Micronutrients in HIV

A bayesian meta-analysis

George M. Carter, Debbie Indyk, Matthew Johnson, Michael Andreae, Kathryn Suslov, Sudharani Busani, Aryan Esmaeili, Henry S. Sacks

Research output: Contribution to journalArticle

13 Citations (Scopus)

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 (4.3,1). 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.

Original languageEnglish (US)
Article numbere0120113
JournalPloS one
Volume10
Issue number4
DOIs
StatePublished - Apr 1 2015

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Bayes Theorem
Micronutrients
disease course
meta-analysis
Meta-Analysis
HIV
Disease Progression
Mortality
population distribution
relative risk
adverse effects
Numbers Needed To Treat
Markov Chains
therapeutics
synthesis
Standard of Care
MEDLINE
Markov processes
Research Design
Language

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Carter, G. M., Indyk, D., Johnson, M., Andreae, M., Suslov, K., Busani, S., ... Sacks, H. S. (2015). Micronutrients in HIV: A bayesian meta-analysis. PloS one, 10(4), [e0120113]. https://doi.org/10.1371/journal.pone.0120113
Carter, George M. ; Indyk, Debbie ; Johnson, Matthew ; Andreae, Michael ; Suslov, Kathryn ; Busani, Sudharani ; Esmaeili, Aryan ; Sacks, Henry S. / Micronutrients in HIV : A bayesian meta-analysis. In: PloS one. 2015 ; Vol. 10, No. 4.
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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 (4.3,1). 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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Carter, GM, Indyk, D, Johnson, M, Andreae, M, Suslov, K, Busani, S, Esmaeili, A & Sacks, HS 2015, 'Micronutrients in HIV: A bayesian meta-analysis', PloS one, vol. 10, no. 4, e0120113. https://doi.org/10.1371/journal.pone.0120113

Micronutrients in HIV : A bayesian meta-analysis. / Carter, George M.; Indyk, Debbie; Johnson, Matthew; Andreae, Michael; Suslov, Kathryn; Busani, Sudharani; Esmaeili, Aryan; Sacks, Henry S.

In: PloS one, Vol. 10, No. 4, e0120113, 01.04.2015.

Research output: Contribution to journalArticle

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T2 - A bayesian meta-analysis

AU - Carter, George M.

AU - Indyk, Debbie

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AU - Andreae, Michael

AU - Suslov, Kathryn

AU - Busani, Sudharani

AU - Esmaeili, Aryan

AU - Sacks, Henry S.

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N2 - 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 (4.3,1). 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.

AB - 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 (4.3,1). 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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Carter GM, Indyk D, Johnson M, Andreae M, Suslov K, Busani S et al. Micronutrients in HIV: A bayesian meta-analysis. PloS one. 2015 Apr 1;10(4). e0120113. https://doi.org/10.1371/journal.pone.0120113