Skip to main content

Advertisement

SpringerLink
Log in

Role of Multivitamins, Micronutrients and Probiotics Supplementation in Management of HIV Infected Children

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objectives

To assess the immuno-clinical response of micronutrients supplementation in human immunodeficiency virus (HIV) infected children (both on and without antiretroviral therapy) and to assess the role of probiotics in improvement of CD4 counts in HIV infected children not on antiretroviral therapy.

Methods

This was an open labeled randomized control study, conducted in Department of Pediatrics and Antiretrovial Therapy (ART) Center, S.N. Medical College, Agra. One hundred and twenty seven HIV infected children aged ≤ 15 y were included in the study. Enroled children were randomized to receive micronutrients for 6 mo or probiotics for 3 mo. Children who did not receive supplements served as control. Change in WHO clinical stage, immunological stage, CD4 counts and body mass index (BMI) status were taken at the end of 6 mo. In probiotic group, mean CD4 count were taken as outcome measure. A detailed history, examination and WHO clinical staging were recorded for all the patients.

Results

In micronutrient supplemented group (not on ART), significant improvement was seen in WHO clinical staging (p = 0.049) when compared to controls after 6 mo. Probiotic supplemented group showed significant increase in CD4 counts compared to control group (p = 0.0022) in children >5 y. Control group showed significant decline in CD4 count in children ≤5 y (−65.3 cells/mm3, p=0.005) and in children >5 y (−87.9 cells/mm3, p=0.05) after 12 wk of supplementation.

Conclusions

Probiotics supplementation has shown significant improvement in CD4 counts. Micronutrients supplementation has shown significant delay in the progression towards advance stage of disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Global Report: UNAIDS report on the global AIDS epidemic 2010 (UNAIDS/10.11E/JC1958E) Available at http://www.unaids.org/documents/20101123_GlobalReport_em.pdf. Accessed on 12 Oct 2011.

  2. Ndeezi G, Tylleskar T, Ndugwa CM, Tumwine JK. Effect of multivitamin supplementation on survival of HIV-infected children: a randomized controlled trail. J Int AIDS Soc. 2010;13:13–8.

    Article  Google Scholar 

  3. Semba RD, Tang AM. Micronutrients and the pathogenesis of human immunodeficiency virus infection. Br J Nutr. 1999;81:181–9.

    Article  CAS  PubMed  Google Scholar 

  4. Baum MK, Shor-Posner G, Lai S, Zhang G, Fletcher MA, Page JB, et al. High risk of HIV-related mortality is associated with selenium deficiency. J Acquir Immune Defic Syndr Hum Retroviral. 1997;15:370–4.

    Article  CAS  Google Scholar 

  5. Tang AM, Graham NM, Saah AJ. Effects of micronutrient intake on survival in human immunodeficiency virus type 1 infection. Am J Epidemiol. 1996;143:1244–56.

    Article  CAS  PubMed  Google Scholar 

  6. Kupka R, Fawzi W. Zinc nutrition and HIV infection. Nutr Rev. 2002;60:69–79.

    Article  PubMed  Google Scholar 

  7. Coutsoudis A, Bobat RA, Coovadia HM, Kuhn L, Tsai WY, Stein ZA. The effect of vitamin A supplementation on the morbidity of children born to HIV infected women. Am J Public Health. 1995;85:1076–81.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Kaiser JD, Campa AM, Ondercin JP, Leoung GS, Pless RF, Baum MK. Micronutrient supplementation increases CD4 count in HIV-infected individuals on highly active antiretroviral therapy: a prospective, double-blind, placebo-controlled trial. J Acquir Immune Defic Syndr. 2006;42:523–8.

    Article  CAS  PubMed  Google Scholar 

  9. WHO/FAO. Evaluation of health and nutritional properties of powder milk and live lactic acid bacteria; Food and Agriculture Organization of the United Nations and World Health Organization Expert Consultation Report: Cordoba, Argentina, 2001. http://www.who.int/foodsafety/publications/fs_management/en/probiotics.pdf. Accessed 15 Mar 2014

  10. Trois L, Cardoso EM, Miura E. Use of probiotics in HIV-infected children: a randomized double-blind controlled study. J Trop Pediatr. 2008;54:19–24.

    Article  PubMed  Google Scholar 

  11. Anukam KC, Osazuwa EO, Osadolor HB, Bruce AW, Reid G. Yogurt containing probiotic lactobacillus rhamnosus GR-1 and L. Reuteri RC-14 helps resolve moderate diarrhea and increases CD4 Count in HIV/AIDS patients. J Clin Gastroenterol. 2008;42:239–43.

    PubMed  Google Scholar 

  12. Lodha R, Manglani M. Antiretroviral therapy in children: recent advances. Indian J Pediatr. 2012;79:1625–33.

    Article  PubMed  Google Scholar 

  13. Irvine SL, Hummelen R, Hekmat S, Looman CW, Habbema JD, Reid G. Probiotic yogurt consumption is associated with an increase of CD4 count among people living with HIV/AIDS. J Clin Gastroenterol. 2010;11:e201-5. doi:10.1097/MCG.0b013e3181d8fba8.

