Fawzi W W, Mbise R L, Hertzmark E, Fataki M R, Herrera M G, Ndossi G, Spiegelman D
Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
Pediatr Infect Dis J. 1999 Feb;18(2):127-33. doi: 10.1097/00006454-199902000-00009.
To determine whether vitamin A supplements result in reduced mortality among HIV-infected and uninfected children.
Randomized, double blind, placebo-controlled trial.
Starting in April, 1993, we randomized 687 children age 6 months to 5 years who were admitted to the hospital with pneumonia. Children who were severely malnourished or had clinical signs of vitamin A deficiency were excluded. At baseline children received placebo or 400 000 IU (or half that for infants) of vitamin A, in addition to standard treatment for pneumonia. They received further doses of the same regimen 4 and 8 months after hospital discharge. Sera from children were tested for HIV antibodies by enzyme-linked immunosorbent assay and Western blot tests. For positive children <15 months of age, HIV infection was confirmed by amplified heat-denatured HIV-p24 antigen assays with confirmatory neutralization assays. HIV status was ascertained for 648 of 687 enrolled children. The mean duration of follow-up was 24.4 months (SD = 12.1).
Of 648 children 58 (9%) were HIV-infected. Compared with uninfected children, all-cause mortality was higher among HIV-infected children, as was mortality caused by pneumonia or diarrhea (P < 0.001 for each). Overall vitamin A supplements resulted in a 49% reduction in mortality [relative risk (RR), 0.51; 95% confidence interval (CI), 0.29 to 0.90, P = 0.02]. Vitamin A supplements reduced all-cause mortality by 63% among HIV-infected children (RR 0.37; CI 0.14 to 0.95, P = 0.04) and by 42% among uninfected children (RR 0.58, CI 0.28 to 1.19, P = 0.14). Vitamin A supplements were also associated with a 68% reduction in AIDS-related deaths (P = 0.05) and a 92% reduction in diarrhea-related deaths (P = 0.01).
Vitamin A deficiency, which is common among children in many developing countries, is particularly severe among HIV-infected children. Our findings indicate that vitamin A supplements, a low cost intervention, reduce mortality of HIV-infected children.
确定维生素A补充剂是否能降低感染和未感染艾滋病毒儿童的死亡率。
随机、双盲、安慰剂对照试验。
从1993年4月开始，我们将687名6个月至5岁因肺炎入院的儿童随机分组。排除严重营养不良或有维生素A缺乏临床体征的儿童。在基线时，除肺炎标准治疗外，儿童接受安慰剂或40万国际单位（婴儿剂量减半）的维生素A。出院后4个月和8个月，他们接受相同方案的进一步剂量。通过酶联免疫吸附试验和蛋白质印迹试验检测儿童血清中的艾滋病毒抗体。对于15个月以下的阳性儿童，通过扩增热变性艾滋病毒p24抗原试验和确证中和试验确认艾滋病毒感染。在687名登记儿童中，648名儿童的艾滋病毒感染状况得以确定。平均随访时间为24.4个月（标准差=12.1）。
在648名儿童中，58名（9%）感染了艾滋病毒。与未感染儿童相比，感染艾滋病毒儿童的全因死亡率更高，肺炎或腹泻导致的死亡率也更高（每项P<0.001）。总体而言，维生素A补充剂使死亡率降低了49%[相对危险度（RR），0.51；95%置信区间（CI），0.29至0.90，P=0.02]。维生素A补充剂使感染艾滋病毒儿童的全因死亡率降低了63%（RR 0.37；CI 0.14至0.95，P=0.04），使未感染儿童的全因死亡率降低了42%（RR 0.58，CI 0.28至1.19，P=0.14）。维生素A补充剂还使与艾滋病相关的死亡减少了68%（P=0.05），与腹泻相关的死亡减少了92%（P=0.01）。
维生素A缺乏在许多发展中国家的儿童中很常见，在感染艾滋病毒的儿童中尤为严重。我们的研究结果表明，维生素A补充剂作为一种低成本干预措施，可降低感染艾滋病毒儿童的死亡率。
