Impact of multivitamin and mineral supplements on mortality and nutritional status of hospitalized severely malnourished HIV/AIDS infected children

摘要

Micronutrient deficiencies, in HIV/AIDS infected children, are common and associated with disease progression and increased mortality. There is no evidence to support specific recommendation for in-patient treatment of severely malnourished HIV/AID infected children. We analyzed the impact of daily oral multivitamin and mineral supplementation on nutritional status and on mortality rate, of severely malnourished HIV/AIDS infected infants, hospitalized in a feeding therapeutic center. Children were randomized at admission in one of the two treatment groups: WHO standard group or additional dose group. The trial has been approved by the national health research ethics committee. Case fatality rate was high in each group. There was no difference in mortality rate between WHO standard group (mortality rate = 16.9%) and “additional dose” group (mortality rate = 17.6%). Kaplan Meir survival curves did not differ between the two groups, (p Log Rank = 0.87). During the inpatient follow-up, the median weight gain (g/kg/d) was low in groups and did not differ between WHO standard group (8.88g/kg/d Min = 4.70, Max = 17.23) and “additional dose” group (10.50g/kg/d, Min = 3.29 Max = 17.81) (Wilcoxon test p-value = 0.10). From admission to discharge, anthropometric Z-scores means evolution did not differ between the two groups: WHZ (p = 0.74), WAZ (p = 0.79) and MUAC (p = 0.73). In this randomized trial among severely malnourished HIV/AIDS infected children, we found no evidence that the provision of daily additional micro-nutrient dose during inpatient treatment, compared to WHO standard, improves nutritional status or reduces case fatality rate. Rigorous malnutrition inpatient treatments, including effective HIV/AIDS management, improve nutritional status of severely mal-nourished HIV infected children.