Micronutrient supplementation in the AIDS diarrhoea-wasting syndrome in Zambia: A randomized controlled trial

Objective: As HIV has spread through sub-Sakaran Africa, persistent diarrho ea has emerged as a major problem in hospitals and in the community in seve rely affected areas. We have previously demonstrated that antiprotozoal the rapy with albendazole reduces diarrhoea in AIDS patients in urban Zambia. T his trial was designed to test the hypothesis that the clinical response to albendazole might be improved by oral micronutrient supplementation, Design: Randomized, placebo-controlled trial. Setting: Home care service of Ndola Central Hospital, Zambia. Patients: HIV-seropositive patients with persistent diarrhoea. Intervention: Patients were randomized to albendazole plus vitamins A, C an d E, selenium and zinc orally or albendazole plus placebo, for 2 weeks. Main outcome measures: Time with diarrhoea following completion of treatmen t; mortality; adverse events. Results: Serum vitamin A and E concentrations before treatment were powerfu l predictors of early mortality, but supplementation did not reduce time wi th diarrhoea or mortality during the first month, even after taking into ac count initial vitamin A or E concentrations, CD4 cell count or clinical mar kers of illness severity. Serum concentrations of vitamins A and E did not increase significantly in supplemented patients compared with those given p lacebo, and there were no changes in CD4 cell count or haematological param eters. No adverse events were detected except those attributable to underly ing disease. Conclusions: Although micronutrient deficiency is predictive of early death in Zambian patients with the diarrhoea-wasting syndrome, short-term oral s upplementation does not overcome it nor influence morbidity or mortality. ( C) 1999 Lippincott Williams & Wilkins.