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Op-Ed

On taking supplements with ARV

An HIV-positive Filipino wants to know if he still needs to take supplements, considering that he is already taking ARVs. Dr. Jose Narciso Melchor Sescon provides needed information on this.

Dr. Jose Narciso Melchor Sescon – president of the AIDS Society of the Philippines and current Chief of Clinics of Sta. Ana Hospital – answers all your HIV-related inquiries. For all your questions, email josescon1@gmail.com or info@outragemag.com.

Dear Doc,

A doctor in one treatment hub openly told PLHIVs who are taking ARVs to not take supplements anymore as we’re just wasting money buying these supplements. What’s your take on this?

Mr. Supplement Curious

Before we discuss the benefits of taking supplements among clients taking ARV, it is first important to be reminded of the link between HIV and nutrition, for they are intimately linked. If good nutrition is not part of the treatment regimen, HIV infection can lead to malnutrition; while poor diet can in turn speed the infection’s progress.

Now, why a client takes supplements apart from his/her ARV is simply because the current diet and nutrition practice of the HIV client may not be enough to cover a good immune system to fight HIV infection together with ARV. As such, it is equally important to have a nutritional assessment regularly apart from the medical check-ups/follow-ups being conducted.

Unfortunately, our knowledge of the effects of micronutrient supplements among people living with HIV is still rather patchy. This is partly because it hasn’t been treated as a major research priority, but also because of difficulties in conducting and interpreting scientific trials.

When scientists compare people who have chosen to take a supplements versus people who haven’t, they cannot be sure that the supplement is making the difference. For example, it could be that those taking the supplement tend to lead generally healthier lifestyles. Therefore, the most reliable evidence comes from large trials in which scientists randomly choose people who take the supplement and who take a dummy pill called a placebo. Yet even the results of randomized trials must be treated with caution because diet and nutritional status vary widely. It is possible for a supplement that benefits one group of people to be ineffective or even harmful in another group.

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What about multivitamins?

A clinical trial involving a thousand HIV positive pregnant women in Tanzania found that daily multivitamins benefited both the mothers and their babies, compared to placebo. Four years after, multivitamins were found to reduce the women’s risk of AIDS and death by around 30%.

Another large clinical trial in Thailand also found that multivitamins led to fewer deaths, but only among people in the advanced stages of HIV disease. A third, smaller trial in Zambia found no benefits from multivitamins after one month of use. Based on these and other less rigorous studies, many experts recommend multivitamins for people living with HIV, particularly those who are undernourished and have advanced disease.

On Vitamins and minerals?

When it comes to supplementing individual vitamins and minerals, the evidence is less clear. Few studies have found significant effects on HIV transmission, disease progression or death rates. The most interesting results have come from studies of vitamin A and zinc.

The general rule here is that HIV positive people care to live longer, and in many ways, they are very much more interested in prolonging their lives, taking various steps to improve their health.

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