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Vitamin supplementation during controlled HIV infection
Jan 23, 2014

In this column, you have often derided the practice of vitamin supplementation. I looked at the study abstract from December 17, 2013, that you referred to, and found that at the very start the authors described a study population of "well-nourished adults," but apparently HIV-negative. So, is there some diagnostic test to ascertain whether those with HIV are correctly receiving or absorbing all the vitamins that they ought to have in the first? Should the absence of overt symptomatic illness be taken as evidence that one is well-nourished, and can it be safely assumed that controlled HIV infection has no effect on vitamin absorption with a healthy diet?

I'm 29 years positive, 52 yo, on Atripla for about 9 years, undetectable, CD4 c.750. Previously my routine check-up showed a severe deficiency of vitamin D, and I consequently started daily dosing of 3,000 to 5,000 IU of vitamin D (depending on the particular configuration available at the drugstore) and at times a daily dose of calcium citrate (currently ran out, but was using it for a year). Besides vitamin D, I've never received any other diagnostic test for vitamins. I live in a northern region of the US and get very little sunshine. Despite the deficiency, I had never been ill from HIV, nor from vitamin D deficiency. Therefore, I had no basis for identifying vitamin D deficiency without a test, nor for measuring its benefits.

Further, I am concerned about the abstract's allusions to possibly bad effects of vitamin supplementation, which are not delineated, leaving the matter rather vague. Also, the abstract cites the possibility that extra vitamins might be good for certain "subpopulations" without ever specifying those groups. In the absence of symptoms, how will I know if multivitamins are harming me, or if I might fit within one of those subpopulations (e.g. HIV infection)?

As it happens, my 80-year old mother knows of my HIV status and has been sending me multivitamin supplies for years. I never requested this, but have not discouraged her, as this is how she feels that she is playing a role in supporting my continued good health, and as you know vitamins have become part of popular culture. I feel conflicted: should I tell my mother to stop sending me vitamins because they are possibly harming my health, or just allow her to keep sending me vitamins while secretly throwing them away?

Inasmuch as I don't observe illness, and don't observe harm or benefits, how concerned should I be about nutrition as whole, and vitamins as a supplement for possibly poor diet or absorption (if that were the case) in the setting of controlled HIV? I think we need these studies, but it would be more helpful if the articles cited either specified a population with controlled HIV, or at least addressed whether controlled HIV has any effect on nutrient absorption.

Response from Dr. Young

Hello and thanks for posting.

Please let's be clear. I deride the practice of *unnecessary* vitamin supplementation in healthy and well-nourished individuals. The scientific data is very clear on this.

Not everyone is healthy or well nourished, and there are clear medical areas of vitamin or mineral deficiencies (like in your case, low vitamin D) where supplementation makes sense. It's the unnecessary supplementation or idea of mega-dose supplements that isn't recommended and maybe even unsafe.

So, to your questions: yes, if one has controlled HIV, is asymptomatic (including normal weight) and has access to a diet with adequate calories, it's probably not necessary to take any additional vitamin or mineral supplements.

With regard to the editorial that I mentioned, it's summarizing a range of clinical studies and a review by the US Preventive Services Task Force (one of the most high quality bodies of smart medical people). This review article published in the Annals of Internal Medicine was a systematic review of vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer. The authors reviewed two decade-long studies of multivitamins of nearly 30,000 people and 24 studies of specific vitamin supplements in nearly 325,000 people and concluded:

" Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. "

So yes, the subjects of these studies were not HIV+ and did not have AIDS-related illness. It's possible that in such sub-populations that the conclusions might be different. But until conclusive data suggests this, I'd wait before I'd recommend ingesting any unneeded substances.

As for your mother, I'd not take anything more than a multivitamin (and even that is very likely overkill). If you can, I'd suggest discussing these new revelations with her and thank her for her love and support of your health. Then ask if there might be a better way for her to show this support (and expense).

I hope that's helpful. Be well, BY



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