    Google Scholar 

  14. Merchant RH, Lala MM. Common clinical problems in children living with HIV/AIDS: systemic approach. Indian J Pediatr. 2012;79:1506–13.

    Article  PubMed  Google Scholar 

  15. Mothi SN, Swamy VH, Lala MM, Karpan S, Gangakhedkar RR. Adolescents living with HIV in the clock is ticking. Indian J Pediatr. 2012;79:1642–7.

    Article  CAS  PubMed  Google Scholar 

  16. Benedich A, Cohen M. Vitamins B: Effects on specific and nonspecific immune responses. In: Chandra R et al., editors. Nutrition and immunology. New York: Alan R Liss Inc; 1988. p. 101–23.

    Google Scholar 

  17. Fawzi WW, Msamanga GI, Spiegelman D, Wei R, Kapiga S, Villamor E. A randomized trial of multivitamin supplements and HIV disease progression and mortality. N Engl J Med. 2004;351: 23–32.

    Google Scholar 

  18. Connick E, Lederman MM, Kotzin BL, Spritzler J, Kuritzker DR, St Clair M, et al. Immune reconstitution in the first year of potent antiretroviral therapy and its relationship to virologic response. J Infect Dis. 2000;181:358–63.

    Article  CAS  PubMed  Google Scholar 

  19. Koletar SL, Williams PL, Wu J, McCutchan JA, Cohn SE, Murphy RL, et al. AIDS Clinical Trials Group 362 Study Team. Long-term follow-up of HIV-infected individuals who have significant increases in CD4 cell counts during antiretroviral therapy. Clin Infect Dis. 2004;39:1500–6.

    Article  PubMed  Google Scholar 

  20. McClelland RS, Baeten JM, Overbaugh J, Richardson BA, Mandaliya K, Emery S, et al. Micronutrient supplementation increases genital tract shedding of HIV-1 in women: results of a randomized trial. J Acquir Immune Defic Syndr. 2004;37:1657–63.

    Article  CAS  PubMed  Google Scholar 

  21. Corbett EL, Marston B, Churchyard GJ, De Cock KM. Multivitamins, nutritions and antiretroviral therapy for HIV diseases in Africa. N Engl J Med. 2004;351:78–80.

    Article  Google Scholar 

  22. Maston B, De Cock KM. Multivitamins, Nutritions and antiretroviral therapy for HIV diseases in Africa. N Engl J Med. 2004;351:78–80.

    Article  Google Scholar 

  23. Fawzi WW, Msamanga GI, Spiegelman D, Urassa EJ, Mcgrath N, Mwakagile D, et al. Randomized trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet. 1998;351:1477–82.

    Google Scholar 

  24. Mehta SF. Effect of vitamins, including vitamin A. on HIV/AIDS patients. Vitam Horm. 2007;75:355–83.

    Article  CAS  PubMed  Google Scholar 

  25. Cunningham-Rundles S, Ahrne S, Bengmark S, Johann-Liang R, Marshall F, Metakis L, et al. Probiotics and immune responses. Am J Gastroenterol. 2000;95:S22–5.

    Article  CAS  PubMed  Google Scholar 

  26. Hummelen R, Reid G, Changalucha J, Niccodemus L, Butamanya, Koyama TED, et al. Effect of 25 weeks probiotic supplementation on immune function of HIV patient’s. Gut Microbes. 2011;2:80–5.

    Article  PubMed  Google Scholar 

  27. Baroja ML, Kirjavainen PV, Hekmat S, Reid G. Antiinflammatory effects of probiotic-yogurt in inflammatory bowel disease patients. Clin Exp Immunol. 2007;149:470–9.

    Article  CAS  Google Scholar 

Download references

Contributions

All the authors have contributed, designed and approved the study. RD will act as guarantor for this paper.

Conflict of Interest

None.

Role of Funding Source

None.

Author information

Authors and Affiliations

  1. Department of Pediatrics, S.N. Medical College, Agra, India

    Neetu Gautam, Rajeshwar Dayal, Dipti Agarwal & Rajesh Kumar

  2. Department of Medicine, S.N. Medical College, Agra, India

    T. P. Singh

  3. ICTC, National JALMA Institute for Leprosy and Other Mycobacterial Disease (I.C.M.R.), Agra, India

    T. Hussain

  4. ART Centre, S.N. Medical College, Agra, India

    S. P. Singh

  5. House no. 1/23, Opp. Kidwai Park, Agra, 282002, Uttar Pradesh, India

    Rajeshwar Dayal

Authors
  1. Neetu Gautam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajeshwar Dayal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dipti Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rajesh Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. P. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. Hussain
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. P. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rajeshwar Dayal.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gautam, N., Dayal, R., Agarwal, D. et al. Role of Multivitamins, Micronutrients and Probiotics Supplementation in Management of HIV Infected Children. Indian J Pediatr 81, 1315–1320 (2014). https://doi.org/10.1007/s12098-014-1407-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-014-1407-6

Keywords

Search

Navigation