Person:

Kawai, Kosuke

We examined whether there are sex differences in the effect of vitamin supplements on birth outcomes, mortality, and morbidity by two years of age among children born to HIV-infected women in Tanzania. A randomized placebo-controlled trial was conducted among 959 mother-infant pairs. HIV-infected pregnant women were randomly assigned to receive a daily oral dose of one of four regimens: multivitamins (vitamins B-complex, C, and E), vitamin A plus β-carotene, multivitamins including vitamin A plus β-carotene, or placebo. Supplements were administered during pregnancy and continued after delivery. The beneficial effect of multivitamins on decreasing the risk of low birth weight was stronger among girls (RR = 0.39, 95% CI 0.22 – 0.67) compared to boys (RR = 0.81, 95% CI 0.44 – 1.49; p for interaction = 0.08). Maternal multivitamin supplements resulted in 32% reduction in mortality among girls (RR = 0.68, 95% CI 0.47 – 0.97), whereas no effect was found among boys (RR = 1.20, 95% CI 0.80 –1.78; p for interaction = 0.04). Multivitamins had beneficial effects on the overall risks of diarrhea that did not differ by sex. Vitamin A plus β-carotene alone increased the risk of HIV transmission, but had no effect on mortality, and we found no sex differences in these effects. Sex differential effects of multivitamins on mortality may be due to sex related differences in the immunological or genetic factors. More research is warranted to examine the effect of vitamins by sex and better understand biological mechanisms mediating such effects.

BACKGROUND

Patients with tuberculosis (TB) often suffer from profound malnutrition.

OBJECTIVE

To examine the patterns and predictors of change in nutritional and hemoglobin status during and after TB treatment.

METHODS

A total of 471 HIV-positive and 416 HIV-negative adults with pulmonary TB were prospectively followed in Dar es Salaam, Tanzania. All patients received 8 months TB treatment following enrollment.

RESULTS

About 40% of HIV-positive and 47% of HIV-negative TB patients had BMI <18.5 kg/m2 at baseline. About 94% of HIV-positive and 84% of HIV-negative participants were anemic at baseline. Both HIV-positive and HIV-negative patients experienced increases in BMI and hemoglobin concentrations over the course of TB treatment. Among HIV-positive patients, older age, low CD4 cell counts, and high viral load were independently associated with a smaller increase in BMI from baseline to 8 months. Female sex, older age, low CD4 cell counts, previous TB infection, and less money spent on food were independently associated with a smaller improvement in hemoglobin among HIV-positive patients during treatment.

CONCLUSION

HIV- positive TB patients, especially those with low CD4 cell counts, showed poor nutritional recovery during TB treatment. Adequate nutritional support should be considered during TB treatment.