Randomized trial of vitamin supplements in relation to transmission of HIV-1 through breastfeeding and early child mortality


Fawzi, WW; Msamanga, GI; Hunter, D; Renjifo, B; Antelman, G; Bang, H; Manji, K; Kapiga, S; Mwakagile, D; Essex, M; Spiegelman, D; (2002) Randomized trial of vitamin supplements in relation to transmission of HIV-1 through breastfeeding and early child mortality. AIDS (London, England), 16 (14). pp. 1935-44. ISSN 0269-9370 DOI: https://doi.org/10.1097/00002030-200209270-00011

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Abstract

BACKGROUND: HIV-1 transmission through breastfeeding is a global problem and has been associated with poor maternal micronutrient status. METHODS: A total of 1078 HIV-infected pregnant women from Tanzania were randomly assigned to vitamin A or multivitamins excluding A from approximately 20 weeks' gestation and throughout lactation. RESULTS: Multivitamins excluding A had no effect on the total risk of HIV-1 transmission (RR 1.04, 95% CI 0.82-1.32, P= 0.76). Vitamin A increased the risk of transmission (RR 1.38, 95% CI 1.09-1.76, P = 0.009). Multivitamins were associated with non-statistically significant reductions in transmission through breastfeeding, and mortality by 24 months among those alive and not infected at 6 weeks. Multivitamins significantly reduced breastfeeding transmission in infants of mothers with low baseline lymphocyte counts (RR 0.37; 95% CI 0.16-0.85, P = 0.02) compared with infants of mothers with higher counts (RR 0.99, 95% CI 0.68-1.45, P = 0.97; -for-interaction 0.03). Multivitamins also protected against transmission among mothers with a high erythrocyte sedimentation rate (P-for-interaction 0.06), low hemoglobin (P-for-interaction 0.06), and low birthweight babies (P-for-interaction 0.04). Multivitamins reduced death and prolonged HIV-free survival significantly among children born to women with low maternal immunological or nutritional status. Vitamin A alone increased breastfeeding transmission but had no effect on mortality by 24 months. CONCLUSION: Vitamin A increased the risk of HIV-1 transmission. Multivitamin (B, C, and E) supplementation of breastfeeding mothers reduced child mortality and HIV-1 transmission through breastfeeding among immunologically and nutritionally compromised women. The provision of these supplements to HIV-infected lactating women should be considered.

Item Type: Article
Keywords: Adult, *Breast Feeding, Child, Dietary Supplements, Disease Transmission, Vertical/*prevention & control/statistics &, numerical data, Double-Blind Method, Female, HIV Infections/drug therapy/epidemiology/*transmission, *Hiv-1, Humans, Infant, Infant, Newborn, Infant, Newborn, Diseases/mortality/*prevention & control, Mortality, Nutritional Status, Pregnancy, Pregnancy Complications, Infectious/*drug therapy/epidemiology, Tanzania/epidemiology, Vitamin A/administration & dosage/therapeutic use, Vitamins/administration & dosage/*therapeutic use, Adult, Breast Feeding, Child, Dietary Supplements, Disease Transmission, Vertical, prevention & control, statistics & numerical data, Double-Blind Method, Female, HIV Infections, drug therapy, epidemiology, transmission, HIV-1, Humans, Infant, Infant, Newborn, Infant, Newborn, Diseases, mortality, prevention & control, Mortality, Nutritional Status, Pregnancy, Pregnancy Complications, Infectious, drug therapy, epidemiology, Research Support, U.S. Gov't, P.H.S., Tanzania, epidemiology, Vitamin A, administration & dosage, therapeutic use, Vitamins, administration & dosage, therapeutic use
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 12351954
Web of Science ID: 179040100011
URI: http://researchonline.lshtm.ac.uk/id/eprint/9887

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