Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA.
Am J Clin Nutr. 2011 Dec;94(6):1683S-1689S. doi: 10.3945/ajcn.111.011999. Epub 2011 Nov 16.
To establish whether there is new evidence to inform changes to WHO 2003 recommendations for micronutrient intake in persons with HIV/AIDS, we conducted a narrative review of the literature published from 2003 to 2010. Although the review focused on new randomized controlled trials of multiple micronutrients in HIV-infected adults, including pregnant and lactating women, we also considered randomized trials of single micronutrients. The review found that there are few published randomized controlled trials of micronutrients in HIV-infected persons and that most trials used high-dose multiple micronutrient supplementation. The trials were heterogeneous with respect to the composition and dose of micronutrients used and the target population studied. Despite this heterogeneity, 5 of 6 trials that used high-dose multiple micronutrients showed benefits in terms of either improved CD4 cell counts or survival. However, many of these trials were small and of short duration, and therefore the long-term risks and benefits of high-dose multiple micronutrients are not established. The current WHO recommendation for an intake of micronutrients at Recommended Dietary Allowance amounts continues to be a reasonable target for persons with clinically stable HIV infection. In light of new data that show adverse effects of high-dose vitamin A, the current recommendation for a single high dose of vitamin A in HIV-infected women within 6 wk of delivery should be reviewed.
为了确定是否有新的证据可以对 2003 年世界卫生组织（WHO）针对艾滋病毒/艾滋病患者微量营养素摄入的建议进行修改，我们对 2003 年至 2010 年期间发表的文献进行了叙述性综述。虽然该综述主要关注针对感染艾滋病毒的成年人（包括孕妇和哺乳期妇女）的多种微量营养素的新随机对照试验，但我们也考虑了单一微量营养素的随机对照试验。综述发现，发表的关于感染艾滋病毒人群中微量营养素的随机对照试验很少，而且大多数试验都使用了高剂量多种微量营养素补充剂。这些试验在使用的微量营养素的组成和剂量以及研究的目标人群方面存在异质性。尽管存在这种异质性，但 6 项使用高剂量多种微量营养素的试验中有 5 项在改善 CD4 细胞计数或生存率方面显示出了益处。然而，这些试验大多规模较小，持续时间较短，因此高剂量多种微量营养素的长期风险和益处尚未确定。目前 WHO 建议的微量营养素摄入量达到推荐膳食允许量（RDA），仍然是临床稳定的艾滋病毒感染者的合理目标。鉴于新数据显示高剂量维生素 A 存在不良反应，目前建议在感染艾滋病毒的妇女分娩后 6 周内单次给予高剂量维生素 A 的建议应进行审查。
