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NORTHWEST AIDS EDUCATION AND TRAINING CENTER Multivitamins in HIV Infection Ben Atkinson, MS RD Madison Clinic Seattle, WA November 21, 2013 Objectives…or what we’re gonna learn today • What a multivitamin is • Prevalence of use • Who needs • Who doesn’t need • Resources Multivitamin/mineral: definition • Fat soluble - A, D, E, K • Water soluble - C, B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B9 (folate), B12 (cobalamin) • Trace elements - Zinc, Magnesium, Selenium, Case: Mr. H • On HAART • Healthy body weight • Watches Dr Oz • Wants to take: - Multivitamin/mineral (no iron) - B-complex 50 - Vitamin E (unsure of dose) - Zinc 50 mg - Vitamin C 500 mg • Food recall - Eating healthfully? Mr. H’s micronutrient intake • Slightly low intake - Vitamin E - Folic Acid • All others at recommended intake levels 100%! Who takes multivitamin/minerals? • 39% of US Population • ‘To improve overall health’ • Underreported to providers Gahche 2011 NCHS Data Brief No. 61, Bailey 2013 JAMA Int Med, Liu 2009 AIDS Pt Care STDs Who needs multivitamins/minerals? • Difficult to say… - Pregnant women - Confounders include IV Drug Use, TB, OIs, malabsorption - Common deficiencies • B12 • Zinc - Vit A, Vit E, Selenium are generally normal - Intake vs Stores Jones 2006 JAIDS, Woods 2003 CID Who doesn’t need multivitamin/minerals? • Many of our patients… • No current evidence to supplement beyond RDA/DV • Are they safe? • Fawzi study 2012 - B-complex + C + E - ~200% DV vs 5-20X DV - No change in HIV or death - No placebo group • Vit E - NFHL: heart disease • Iron/Calcium - Dolutegravir Isanaka 2012 JAMA, Falcone 2010 AJCN How to assess intake • Multi-pass diet recall • 1st pass - What did you eat yesterday? • 2nd pass - How much did you eat? - At what time? • 3rd pass - Typical foods: coffee - Cultural foods: tortillas myfitnesspal.com Meet recommended intake via food • Vitamin C • Folic Acid • Vitamin A • Iron Zinc B12 Vit E • Magnesium Other Bs • Selenium • Calcium Vit D Resources • Choosemyplate.gov • https://www.supertracker.usda.gov/foodtracker.aspx • Idndpg.org • Eatright.org • CDC Diabetes Prevention Program - http://www.cdc.gov/diabetes/prevention/pdf/handouts.pdf • [email protected]
