***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: RATIONALE Vitamin D has been shown to be involved in the host immune response toward Mycobacterium tuberculosis . OBJECTIVES To test whether vitamin D supplementation of patients with tuberculosis ( TB ) improved clinical outcome and reduced mortality . METHODS We conducted a r and omized , double-blind , placebo-controlled trial in TB clinics at a demographic surveillance site in Guinea-Bissau . We included 365 adult patients with TB starting antituberculosis treatment ; 281 completed the 12-month follow-up . The intervention was 100,000 IU of cholecalciferol or placebo at inclusion and again 5 and 8 months after the start of treatment . MEASUREMENTS AND MAIN RESULTS The primary outcome was reduction in a clinical severity score ( TBscore ) for all patients with pulmonary TB . The secondary outcome was 12-month mortality . No serious adverse effects were reported ; mild hypercalcemia was rare and present in both arms . Reduction in TBscore and sputum smear conversion rates did not differ among patients treated with vitamin D or placebo .  Overall mortality was 15 % ( 54 of 365 ) at 1 year of follow-up and similar in both arms ( 30 of 187 for vitamin D treated and 24 of 178 for placebo ; relative risk , 1.19 [ 0.58 - 1.95 ] ) . HIV infection was seen in 36 % ( 131 of 359 ) : 21 % ( 76 of 359 ) HIV-1 , 10 % ( 36 of 359 ) HIV-2 , and 5 % ( 19 of 357 ) HIV-1 + 2 . CONCLUSIONS Vitamin D does not improve clinical outcome among patients with TB and the trial showed no overall effect on mortality in patients with TB ; it is possible that the dose used was insufficient . Clinical trial registered with www.controlled-trials.com/is rct n ( IS RCT N35212132 ) Background : Micronutrient supplementation has been shown to reduce the progression of HIV but does not have an effect on the intestinal barrier or the intestinal microbiota of HIV patients . Studies have suggested that probiotics could potentially complement micronutrients in preserving the immune-function of HIV patients . Objective : Assess the impact of micronutrient supplemented probiotic yogurt on the immune function of HIV patients . Design : We performed a r and omized , double blind , controlled trial with CD4 count as primary outcome among HIV patients naïve to anti-retroviral treatment . Secondary outcomes included hematological parameters , incidence of diarrhea and clinical symptoms . A total of 112 HIV patients were r and omized to receive a micronutrient fortified yogurt with ( n = 55 ) or without additional probiotic Lactobacillus rhamnosus GR-1 ( n = 57 ) for four weeks . Results : An average decline in CD4 count of −70 cells/μL ( 95 % CI : −154 to −15 ) was observed in the micronutrient , probiotic group versus a decrease of −63 cells/μL ( 95 % CI : −157 to −30 ) in the micronutrient control group ( p = 0.9 ) . Additional probiotic supplementation was well tolerated and not associated with adverse events . No difference between groups was detected in incidence of diarrhea or clinical symptoms . An improvement of hemoglobin levels was observed for all subjects , based upon a mean difference from baseline of 1.4 g/L ( SD = 6 ) ( p = 0.02 ) . Conclusion : The addition of probiotics to a micronutrient fortified yogurt was well tolerated by HIV patients but was not associated with a further increase in CD4 count after one month Background Use of multivitamin supplements during the pre-HAART era has been found to reduce viral load , enhance immune response , and generally improve clinical outcomes among HIV-infected adults . However , immune reconstitution is incomplete and significant mortality and opportunistic infections occur in spite of HAART . There is insufficient research information on whether multivitamin supplementation may be beneficial as adjunct therapy for HIV-infected individuals taking HAART . We propose to evaluate the efficacy of a single recommended daily allowance ( RDA ) of micronutrients ( including vitamins B-complex , C , and E ) in slowing disease progression among HIV-infected adults receiving HAART in Ug and a. Methods / Design We are using a r and omized , double-blind , placebo-controlled trial study design . Eligible patients are HIV-positive adults aged at least 18 years , and are r and omized to receive either a placebo ; or multivitamins that include a single RDA of the following vitamins : 1.4 mg B1 , 1.4 mg B2 , 1.9 mg B6 , 2.6 mcg B12 , 18 mg niacin , 70 mg C , 10 mg E , and 0.4 mg folic acid . Participants are followed for up to 18 months with evaluations at baseline , 6 , 12 and 18 months . The study is primarily powered to examine the effects on immune reconstitution , weight gain , and quality of life . In addition , we will examine the effects on other secondary outcomes including the risks of development of new or recurrent disease progression event , including all-cause mortality ; ARV regimen change from first- to second-line therapy ; and other adverse events as indicated by incident peripheral neuropathy , severe anemia , or diarrhea . Discussion sThe conduct of this trial provides an opportunity to evaluate the potential benefits of this affordable adjunct therapy ( multivitamin supplementation ) among HIV-infected adults receiving HAART in a developing country setting .Trial registration Clinical Trial Registration -URL : http://www . clinical trials.gov . Unique identifier : BACKGROUND Suboptimal vitamin D ( vitD ) status is common in children and young adults infected with human immunodeficiency virus ( HIV ) . The vitD supplemental dose needed to normalize vitD status in this population is unknown . METHODS In this double-blind trial , subjects infected with HIV ages 8.3 to 24.9 years were r and omized to vitD3 supplementation of 4000 IU/day or 7000 IU/day and evaluated at 6 and 12 week for changes in vitD status and HIV indicators . A dose was considered unsafe if serum calcium was elevated ( above age and sex-specific range ) associated with elevated serum 25 hydroxyvitamin D ( 25(OH)D ) ; > 160 ng/mL ) . RESULTS At baseline , 95 % of subjects ( n = 44 ; 43 % with perinatally acquired HIV , 57 % with behaviorally acquired HIV ) had a  suboptimal serum 25(OH)D concentration of < 32 ng/mL ( mean ± st and ard deviation , 19.3 ± 7.4 ; range , 4.4 - 33.6 ng/mL ) . After 12 weeks ( main outcome ) of D3 supplementation , both D3 doses were safe and well tolerated , with no evidence of elevation of serum calcium concentrations or deterioration in HIV immunologic or virologic status . Sufficient vitD status , defined as serum 25(OH)D ≥32 ng/mL , was achieved in 81 % of all subjects , and only the 7000 IU/day group ( 86 % ) achieved this a priori efficacy criterion in > 80 % of subjects . Change in serum 25(OH)D did not differ between HIV acquisition groups . CONCLUSIONS A 7000 IU/day D3 supplementation was safe and effective in children and young adults infected with HIV Background : Iron deficiency is common among female injection drug users , but it is unclear whether iron supplementation can reduce anemia and improve iron status without increasing plasma hepatitis C virus ( HCV ) or HIV RNA levels . Methods : We conducted a phase 3 , double-blind , r and omized , controlled clinical trial of daily micronutrients with 18 mg of iron ( iron group ) versus micronutrients without iron ( control group ) for 12 months among hepatitis C-positive female injection drug users in Baltimore , Maryl and . The main outcome measures were hemoglobin , markers of iron status , plasma HCV RNA , plasma HIV RNA , and liver enzymes at 6 and 12 months of follow-up . Results : Four hundred fifty-eight women ( 320 HIV-negative and 138 HIV-positive ) enrolled in the trial . There were no significant differences in the proportion of women with anemia , ferritin < 30 ng/mL , log10 plasma HCV RNA , or log10 plasma HIV RNA between treatment groups at enrollment . The proportion with anemia in the iron and control groups , respectively , was 20.7 % versus 31.3 % ( P = 0.026 ) at 6 months and 26.2 % versus 30.4 % ( P = 0.5 ) at 12 months ; with ferritin < 30 ng/mL , the proportion was 29.2 % versus 55.5 % ( P < 0.0001 ) at 6 months and 26.2 % versus 46.9 % ( P = 0.0018 ) at 12 months . In the iron and control groups , respectively , mean log10 plasma HCV