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


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.

Share and Cite:

Savadogo, L. , Donnen, P. , Kouéta, F. , Kafando, E. , Hennart, P. and Dramaix, M. (2013) Impact of multivitamin and mineral supplements on mortality and nutritional status of hospitalized severely malnourished HIV/AIDS infected children. Open Journal of Epidemiology, 3, 213-219. doi: 10.4236/ojepi.2013.34031.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Brahmbhatt, H., Kigozi, G., Wabwire-Mangen, F., Serwadda, D., Lutalo, T., Nalugoda, F., Sewankambo, N., Kiduggavu, M., Wawer, M. and Gray, R. (2006) Mortality in HIV-infected and uninfected children of HIV-infected and uninfected mothers in rural Uganda. Journal of Acquired Immune Deficiency Syndromes, 41, 504-508.
[2] Kawo, G., Karlsson, K., Lyamuya, E., Kalokola, F., Fataki, M., Kazimoto, T., Kitundu, J., Msaky, H., Munubhi, E., Ostborn, A., Bredberg-Raden, U., Swai, A., Mbise, R., Msengi, A., Mhalu, F. and Biberfeld, G. (2000) Prevalence of HIV type 1 infection associated clinical features and mortality among hospitalized children in Dar es Salam, Tanzania. Scandinavian Journal of Infectious Diseases, 32, 357-363.
[3] Kafwembe, E.M., Kelly, P. and Ngalande, P. (2001) Vitamin A levels in HIV/AIDS. East African Medical Journal, 78, 451-453.
[4] Van-Staden, A.M., Barnard, H.C., Nel, M., Attwood, E.M., Oosthuizen, G.M., Dannhauser, A., Van-der-Ryst, E. and LeRoux, G.D. (1998) Nutritional status of HIV-1 sero-positive patients in the Free State Province of South Africa-laboratory parameters. Central African Journal of Medicine, 44, 246-250.
[5] Beach, R.S., Mantero Atienza, E., Shor-Posner, G., Javier, J.J., Szapocznik, J. and Morgan, R. (1992) Specific micronutriment abnormalities in asymptomatic HIV-1 infection. AIDS, 6, 701-708.
[6] Bogden, J.D., Baker, H. and Frank, O. (1990) Micronutriment status and human immunodeficiency virus infection. Annals of the New York Academy of Sciences, 587, 189-195.
[7] Baum, M.K., Shor-Posner, G. and Lu, Y. (1995) Micro-nutrients and HIV-1 disease progression. AIDS, 9, 1051-1056.
[8] Tang, A.M., Graham, N.M.H. and Saah, A.J. (1996) Effects of micronutrient intake on survival in human immunodeficiency virus type 1 infection. American Journal of Epidemiology, 143, 1244-1256.
[9] Fawzi, W. (2003) Micronutrients and human immunodeficiency virus type 1 disease progression among adults and children. Clinical Infectious Diseases, 37, S112-S116.
[10] Young, T. (2006) Effects of micronutrient supplementation on morbidity and mortality among HIV-infected individuals—A summary of the evidence. South African Medical Journal, 96, 1062-1064.
[11] Bobat, R., Coovadia, H., Stephen, C., Naidoo, K.L., Mc-Kerrow, N., Black, R.E. and Moss, W.J. (2005) Safety and efficacy of zinc supplementation for children with HIV-1 infection in South Africa: A randomised double-blind placebo-controlled trial. Lancet, 366, 1862-1867.
[12] Coutsoudiis, A., Bobat, R.A., Coovadia, H.M., Kuhn, L., Tsai, W-Y. and Stein, Z.A. (1995) The effects of vitamin a supplementation on the morbidity of children born to HIV-infected women. American Journal of Public Health, 85, 1076-1081.
[13] Sombié, I., Nacro, B., Tiendrébéogo, S., Dao, B., Cartoux, M., Meda, N., Ky-Zerbo, O., Dabis, F., Mandelbrot, L. and Van de Perre, P. (1999) Maternal HIV infection and the anthropometric characteristics of children at birth in Burkina Faso. Sante, 9, 173-177.
