Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania

Background. In HIV-1-infected women, poor micronutrient status has been associated with faster progression of HIV-1 disease and adverse birth outcomes. We assessed the effects of vitamin A and multivitamins on birth outcomes in such women. Methods. In Tanzania, 1075 HIV-1-infected pregnant women at between 12 and 27 weeks' gestation received placebo (n = 267), vitamin A (n = 269), multivitamins excluding vitamin A (n = 269), or multivitamins including vitamin A (n = 270) in a randomised, double-blind, placebo-controlled trial with a 2 x 2 factorial design. We measured the effects of multivitamins and vitamin A on birth outcomes and counts of T lymphocyte subsets. We did analyses by intention to treat. Results. 30 fetal deaths occurred among women assigned multivitamins compared with 49 among those not on multivitamins (relative risk 0.61 [95% CI 0.39-0.94] p = 0.02). Multivitamin supplementation decreased the risk of low birthweight (< 2500 g) by 44% (0.56 [0.38-0.82] p = 0.003), severe preterm birth (< 34 weeks of gestation) by 39% (0.61 [0.38-0.96] p = 0.03), and small size for gestational age at birth by 43% (0.57 [0.39-0.82] p = 0.002). Vitamin A supplementation had no significant effect on these variables. Multivitamins, but not vitamin A, resulted in a significant increase in CD4, CD8, and CD3 counts. Interpretation. Multivitamin supplementation is a low-cost way of substantially decreasing adverse pregnancy outcomes and increasing T-cell counts in HIV-1-infected women. The clinical relevance of our findings for vertical transmission and clinical progression of HIV-1 disease is yet to be ascertained.