***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: Although r and omised trials are important for evidence -based medicine , little is known about their overall characteristics . We assessed the epidemiology and reporting of method ological details for all 519 PubMed -indexed r and omised trials published in December , 2000 ( 383 [ 74 % ] parallel-group , 116 [ 22 % ] crossover ) . 482 ( 93 % ) were published in specialty journals . A median of 80 participants ( 10th-90th percentile 25 - 369 ) were recruited for parallel-group trials . 309 ( 60 % ) were blinded . Power calculation , primary outcomes , r and om sequence generation , allocation concealment , and h and ling of attrition were each adequately described in less than half of publications . The small sample sizes are worrying , and poor reporting of method ological characteristics will prevent reliable quality assessment of many published trials BACKGROUND Results from observational studies suggest that micronutrient status is a determinant of the progression of human immunodeficiency virus ( HIV ) disease . METHODS We enrolled 1078 pregnant women infected with HIV in a double-blind , placebo-controlled trial in Dar es Salaam , Tanzania , to examine the effects of daily supplements of vitamin A ( preformed vitamin A and beta carotene ) , multivitamins ( vitamins B , C , and E ) , or both on progression of HIV disease , using survival  models . The median follow-up with respect to survival was 71 months ( interquartile range , 46 to 80 ) . RESULTS Of 271 women who received multivitamins  , 67 had progression to World Health Organization ( WHO ) stage 4 disease or died -- the primary outcome --as compared with 83 of 267 women who received placebo ( 24.7 percent vs. 31.1 percent ; relative risk , 0.71 ; 95 percent confidence interval , 0.51 to 0.98 ; P=0.04 ) . This regimen was also associated with reductions in the relative risk of death related to the acquired immunodeficiency syndrome ( 0.73 ; 95 percent confidence interval , 0.51 to 1.04 ; P=0.09 ) , progression to WHO stage 4 ( 0.50 ; 95 percent confidence interval , 0.28 to 0.90 ; P=0.02 ) , or progression to stage 3 or higher ( 0.72 ; 95 percent confidence interval , 0.58 to 0.90 ; P=0.003 ) . Multivitamins also result ed in significantly higher CD4 + and CD8 + cell counts and significantly lower viral loads . The effects of receiving vitamin A alone were smaller and for the most part not significantly different from those produced by placebo . Adding vitamin A to the multivitamin regimen reduced the benefit with regard to some of the end points examined . CONCLUSIONS Multivitamin supplements delay the progression of HIV disease and provide an effective , low-cost means of delaying the initiation of antiretroviral therapy in HIV-infected women Background Vitamin D has a potential role in slowing HIV disease progression and preventing mortality based on its extensive involvement in the immune system ; however , this relationship has not been examined in large studies or in re source -limited setting s. Methodology /Principal Findings Vitamin D levels were assessed in 884 HIV-infected pregnant women at enrollment in a trial of multivitamin supplementation ( not including vitamin D ) in Tanzania . Women were followed up for a median of 69.5 months , and information on hemoglobin levels , HIV disease progression , and mortality was recorded . Proportional hazard models and generalized estimating equations were used to assess the relationship of these outcomes with vitamin D status . Conclusions / Significance Low vitamin D status ( serum 25-hydroxyvitamin D<32ng/mL ) was significantly associated with progression to WHO HIV disease stage III or greater in multivariate models ( incidence rate ratio [ RR ] : 1.25 ; 95 % confidence intervals [ CI ] : 1.05 , 1.50 ) . No significant relationship was observed between vitamin D status and T-cell counts during follow-up . Women with low vitamin D status had 46 % higher risk of developing severe anemia during follow-up , compared to women with adequate vitamin D levels ( RR : 1.46 ; 95 % CI : 1.09 , 1.96 ) . Women in the highest vitamin D quintile had a 42 % lower risk of all-cause mortality , compared to the lowest quintile ( RR : 0.58 ; 95 % CI : 0.40 , 0.84 ) . Vitamin D status had a protective association with HIV disease progression , all-cause mortality , and development of anemia during follow-up in HIV-infected