month period. The people in this group were also much more likely to have higher CD4 counts—a sign of a healthier immune system.

Although Marlink was excited by the results, he noted that multivitamins should never be considered a substitute for ART treatment for individuals with low CD4 counts. ART has proven highly effective in staving off AIDS in HIV-infected individuals for long periods of time.

“Scaling up ART in Africa is what all of us [doing AIDS research at HSPH] have been working on for more than a dozen years,” Marlink said. “We’re not there yet, though. Depending on the country, we’ve probably only met about half, if you’re very optimistic, of the urgent need in the world of people who need ART drugs right now, today. So anything else that can be done would be a positive thing.”

Other HSPH authors on the study included [[Max Essex]], chair of HAI and Mary Woodard Lasker Professor of Health Sciences; [[Mansour Farahani]], research director and research scientist at HAI; and [[Joseph Makhema]], director of the Botswana-Harvard Partnership.

Karen Feldscher