Effect of Periodic Vitamin A Supplementation on Mortality and Morbidity of Human Immunodeficiency Virus-Infected Children in Uganda: A Controlled Clinical Trial

Nutrition. 2005 Jan;21(1):25-31. doi: 10.1016/j.nut.2004.10.004.

Abstract

Objective: We investigated whether vitamin A supplementation would decrease mortality and morbidity rates in children infected with the human immunodeficiency virus (HIV).

Methods: We conducted a randomized, double-blind, placebo-controlled clinical trial at Mulago Hospital, a large hospital that serves the urban and semiurban populations of Kampala, Uganda. One hundred eighty-one HIV-infected children were enrolled at 6 mo and randomized to receive vitamin A supplementation, 60 mg retinol equivalent, or placebo every 3 mo from ages 15 to 36 mo. Morbidity was assessed through a 7-d morbidity history every 3 mo, and vital events were measured. Children received daily trimethoprim-sulfamethoxazole prophylactic therapy.

Results: After age 15 mo, children were followed for a median of 17.8 mo (interquartile range = 11.1 to 21.0 mo). The trial was stopped when there was a new policy to implement a program of mass supplementation of vitamin A in the country. Mortality rates among 87 children in the vitamin A group and 94 children in the control group were 20.6% and 32.9%, respectively, yielding a relative risk of 0.54 (95% confidence interval, 0.30 to 0.98; P = 0.044) after adjusting for baseline weight-for-height Z score. Children who received vitamin A had lower modified point prevalences of persistent cough (odds ratio, 0.47; 95% confidence interval, 0.23 to 0.96; P = 0.038) and chronic diarrhea (odds ratio, 0.48; 95% confidence interval, 0.19 to 1.18; P = 0.11) and a shorter duration of ear discharge (P = 0.03). Vitamin A supplementation had no significant effect on modified point prevalences of fever, ear discharge, bloody stools, or hospitalizations.

Conclusions: Vitamin A supplementation decreases mortality rate in HIV-infected children and should be considered in the care for these children in developing countries.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Infective Agents / administration & dosage
  • Child, Preschool
  • Confidence Intervals
  • Dietary Supplements
  • Double-Blind Method
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / mortality*
  • Humans
  • Infant
  • Male
  • Morbidity
  • Nutritional Status
  • Risk Factors
  • Severity of Illness Index
  • Trimethoprim, Sulfamethoxazole Drug Combination / administration & dosage
  • Uganda / epidemiology
  • Vitamin A / administration & dosage*
  • Vitamin A / therapeutic use
  • Vitamin A Deficiency / complications
  • Vitamin A Deficiency / prevention & control*

Substances

  • Anti-Infective Agents
  • Vitamin A
  • Trimethoprim, Sulfamethoxazole Drug Combination