Running head: ABSTRACT AND SUMMARY

Research Article and Evidence Summary

Alyssa Collins
University of Southern Mississippi

Running head: ABSTRACT AND SUMMARY

Section 1. Table 3.1.a Evidence Worksheet for Primary Research Report
Citation:

Fawzi, W., Msamanga, G., Spiegelman, D., Wei, R.,

Kapiga, S., Villamor, E., Hunter, D. (2004). A
Randomized Trial of Multivitamin Supplements and
HIV Disease Progression and Mortality. New
England Journal of Medicine, 351, 23-32.
doi:10.1056/NEJMoa040541

Study Design:
Research Purpose:

Inclusion Criteria:
Exclusion Criteria:
Description of Study
Protocol
Data Collection
Summary:

Description of Actual
Data Sample:

Summary of Results

The study design was a randomized trial.

The purpose of the study was to determine if
supplementation of solely vitamin A, a multivitamin, or a
combination of both had significant effects on the
progression of human immunodeficiency virus (HIV).
Women enrolled in the study lived in Tanzania, were
pregnant and HIV positive.
There was no exclusion criteria stated.
Participants were randomly assigned to receive a daily dose
of either: a multivitamin containing vitamins B, C and E, the
multivitamin and vitamin A, solely vitamin A, or a placebo.
Participants were followed from enrollment, between 1995
and 1997, to the end of the study in 2003. The women
attended monthly physical examinations at a clinic where
health and HIV status were assessed. Height, weight and the
circumference of the middle arm were measured at that
time. Compliance was measured by the number of tablets
returned during monthly meetings. CD4+, CD8+, and CD3+
levels were measured at baseline and every 6 months after.
Of the 1078 women who started the trial, 299 of these either
advanced to World Health Organization (WHO) stage 4, or
died from disease-related causes. At baseline, characteristics
including age, education level, vitamin A, E, hemoglobin,
CD4+ and CD8+ levels were similar between the four
groups.
Women in the multivitamin group were less likely to
progress to WHO stage 4, or die from the disease compared
to the group receiving the placebo (P=0.04). Multivitamin
supplementation decreased HIV symptoms such as
gastrointestinal and oral manifestations, rashes, fatigue, and
upper respiratory tract infections. CD4+ levels were higher

Running head: ABSTRACT AND SUMMARY

Author Conclusion:
Review Comments:

by 48 cells per cubic millimeter for participants taking

multivitamins than those who took placebos (P=0.01).
Multivitamin supplementation is a cost-effective method to
delay the development of HIV for women.
Strengths of the study include time and number of
participants. The study was able to follow women for
extended periods of time, which allowed for greater data
collection. Additionally, the number of participants allowed
for more accurate results from a larger sample of the
population. A limitation would be that since the trial was
only conducted on pregnant women, it does not show how
multivitamin supplementation can aid in slowing HIV
progression in other populations.

Section 2. Use of evidence in patient care

Human immunodeficiency virus is a disease that impairs both immune system
function and nutrition status. Common symptoms from HIV and its treatment are diarrhea
and severe weight loss. Therefore, proper nutrition is vital in fighting the progression of
HIV and associated malnutrition. According to the research presented by the New
England Journal of Medicine, progression of HIV can be slowed by daily
supplementation of multivitamins containing vitamins B, C and E. Similar findings were
presented in the evidence analysis library with micronutrient supplementation and the
progression of HIV. One study showed a 24% increase in CD4 count with micronutrient
supplementation in adults with HIV. The patient I worked with was presenting severe
malnutrition, with definite loss of muscle mass and subcutaneous fat. He told me that he
ate 5-6 meals a day in an attempt to gain weight. Since the severe wasting is due to his
diagnosis of HIV, I would suggest supplements in addition to increasing calorie intake,
especially supplementation of a multivitamin containing B, C, and E. Not only would the
supplement improve his nutrition status, but it would also slow the progression of his

Running head: ABSTRACT AND SUMMARY

disease, providing him a longer and healthier life. As an RD, I would present and discuss
the information I found in both the research and the evidence analysis library with the
patient, and encourage him to follow the recommendations set by these.
Section 3. References
Academy of Nutrition and Dietetics Evidence Analysis Library (2009). HIV/AIDS:
Micronutrient Supplementation. Academy of Nutrition and Dietetics,
https://www.andeal.org/topic.cfm?menu=5312&cat=3141
Fawzi, W., Msamanga, G., Spiegelman, D., Wei, R., Kapiga, S., Villamor, E., Hunter, D.
(2004). A Randomized Trial of Multivitamin Supplements and HIV Disease
Progression and Mortality. New England Journal of Medicine, 351, 23-32.
doi:10.1056/NEJMoa040541