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Do supplements help people with HIV?

No supplement replaces antiretroviral therapy (ART), the daily HIV medicine. The multivitamin benefits come from people not taking ART: comparing 538 pregnant women in Tanzania, daily B, C and E vitamins slowed progression to AIDS (grade B). In 3,418 adults starting ART, high-dose multivitamins added nothing and raised a liver enzyme. St John's wort and garlic supplements cut blood levels of some HIV drugs in volunteers. Check every supplement with your HIV clinician.

Last reviewed

How we grade evidenceEditorial policy

What the studies found

  • Grade B. Multivitamins slowed HIV in people without HIV medicine. In a Tanzanian trial in pregnant women, daily B, C and E vitamins cut progression to AIDS (WHO stage 4) or death to 24.7% from 31.1% over a median of 71 months. In 878 adults in Botswana not yet on ART, only a combined multivitamin-plus-selenium pill slowed the fall in CD4 cells (the immune cells HIV attacks); neither part worked alone. (Fawzi 2004; Baum 2013)
  • Grade B. Across all trials, routine supplements show no clear benefit. A Cochrane review found multiple micronutrients may make little or no difference to deaths in 7 trials with 2,897 people, and single nutrients such as vitamin D, zinc or selenium did not clearly change CD4 counts or viral load. (Visser 2017)
  • Grade B. With ART, high doses added nothing. In 3,418 adults starting ART, high-dose multivitamins did no better than standard doses on progression or death (72% in both groups), and the trial stopped early because a liver enzyme (ALT) rose more often. (Isanaka 2012)
  • Grade C. Two herbs lowered HIV drug levels in small volunteer studies. St John's wort lowered indinavir blood levels by 57%, and garlic supplements cut saquinavir by 51%; lower drug levels can lead to drug resistance. (Piscitelli 2000; Piscitelli 2002)

Who should be careful

  • Never take St John's wort with HIV medicine, and ask before using garlic supplements. Interactions with newer HIV drugs have not all been tested, so tell your HIV pharmacist about every product.
  • Don't take high-dose multivitamins on top of ART unless your clinician advises it; in the large trial they raised a liver enzyme. (Isanaka 2012)
  • Don't stop, skip or change HIV medicine on your own.
  • Contact your HIV clinic promptly for fever, night sweats, weight loss, new rashes, persistent diarrhea or yellow skin or eyes.
  • If you are pregnant, breastfeeding or under 18, ask a clinician first.

Try first

  • Take ART every day. In 4,685 adults with healthy immune counts, starting ART right away cut serious illness or death to 1.8% from 4.1%. (START 2015)
  • Ask for blood tests for specific shortages, such as vitamin D. The Cochrane review says supplements should still be used when a deficiency is found or the diet falls short. (Visser 2017)

Sources

  1. Fawzi WW, et al. A randomized trial of multivitamin supplements and HIV disease progression and mortality. N Engl J Med. 2004. PubMed 15229304 · doi:10.1056/NEJMoa040541
  2. Baum MK, et al. Effect of micronutrient supplementation on disease progression in asymptomatic, antiretroviral-naive, HIV-infected adults in Botswana: a randomized clinical trial. JAMA. 2013. PubMed 24281460 · doi:10.1001/jama.2013.280923
  3. Visser ME, et al. Micronutrient supplementation in adults with HIV infection. Cochrane Database Syst Rev. 2017. PubMed 28518221 · doi:10.1002/14651858.CD003650.pub4
  4. Isanaka S, et al. Effect of high-dose vs standard-dose multivitamin supplementation at the initiation of HAART on HIV disease progression and mortality in Tanzania: a randomized controlled trial. JAMA. 2012. PubMed 23073950 · doi:10.1001/jama.2012.13083
  5. Piscitelli SC, et al. Indinavir concentrations and St John's wort. Lancet. 2000. PubMed 10683007 · doi:10.1016/S0140-6736(99)05712-8
  6. Piscitelli SC, et al. The effect of garlic supplements on the pharmacokinetics of saquinavir. Clin Infect Dis. 2002. PubMed 11740713 · doi:10.1086/324351
  7. INSIGHT START Study Group, et al. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. N Engl J Med. 2015. PubMed 26192873 · doi:10.1056/NEJMoa1506816