I was recently diagnosed HIV+ (1/06) and started therapy with Sustiva and Epzicom on 3/06. As soon as I was diagnosed I started taking a multi-vitamin either Centrum or one a day for men. I recently started taking an additional supplement of vitamin E. Vitamin E 400 IU, and I have read different yet conflicting reports of the benefits of Vitamin E and the help that it provides. I have to admit that I feel better already and want to continue taking the supplement, but I am afraid I may be hurting myself in the process. I am a healthy guy for the most part, overweight and the HAART treatment has significantly stopped my disease progression as I am undetectable and my CD4 continues on the rise. In your opinion as the Great Doctor Eric, am I causing more harm than good to my body? I did read a study from January, 2005 that it may cause mortality and help ward off chronic illness such as heart disease and cancer. I am confused isn't increased mortality good. After reading the following, can you please tell me if I should stop taking the supplement or continue? Maybe I am reading to much in this, or are there any more recent studies since the 2005 study? Thanks, D

Meta-Analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality

Edgar R. Miller, III, MD, PhD; Roberto Pastor-Barriuso, PhD; Darshan Dalal, MD, MPH; Rudolph A. Riemersma, PhD, FRCPE; Lawrence J. Appel, MD, MPH; and Eliseo Guallar, MD, DrPH

4 January 2005 | Volume 142 Issue 1 Background: Experimental models and observational studies suggest that vitamin E supplementation may prevent cardiovascular disease and cancer. However, several trials of high-dosage vitamin E supplementation showed nonstatistically significant increases in total mortality. Purpose: To perform a meta-analysis of the doseresponse relationship between vitamin E supplementation and total mortality by using data from randomized, controlled trials. Patients: 135 967 participants in 19 clinical trials. Of these trials, 9 tested vitamin E alone and 10 tested vitamin E combined with other vitamins or minerals. The dosages of vitamin E ranged from 16.5 to 2000 IU/d (median, 400 IU/d). Data Sources: PubMed search from 1966 through August 2004, complemented by a search of the Cochrane Clinical Trials Database and review of citations of published reviews and meta-analyses. No language restrictions were applied. Data Extraction: 3 investigators independently abstracted study reports. The investigators of the original publications were contacted if required information was not available. Data Synthesis: 9 of 11 trials testing high-dosage vitamin E ( 400 IU/d) showed increased risk (risk difference > 0) for all-cause mortality in comparisons of vitamin E versus control. The pooled all-cause mortality risk difference in high-dosage vitamin E trials was 39 per 10 000 persons (95% CI, 3 to 74 per 10 000 persons; P = 0.035). For low-dosage vitamin E trials, the risk difference was 16 per 10 000 persons (CI, 41 to 10 per 10 000 persons; P > 0.2). A doseresponse analysis showed a statistically significant relationship between vitamin E dosage and all-cause mortality, with increased risk of dosages greater than 150 IU/d. Limitations: High-dosage ( 400 IU/d) trials were often small and were performed in patients with chronic diseases. The generalizability of the findings to healthy adults is uncertain. Precise estimation of the threshold at which risk increases is difficult. Conclusion: High-dosage ( 400 IU/d) vitamin E supplements may increase all-cause mortality and should be avoided.

What do you think? D

Thank you for your post.

It is wonderful that you are doing so well on your current antiretroviral regimen. I would encourage you to continue to take this medication and enhance your overall diet and exercise, if possible. It has been very difficult to demonstrate in well designed studies the benefit of high doses of most vitamins, including Vitamin E. I am not an expert in this area but my read of the data is much like yours, that the results have been conflicting. The study you included in your posting actually suggested that increased doses of Vitamin E were bad. The study showed that those who took extra Vitamin E were more likely to die than those who did not. That being said, there are many limitations to that study.

In my mind, patients should focus on what we know about the importance of a good healthy diet, exercise, adherence with antiretroviral therapy and avoidance of drugs, alcohol and smoking. I think it is reasonable to supplement this with a once a day vitamin if desired.

I do encourage you to discuss this further with your primary provider and a dietician/nutritionist if you have access to someone with this expertise.

Best, Eric