women . If confirmed in r and omized trials , vitamin D supplementation could represent a simple and inexpensive method to prolonging the time to initiation of antiretroviral therapy in HIV-infected patients , particularly in re source -limited setting BACKGROUND In observational studies , the zinc status of HIV-infected persons has been associated with both positive and adverse clinical outcomes . Such endpoints may affect the risk of adverse birth outcomes among HIV-infected women . OBJECTIVE We examined the effects of zinc supplements on birth outcomes , hematologic indicators , and counts of T lymphocyte subsets among 400 HIV-infected pregnant women . DESIGN Eligible women between 12 and 27 wk of gestation were r and omly assigned to daily oral supplementation with either 25 mg Zn or placebo between recruitment and 6 wk after delivery . All women received iron , folic acid , and multivitamin supplements irrespective of the experimental assignment . RESULTS We observed no significant differences in birth weight , duration of gestation , or fetal and neonatal mortality between women in the zinc and placebo groups . Hemoglobin concentrations increased between baseline and 6 wk postpartum in both groups . However , the rise in hemoglobin over this period was significantly lower ( P = 0.03 ) in the zinc group ( x + /- SD : 11.5 + /- 17.9 g/L ) than in the placebo group ( 15.2 + /- 18.6 g/L ) . Similarly , the changes in red blood cell count and in packed cell volume over the same period were significantly lower in the zinc group ( P < 0.01 and P = 0.01 , respectively ) . Zinc had no effect on CD4(+ ) , CD8(+ ) , or CD3(+ ) cell counts during the follow-up period . CONCLUSION Because of the lack of beneficial effects of zinc on adverse pregnancy outcomes and the likelihood of negative effects on hemoglobin concentrations , no compelling evidence exists to support the addition of zinc to prenatal supplements intended for pregnant HIV-infected women Iron deficiency is one of the main causes of anemia during pregnancy , although other micronutrient deficiencies may play a role . We examined the effects of daily antenatal and postnatal supplementation with four combinations of micronutrients on  maternal hematologic indicators  in a double-masked r and omized controlled community trial . Communities , called sectors , were r and omly assigned to supplementation with folic acid ( 400 microg ) , folic acid plus iron ( 60 mg ) , folic acid plus iron and zinc ( 30 mg ) and folic acid plus iron , zinc and 11 other micronutrients , each at the approximate recommended daily allowance for pregnancy all given with vitamin A as retinol acetate ( 1000 microg retinol equivalent ) , or vitamin A alone as the control group .  Hemoglobin ( Hb ) and indicators of iron status were assessed at baseline and at 32 wk of gestation . At 6-wk postpartum , Hb assessment was repeated using a finger stick . Severely anemic women ( Hb < 70 g/L ) were treated according to WHO recommendations . Folic acid alone had no effect on maternal anemia or iron status . Hb concentrations were 14 g/L , [ 95 % confidence limits ( CL ) , 8.3 - 19.2 ] , 10.0 g/L ( CL , 5.2 - 14.8 ) and 9.4 g/L ( CL , 4.7 - 14.1 ) higher in the groups receiving folic acid plus iron , folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients , respectively , relative to the control . Anemia in the third trimester was reduced by 54 % with folic acid plus iron , by 48 % with folic acid plus iron and zinc and by 36 % with folic acid plus iron , zinc and multiple micronutrients supplementation , relative to the control ( P < 0.05 ) . Thus , the combinations of folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients provided no additional benefit in improving maternal hematologic status during pregnancy compared with folic acid plus iron . The level of compliance and baseline Hb concentrations modified the effect of iron The impact of iron-only supplements ( FE ) versus multiple micronutrient supplements containing iron ( MM ) during pregnancy on iron status was assessed in a sub sample ( n = 453 ) of women who participated in a r and omized double-blind trial in Mexico . Compliance , monitored by observation , was high ( > 85 % ) . The two groups were similar at recruitment ( < 13 wk gestation ) for various sociodemographic characteristics and for mean hemoglobin ( Hb ) concentrations and prevalence of anemia ( Hb < 110 g/L ; 11 % ) . However , mean serum ferritin was higher ( P < 0.05 ) in the MM group ( n = 142 ) compared to the FE group ( n = 148 ) and the prevalence of iron deficiency ( serum ferritin < 12 micro g/L ) was lower in the MM group ( 44.4 % ) compared to the FE group ( 57.4 % ) . By the third trimester , almost half the women were anemic in both groups , and mean Hb ( g/L ) was lower for the MM group ( 104.2 ; 95 % CI : 102.5 , 106.0 ) compared to the FE group ( 108.1 ; 95 % CI : 106.4 , 109.8 ) after adjusting for baseline serum ferritin . In contrast , there were no differences in Hb concentrations at 1 mo postpartum or in mean ferritin and prevalence of iron deficiency at 32 wk gestation and 1 mo postpartum ( 90.9 and 45.1 % for the MM group ; 92.6 and 47.3 % for the FE group , respectively ) . In conclusion , rather than improve Hb or iron status relative to FE-only supplements as hypothesized , MM supplements may have slightly reduced Hb concentrations during pregnancy . Neither supplement was able to meet iron needs as evidence d by dramatic increases in anemia and iron deficiency by the end of pregnancy BACKGROUND The pattern of weight gain during pregnancy among HIV-infected women is largely unknown . Multivitamin supplementation was shown to be effective in preventing adverse pregnancy outcomes among HIV-positive women . These protective effects could be mediated in part by an improvement in the pattern of gestational weight gain . OBJECTIVE We examined the effects of multivitamin and vitamin A supplements on weight gain during the second and third trimesters of pregnancy among HIV-infected women . DESIGN We enrolled 1075 pregnant , HIV-1-positive women from Dar es Salaam , Tanzania , in a r and omized , placebo-controlled trial . Using a 2-by-2 factorial design , we assigned each woman to 1 of 4 regimens : multivitamins ( thiamine , riboflavin , niacin , folic acid , and vitamins B-6 , B-12 , C , and E ) , vitamin A , multivitamins including vitamin A , or placebo . The women took these oral supplements daily and were weighed monthly until the end of pregnancy . RESULTS The mean rate of weight gain was 306 g/wk during the second trimester and 247 g/wk during the third trimester . During the third trimester , average weight gain was significantly greater ( by 304 g ; 95 % CI : 17 , 590 ; P = 0.04 ) and the risk of low rate of weight gain ( < or= 100 g/wk ) was significantly lower ( relative risk : 0.73 ; 95 % CI : 0.58 , 0.93 ) in women who received multivitamins than in women who did not . Multivitamins including vitamin A were protective against low weight gain during the second trimester compared with multivitamins alone . CONCLUSION Multivitamin supplementation during pregnancy improves the pattern of weight gain among HIV-infected women BACKGROUND Multiple micronutrient supplementation of Nepalese women during pregnancy is associated with a significant increase in birth weight . OBJECTIVE We tested the hypothesis that improved birth weight in infants of mothers supplemented with micronutrients is associated with a decrease in inflammatory responses and an increase in the production of T helper 1 cells and T helper 2 cells . DESIGN The study was embedded in a r and omized controlled trial of 15 micronutrients , compared with iron-folate supplementation ( control ) , given during 
    Output:
    
None of the women were receiving antiretrovrial therapy (ART).Multiple  micronutrient supplements conferred multiple clinical benefits to pregnant women and their offspring .
No significant adverse effects were reported .
No significant clinical benefits were found from zinc supplementation of pregnant Tanzanian women .
Selenium supplements given during and after pregnancy did not delay maternal HIV disease progression or improve pregnancy outcomes , but may improve child survival and decrease maternal diarrhoeal morbidity .
There were no differences in maternal and infant outcomes when women received single RDA multivitamins or multiple RDA multivitamin supplementation .
Specific recommendations for pregnant and lactating women infected with HIV would be to include the provision of multivitamin supplements in single RDA formulations during the antenatal period and at least for 6 weeks post-partum , especially for women who are breast-feeding .
There is no conclusive evidence to provide st and -alone zinc or selenium supplementation to HIV-infected pregnant and lactating women .