At present, there is no convincing evidence that vitamin and mineral supplements positively impact on progression of disease or death in people with HIV. No well-controlled studies have examined the relationship between supplements and disease in people with HIV. Universal recommendations for specific supplementation regimens in people with HIV are, therefore, based on speculation and uncontrolled anecdotes.
The presence of a vitamin or mineral deficiency does not imply that supplementation will correct it. Deficiencies may be caused by many factors, including some which may not respond to supplementation. HIV-induced metabolic changes or malabsorption can result in vitamin deficiency, although they will not respond to supplementation. Importantly, several studies demonstrated vitamin and mineral deficiencies in people with HIV although the subjects ate properly and, in some cases, even took supplements. Furthermore, correct vitamin and mineral doses are not been established to correct specific levels of deficiency.
Beneficial claims are frequently for very large doses of vitamins ("mega-dosing"), often hundreds or thousand times higher than nutritionally required levels. Using vitamins in this manner is more similar to drug therapy than nutrition, and should be considered in pharmacological terms. Some "mega-doses" of vitamins may have legitimate pharmacologic uses, although none have been demonstrated for HIV disease. Certain vitamins, like Vitamin A and Vitamin D, produce very serious toxicities not far above their nutritionally required levels. Other vitamins, like Vitamin E, appear to have no upper limits for safe consumption. See Table II.
Vitamin A (and beta-Carotene -- a pro-vitamin that is converted into vitamin A by the body), first discovered in 1915, is found in both animal and plant products. Vitamin A has a role in many physiological functions, including reproduction, skin, vision, the immune system, and bone. Vitamin A deficiency can cause numerous non-specific signs, although nyctalopia and xerophthalmia (two diseases of the eye) are the best described syndromes. Vitamin A deficiency is considered extremely rare in the developed world because many common foods, including margarine, are fortified with the vitamin, and because the body can store Vitamin A successfully in the liver and intestine for long periods of time, compensating for periodic deficiencies. Diseases associated with vitamin A deficiency occur only after prolonged periods of deprivation.
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