RNA ( IU/mL ) was 5.2 versus 5.2 ( P = 0.86 ) at 6 months and 5.4 versus 5.3 ( P = 0.6 ) at 12 months . Among HIV-positive subjects , mean log10 plasma RNA ( copies/mL ) in the iron and placebo groups , respectively , was 3.8 versus 3.7 ( P = 0.75 ) at 6 months and 3.7 versus 4.1 ( P = 0.19 ) at 12 months . There were no significant differences in liver enzyme levels between the treatment groups at enrollment , 6 months , and 12 months . Conclusions : A daily micronutrient supplement with iron can reduce anemia and improve iron status in female injection drug users without increasing plasma HCV or HIV RNA levels or altering liver enzymes BACKGROUND Studies suggest that vitamin D deficiency is a risk factor for cardiovascular disease and diabetes . Vitamin D deficiency is prevalent in HIV patients but the effect of vitamin D supplementation on cardiovascular risk in this population is unknown . METHODS We conducted a r and omized , double-blind , placebo-controlled trial among 45 HIV-infected adults in Clevel and ( OH , USA ) on stable antiretroviral therapy with durable virological suppression and a baseline serum 25-hydroxyvitamin D level of ≤20 ng/ml . Participants were r and omized 2:1 to vitamin D3 4,000 IU daily or placebo  for 12 weeks . The primary outcome was a change in flow-mediated brachial artery dilation ( FMD ) . RESULTS Baseline demographics were similar except for age ( vitamin D versus placebo , mean ±sd 47 ±8 versus 40 ±10 years ; P=0.009 ) . Both groups had reduced FMD at baseline ( median values 2.9 % [ IQR 1.6 - 4.8 ] for vitamin D versus 2.5 % [ IQR 1.7 - 6.4 ] for placebo ; P=0.819 ) . Despite an increase in the concentration of serum 25-hydroxyvitamin D from baseline to 12 weeks ( 5.0 ng/ml [ IQR -0.9 - 7.4 ] versus -1.9 ng/ml [ IQR -4.0 - 0.1 ] for vitamin D versus placebo , respectively ; P=0.003 ) , there was no difference in FMD change ( 0.55 % [ IQR -1.05 - 2.13 ] versus 0.29 % [ IQR -1.61 - 1.77 ] ; P=0.748 ) . Vitamin D supplementation was associated with a decrease in total and non-high-density lipoprotein cholesterol , and an increase in indices of insulin resistance . CONCLUSIONS Among HIV-infected individuals with vitamin D deficiency , supplementation with 4,000 IU vitamin D3 daily for 12 weeks modestly improved vitamin D status and cholesterol but worsened insulin resistance without change in endothelial function . The mechanisms of resistance to st and ard doses of vitamin D and the complex role of vitamin D in glucose metabolism in this population require further investigation Background Approximately 30 % of HIV-1-infected patients receiving antiretroviral therapy who achieve virologic control have unsatisfactory immune reconstitution , with CD4 + T-cell counts persistently below 350 cells/μL. These patients are at elevated risk for clinical progression to AIDS and non-AIDS events . CD4 + T-cell depletion following infection and persistent immune activation can partially explain this low CD4 + T-cell recovery . Recent data suggest a link between the tryptophan oxidation pathway , immune activation and HIV disease progression based on overstimulation of the tryptophan oxidation pathway by HIV antigens and by interferon-gamma . This overstimulation reduces levels of circulating tryptophan , result ing in inflamm 
    Output:
    
Supplementation probably does increase blood concentrations of vitamin D and zinc ( data not pooled , vitamin D : 4 trials , 299 participants , zinc : 4 trials , 484 participants , moderate certainty evidence ) and may also increase blood concentrations of vitamin A ( data not pooled , 3 trials , 495 participants , low certainty evidence ) , especially in those who are deficient .
Authors ' conclusions The analyses of the available trials have not revealed consistent clinical ly important benefits with routine multiple micronutrient supplementation in people living with HIV .
These findings should not be interpreted as a reason to deny micronutrient supplements for people living with HIV where specific deficiencies are found or where the person 's diet is insufficient to meet the recommended daily allowance of vitamins and minerals