Mega-doses of vitamins *hurt* HIV patients

An outcome some of you might expect, but for reasons you probably dont expect--

Let me tell you the punchline first:

Effect of High-Dose vs Standard-Dose Multivitamin Supplementation at the Initiation of HAART on HIV Disease Progression and Mortality in Tanzania, A Randomized Controlled Trial

Scientists had a pool of patients (over 3000) with HIV infection, who were prescribed HAART.  They divided that group into two-- One group got a multivitamin, and one group got a 'high-dose' multivitamin.  Part way through the study, they had to shut it down, because the patients on the 'high-dose' had elevated levels of ALT, read: liver damage.

Some of you might be reacting this way to this paper:

OHMYGAWD. ONCE AGAIN CAM HAS VIOLATED THE SCIENTIFIC COMMUNITY BY DOING CRAPPY, DAMAGING RESEARCH THAT HAS NOT ONLY HAS NO BENEFIT, BUT ACTUALLY HURTS PEOPLE.

That was my reaction too, until I thought about it from a different perspective.

The patient population in this study was from Tanzania.  A bit of Googling turned up the stats that 30-40% of the Tanzanian population is undernourished, with a Global Hunger Index in the 'alarming' range.

How does hunger/undernourishment interact with HIV?  If it makes things worse, what can we do to make things better?

The obvious answer would be 'Well feed the damn people!'.  But scientists cannot do that.  We cannot write "Give people bacon and eggs and orange juice and salmon with a spinach salad and beef stew and chocolate chip cookies" into their study protocols.  In fact, we can get in trouble for offering food/juice/etc to undernourished populations in exchange for participation.  You can get starving people to do things they normally would not agree to do in exchange for food for themselves and their families.  Its coercion.

We can, however, sanitize and industrialize 'get people the nutrients they need' via dietary supplements.

In the industrialized world, vitamin supplementation is a luxury ('expensive pee').  When you are undernourished, vitamin supplementation is a different story all together.  You wouldnt dismiss giving Vitamin C to someone with scurvy, or Vitamin D to someone with Rickets, likewise maybe supplementing vitamins to people with HIV would have a genuine impact on disease/disease progression.

In fact, previous studies, with patients not on HAART, indicated that vitamin supplementation in undernourished HIV+ populations did have a positive impact on disease.

So this study was just taking that research to another level-- Does vitamin supplementation help with patients on HAART?  Is more supplementation better?

Unfortunately, this study was functionally 'missing an arm'-- there were only two groups of patients.  One on the multivitamin, and one on the super-dose, so they could not answer the first question.  There was no group of matched patients who got no multivitamin at all.

"AWWWWWW!  CRAPPY STUDY DESIGN!!!!"

No-- Scientists were bound by ethics again.  If previous research indicated that vitamin supplementation was beneficial, then it would have been unethical to withhold the supplementation.  But not having a placebo arm crippled the ability of the scientists to figure out what, exactly, happened in this study.

Because 'more' supplementation was definitely not 'better'.  It is possible that in HAART patients, for whatever reason, supplementation isnt helpful at all.  The effect is only seen in patients who are not on HAART.  We dont know, and we cant know from the way this study was set up.

But, we do know now that even in undernourished HIV+ populations, mega doses of vitamins are Not Good.

I would really like to see the reasoning behind someone thinking mega doses of vitamins for otherwise well nourished HIV- populations is a good idea...