PLoS ONE (Jan 2015)

Micronutrients in HIV: a Bayesian meta-analysis.

  • George M Carter,
  • Debbie Indyk,
  • Matthew Johnson,
  • Michael Andreae,
  • Kathryn Suslov,
  • Sudharani Busani,
  • Aryan Esmaeili,
  • Henry S Sacks

DOI
https://doi.org/10.1371/journal.pone.0120113
Journal volume & issue
Vol. 10, no. 4
p. e0120113

Abstract

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BackgroundApproximately 28.5 million people living with HIV are eligible for treatment (CD4ObjectivesWe synthesized evidence on the effect of micronutrient supplementation on mortality and rate of disease progression in HIV disease.MethodsWe searched MEDLINE, EMBASE, the Cochrane Central, AMED and CINAHL databases through December 2014, without language restriction, for studies of greater than 3 micronutrients versus any or no comparator. We built a hierarchical Bayesian random effects model to synthesize results. Inferences are based on the posterior distribution of the population effects; posterior distributions were approximated by Markov chain Monte Carlo in OpenBugs.Principal findingsFrom 2166 initial references, we selected 49 studies for full review and identified eight reporting on disease progression and/or mortality. Bayesian synthesis of data from 2,249 adults in three studies estimated the relative risk of disease progression in subjects on MNS vs. control as 0.62 (95% credible interval, 0.37, 0.96). Median number needed to treat is 8.4 (4.8, 29.9) and the Bayes Factor 53.4. Based on data reporting on 4,095 adults reporting mortality in 7 randomized controlled studies, the RR was 0.84 (0.38, 1.85), NNT is 25 (4.3, ∞).ConclusionsMNS significantly and substantially slows disease progression in HIV+ adults not on ARV, and possibly reduces mortality. Micronutrient supplements are effective in reducing progression with a posterior probability of 97.9%. Considering MNS low cost and lack of adverse effects, MNS should be standard of care for HIV+ adults not yet on ARV.