Multivitamins could prolong and improve the quality of life of millions of people infected with AIDS, according to the results of a new study published this week in the New England Journal of Medicine. Vitamin supplements which are abundent and cheap, may have their greatest impact in Africa, where HIV infection is exacting the biggest toll worldwide.

Investigators, led by Wafaie Fawzi of the Harvard University Department of Nutrition in Massachusetts, found that women who took multivitamins were siginificantly less likely to progress to advanced HIV disease than women who did not take multivitamins.

"They were also less likely to die as well compared to women in the control group. They had fewer symptoms of later stage of HIV infection, such as mouth ulcers, mouth infections or diahrreal disease,? Dr. Fawzi said. ?And multivitamins also signifcantly increased CD-4 cell counts, which are immune cells that are necessary for boosting immune function in the context of HIV infection."

Thirty percent of women who took multivitamins showed a clear advantage over women who either did not receive the vitamins or who were given daily doses of vitamin A.

Researchers found vitamins C, B and E were beneficial, but not vitamin A by itself.

Writing in the New England Journal of Medicine, Dr. Barbara Marston of the U.S. Centers for Disease Control in western Kenya says it's difficult to say why some vitamins seem helpful and others do not.

"I think the information about multivitamins and HIV is confusing and conflicted. There's some information that vitamins promote immunity,? Dr. Marston said. ?There's some information that vitamins stimulate HIV replication. And it's very difficult to guess without a trial what multivitamins would do."

Because AIDS impairs the body's absorption and utilization of nutrients in people infected with HIV, researchers gave the participants doses of B and E that were many times greater than the recommended daily amount of each vitamin.

Dr. Marston says more studies are needed to determine the extent to which multivitamins work in slowing progression of the AIDS virus. If nothing else, Dr. Marston says taking daily vitamin pills could help get HIV-infected individuals accustomed to taking antiretroviral drugs, which also need to be taken daily.

"Multivitamins haven't been widely promoted in Africa because they weren't thought to be sustainable,? Dr. Marston said. ?So, the idea of giving someone a tablet everyday for long term is very difficult to imagine. So is this whole idea of giving anteretroviral treatment, and if we're going to do that, adding multivitamins to that would be a very simple thing. Multivitamins would be much simpler than trying to get people to take complex combinations of antiretroviral treatment."

A previous study by Dr. Fawzi and colleagues also found that multivitamins significantly reduce the risk of mother-to-infant HIV transmission. The new study adds more evidence that vitamins appear to slow progression of the AIDS virus.

"We're just excited and delighted by these findings and look forward to seeing them put into practice,? Dr. Fawzi said. ?We sort of look at the findings as a reason to encourage the use of multivitamin supplements as supportive care, and would like again to note that these would be a low cost means delaying antriviral care and would not be by any means be a replacement for that important intervention."

The findings are based on a study of more than 1,000 HIV-infected women in Dar es Salaam, Tanzania who were followed for five years after giving birth.