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Meta-Analysis
. 2015 Apr 1;10(4):e0120113.
doi: 10.1371/journal.pone.0120113. eCollection 2015.

Micronutrients in HIV: a Bayesian meta-analysis

George M Carter  1 , Debbie Indyk  2 , Matthew Johnson  3 , Michael Andreae  4 , Kathryn Suslov  2 , Sudharani Busani  2 , Aryan Esmaeili  2 , Henry S Sacks  2
Affiliations
Meta-Analysis

Micronutrients in HIV: a Bayesian meta-analysis

George M Carter et al. PLoS One. .

Erratum in

Abstract

Background: Approximately 28.5 million people living with HIV are eligible for treatment (CD4<500), but currently have no access to antiretroviral therapy. Reduced serum level of micronutrients is common in HIV disease. Micronutrient supplementation (MNS) may mitigate disease progression and mortality.

Objectives: We synthesized evidence on the effect of micronutrient supplementation on mortality and rate of disease progression in HIV disease.

Methods: We searched MEDLINE, EMBASE, the Cochrane Central, AMED and CINAHL databases through December 2014, without language restriction, for studies of greater than 3 micronutrients versus any or no comparator. We built a hierarchical Bayesian random effects model to synthesize results. Inferences are based on the posterior distribution of the population effects; posterior distributions were approximated by Markov chain Monte Carlo in OpenBugs.

Principal findings: From 2166 initial references, we selected 49 studies for full review and identified eight reporting on disease progression and/or mortality. Bayesian synthesis of data from 2,249 adults in three studies estimated the relative risk of disease progression in subjects on MNS vs. control as 0.62 (95% credible interval, 0.37, 0.96). Median number needed to treat is 8.4 (4.8, 29.9) and the Bayes Factor 53.4. Based on data reporting on 4,095 adults reporting mortality in 7 randomized controlled studies, the RR was 0.84 (0.38, 1.85), NNT is 25 (4.3, ∞).

Conclusions: MNS significantly and substantially slows disease progression in HIV+ adults not on ARV, and possibly reduces mortality. Micronutrient supplements are effective in reducing progression with a posterior probability of 97.9%. Considering MNS low cost and lack of adverse effects, MNS should be standard of care for HIV+ adults not yet on ARV.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow Chart of Selection Process of Reviewed Studies.
Fig 2
Fig 2. Density Strip Plot of Relative Risk of Progression to Clinical Disease/AIDS.
Bayesian random effects analysis (favors treatment on the left of 1.0); density plots on the figure on the left represent combined data; on the right accounts for individual study arms and the impact of adding selenium or vitamin A to MNS [55].
Fig 3
Fig 3. Density Strip Plot of Effect of MNS on Mortality.
Bayesian random effects analysis (favors treatment on the left of 1.0); density plots on the figure on the left represent combined data; on the right accounts for individual study arms and the impact of adding selenium, vitamin A or zinc to MNS.
See this image and copyright information in PMC

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