[14] Lepage, P., Msellati, P., Hitimana, D.G., Bazubagira, A., Van Goethem, C., Simonon, A., Karita, E., Dequae-Merchadou, L., Van de Perre, P. and Dabis, F. (1996) Growth of human immunodeficiency type 1-infected and uninfected children: A prospective cohort study in Kigali, Rwanda, 1988 to 1993. The Pediatric Infectious Disease Journal, 15, 479-485.
[15] Prazuck, T., Tall, F. and Nacro, B. (1993) HIV infection and severe malnutrition: A clinical and epidemiological study in Burkina Faso. AIDS, 7, 103-108.
[16] Somé, J.F., Bellamy, G. and Auregan, G. (2000) Malnutrition et statut sérologique des enfants admis dans un CREN de Ouagadougou: Comparaison des aspects anthropométriques, biologiques et évolutifs. 9èmes journées des sciences de la santé, 9-12, Bobo-Dioulasso.
[17] Ticklay, I.M., Nathoo, K.J., Siziya, S. and Brady, J.P. (1997) HIV infection in malnourished children in Harare, Zimbabwe. East African Medical Journal, 74, 217-220.
[18] Mgone, C.S., Mhalu, F.S. and Shao, J.F. (1991) Prevalence of HIV1 infection and symptomatology of AIDS in severely malnourished children in Dars Es Salaam, Tanzania. Journal of Acquired Immune Deficiency Syndromes, 4, 910-913.
[19] Collins, S., Dent, N., Binns, P., Bahwere, P., Sadler, K. and Hallam, A. (2006) Management of severe acute malnutrition in children. Lancet, 368, 1992-2000.
[20] Beau, J.P., Imboua-Coulibaly, L. and Du Lou, A.D. (1999) The effect of nutritional management on the mortality of malnourished uninfected and infected with the human immunodeficiency virus. Sante, 9, 163-167.
[21] Puoane, T., Sanders, D., Chopra, M., Ashworth, A., Strasser, S., McCoy, D., Zulu, B., Matinise, N. and Mdingazwe, N. (2001) Evaluating the clinical management of severely malnourished children—A study of two rural district hospitals. South African Medical Journal, 91, 137-141.
[22] Kessler, L., Daley, H., Malenga, G. and Graham, S. (2000) The impact of the human immuno deficience virus 1 on the management of severe malnutrition in Malawi. Annals of Tropical Paediatrics, 20, 50-56.
[23] Buys, H., Hendricks, M., Eley, B. and Hussey, G. (2002) The role of nutrition and micronutrients in paediatric HIV infection. SADJ, 57, 454-456.
[24] Semba, R.D., Ndugwa, C., Perry, R.T., Clark, T.D., Jackson, J.B., Melikian, G., Tielsch, J. and Mmiro, F. (2005) Effect of periodic vitamin A supplementation on mortality and morbidity of human immunodeficiency virus-infected children in Uganda: A controlled clinical trial. Nutrition, 21, 25-31.
[25] Simpore, J., Zongo, F., Kabore, F., Dansou, D., Bere, A., Nikiema, J-B., Pignatelli, S., Biondi, D.M., Ruberto, G. and Musumeci, S. (2005) Nutrition Rehabilitation of HIV-Infected and HIV-Negative Undernourished Children Utilizing Spirulina. Annals of Nutrition and Metabolism, 49, 373-380.
[26] Paton, N.I., Sangeetha, S., Earnest, A. and Bellamy, R. (2006) The impact of malnutrition on survival and the CD4 count response in HIV-infected patients starting antiretroviral therapy. HIV Medicine, 7, 323-330.
[27] Grobler, L., Siegfried, N., Visser, M.E., Mahlungulu, S.S. and Volmink, J. (2013) Nutritional interventions for reducing morbidity and mortality in people with HIV. Cochrane Database of Systematic Reviews, 2, CD004536.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.