{"id":3328,"date":"2012-10-17T07:12:53","date_gmt":"2012-10-17T11:12:53","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=3328"},"modified":"2015-06-04T15:13:45","modified_gmt":"2015-06-04T19:13:45","slug":"its-time-to-tell-our-patients-to-stop-their-vitamin-supplements","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/its-time-to-tell-our-patients-to-stop-their-vitamin-supplements\/2012\/10\/17\/","title":{"rendered":"It&#8217;s Time to Tell Our Patients to Stop Their Vitamin Supplements"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2012\/10\/10556101_blog1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright  wp-image-3331\" title=\"10556101_blog\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2012\/10\/10556101_blog-300x2251.jpg\" alt=\"\" width=\"240\" height=\"180\" \/><\/a>Over in <em>JAMA<\/em>, there&#8217;s a <a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1383231\" target=\"_blank\">large study<\/a> out today that (yet again) failed to demonstrate a benefit of vitamins.<\/p>\n<p>Over 3000 patients with HIV in Tanzania were randomized to receive either\u00a0high-dose or standard-dose multivitamin supplementation, in addition to &#8220;<a href=\"http:\/\/blogs.nejm.org\/index.php\/haart-era-now-longer-then-pre-haart-era-can-we-officially-retire-haart\/2012\/07\/01\/\" target=\"_blank\">HAART<\/a>&#8221; (ugh). Though the study was planned for 24 months, it was stopped early by the Data Safety and Monitoring Board due to a higher rate of LFT abnormalities in the high-dose vitamin group. Not only that, the <em>sickest<\/em> patients &#8212; those with BMI &lt; 16 &#8212; seemed to do even worse on the mega-dose, with a higher risk of death that almost reached statistical significance (relative risk 1.36; 95% CI, 0.93-1.98; p=.11).<\/p>\n<p>One could quibble with the generalizability of the results to current standard of care in well-resourced areas &#8212; for example, the most common regimen was d4T, 3TC, and nevirapine, used in nearly 60% &#8212; but it&#8217;s hard to imagine how this makes the results <em>less<\/em> convincing. After all, one would expect that vitamin supplementation would be more important in settings where malnutrition and advanced HIV disease are highly prevalent.<\/p>\n<p>So what should we do?<\/p>\n<p>I&#8217;ve been keeping quiet with my patients who insist on taking\u00a0handfuls\u00a0of vitamins, despite their having access to real food and nothing at all to suggest dietary insufficiency. With this study, however, I will strongly encourage them to save their money &#8212; the only people benefiting from their daily intake are those in the <a href=\"http:\/\/www.cnn.com\/2011\/HEALTH\/04\/13\/supplements.dietary\/index.html\" target=\"_blank\">$27-billion dollar\/year<\/a> vitamin industry.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Over in JAMA, there&#8217;s a large study out today that (yet again) failed to demonstrate a benefit of vitamins. Over 3000 patients with HIV in Tanzania were randomized to receive either\u00a0high-dose or standard-dose multivitamin supplementation, in addition to &#8220;HAART&#8221; (ugh). Though the study was planned for 24 months, it was stopped early by the Data [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,10],"tags":[],"class_list":["post-3328","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-research"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/3328","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=3328"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/3328\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=3328"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=3328"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=3328"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}