1. T HE R OLE OF M ULTIVITAMINS IN P AEDIATRIC HIV M ANAGEMENT IN N IGERIA : A R ANDOMIZED C ONTROLLED S TUDY

2. B ACKGROUND The signature of Human Immunodeficiency Virus (HIV) infection is immune deficiency Management involves the use of combination antiretroviral drugs Certain micronutrients are reported to boost immunity and haematological status in people living with HIV (PLHIV)

3. V ICIOUS CYCLE BETWEEN HIV INFECTION AND MICRONUTRIENT DEFICIENCIES Increased Morbidity HIV related diminished nutritional intakes and malabsorption Micronutrient deficiencies Oxidative stress and Immunosuppression Increased viral loads, decreased CD4 counts

4. R ESEARCH OBJECTIVES To determine the effect of multivitamins on health outcomes To determine if higher strength multivitamins may be able to provide better health outcomes compared to lower strength multivitamins -Primary outcome: CD4 count -Secondary outcomes: Haemoglobin (Hb) levels, serum selenium and serum zinc levels.

5. M ETHODOLOGY Group A multivitaminGroup B multivitaminGroup C multivitamin 7 micronutrients at RDA22 micronutrients at RDA22 micronutrients at 3RDA

6. R ESULTS Significant increase in Hb conc. after 3 months No significant change in CD4 count after 3 months

7. R ESULTS SIGNIFICANT REDUCTION IN PREVALENCE OF ANAEMIA AFTER 3 MONTHS MULTIVITAMIN USE P= 0.004 Anaemia status at baselineAnaemia status after 3 months

8. R ESULTS N O CHANGE IN PREVALENCE OF IMMUNE DEFICIENCY AFTER 3 MONTHS, P=0.405 Immune status at baselineImmune status after 3 months

9. D ISCUSSION A vicious cycle between micronutrient deficiency, immune deficiency and HIV disease progression has been reported in a number of studies After 3 months of multivitamin use, no significant increase in CD4 count was observed. Hb concentration was increased and prevalence of anaemia was reduced. So far, this study therefore supports recommendations for multivitamin intervention for PLHIV bearing in mind the link between anaemia and increased risk of morbidity and mortality in PLHIV.

10. R EFERENCES Fawzi, W., Msamanga, G., Kupka, R., Spiegelman, D., Villamor, E., Mugusi, F., Wei, R. and Hunter, D. (2007) ‘Multivitamin supplementation improves hematologic status in HIV-infected women and their children in Tanzania’, The American journal of clinical nutrition., 5(85) National Agency for the Control of AIDS (NACA) (2015) Global AIDS response. Country Progress Report, Nigeria GARPR 2015. Available at: http://www.unaids.org/en/regionscountries/countries/nigeri a Semba, R. and Tang, A. (1999) ‘Micronutrients and the pathogenesis of human immunodeficiency virus infection.’, The British journal of nutrition., 3(81)