Text Box: EFFECT OF VITAMIN A ON MORBIDITY AND MORTALITY OF HIV-INFECTED CHILDREN
Semba RD,1 Ndugwa C,2 Perry RO,1 Clark TD,1 Jackson JB,1 Olness K,3 Melikian G,1 Tielsch J,1 and Mmiro F.2
1 Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
2 Makerere University, Kampala, Uganda
3 Case Western Reserve University, Cleveland, Ohio, USA

Objective: To determine whether periodic high dose vitamin A supplementation can reduce morbidity and mortality among HIV-infected children in sub-Saharan Africa.
Methods:  In a randomized, controlled clinical trial in Kampala, Uganda, 181 HIV-infected children received either vitamin A, 200,000 IU, or placebo every 3 months from 15 until 36 months of age.  All children received disease-targeted therapy with vitamin A for measles and diarrheal disease and daily cotrimoxazole prophylaxis against opportunistic infections.  Incidence density of morbidity was determined by generalized estimating equations.
Results:  Mortality rates in the vitamin A and control groups were 20.6% and 32.9%, respectively, yielding relative risk (RR) of 0.54 (95% CI 0.30-0.98, P = 0.044) after adjusting for baseline weight-for-height Z score.  Children who received vitamin A had lower incidence of chronic cough (OR 0.47, 95% CI 0.23-0.96, P = 0.04), chronic diarrhea (OR 0.48, 95% CI 0.19-1.18, P = 0.11), and duration of otitis media (P = 0.03).  Vitamin A had no significant effect on incidence of fever, otitis media, or bloody stools.
Conclusions:  Vitamin A supplementation reduced mortality of HIV-infected children by 46%.  Vitamin A supplementation should be considered as part of the package of medical care for HIV- infected children in developing countries.
2474