Antiretroviral treatment is associated with iron deficiency in HIV-infected Malawian women that is mitigated with supplementation, but is not associated with infant iron deficiency during 24 weeks of exclusive breastfeeding

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Widen, Elizabeth M ; Bentley, Margaret E ; Chasela, Charles S ; Kayira, Dumbani ; Flax, Valerie L ; Kourtis, Athena P ; Ellington, Sascha R ; Kacheche, Zebrone ; Tegha, Gerald ; Jamieson, Denise J ; van der Horst, Charles M ; Allen, Lindsay H ; Shahab-Ferdows, Setareh ; Adair, Linda S
  More +
• Description:
  Objective ; In resource-limited settings without safe alternatives to breastfeeding, the WHO recommends exclusive breastfeeding and antiretroviral (ARV) prophylaxis. Given the high prevalence of anemia among HIV-infected women, mothers and their infants (via fetal iron accretion) may be at risk of iron deficiency. We assessed the effects of maternal micronutrient-fortified lipid-based nutrient supplements (LNS) and maternal ARV treatment or infant ARV prophylaxis on maternal and infant iron status during exclusive breastfeeding from birth to 24 weeks. ; Methods ; The Breastfeeding, Antiretrovirals, and Nutrition Study was a randomized controlled trial conducted in Lilongwe, Malawi from 2004-2010. HIV-infected mothers (CD4>200 cells/ul) and their infants were randomly assigned to 28-week interventions: maternal-LNS/maternal-ARV (n=424), maternal-LNS/infant-ARV (n=426), maternal-LNS (n=334), maternal-ARV (n=425), infant-ARV (n=426), or control (n=334). Longitudinal models tested intervention effects on hemoglobin (Hb). In a subsample (n=537) with multiple iron indicators, intervention effects on Hb, transferrin receptors (TfR) and ferritin were tested with linear and Poisson regression. ; Results ; In longitudinal models, LNS effects on maternal and infant Hb were minimal. In subsample mothers, maternal ARVs were associated with tissue iron depletion (TfR>8.3 mg/L) (Risk ratio (RR): 3.1, p<0.01), but not in ARV-treated mothers receiving LNS (p=0.17). LNS without ARVs, was not associated with iron deficiency or anemia (p>0.1). In subsample infants, interventions were not associated with impaired iron status (all p-values>0.1). ; Conclusions ; Maternal ARV treatment with protease inhibitors is associated with maternal tissue iron depletion; but LNS mitigates adverse effects. ARVs do not appear to influence infant iron status; however, extended use needs to be evaluated.
• Keywords:
  • Anti-HIV Agents
  • Breast Feeding
  • Dietary Supplements
  • Drug Administration Schedule
  • Female
  • HIV Infections
  • Hemoglobins
  • Humans
  • Infant
  • Infant, Newborn
  More +
• Source:
  J Acquir Immune Defic Syndr. 69(3):319-328
• Pubmed ID:
  25723140
• Pubmed Central ID:
  PMC4506710
• Document Type:
  Journal Article
• Funding:
  SIP 22-09 U48-DP001944-01/DP/NCCDPHP CDC HHSUnited States/ ; D43 TW001039/TW/FIC NIH HHSUnited States/ ; U48DP001944/ACL HHSUnited States/ ; R03 HD057775/HD/NICHD NIH HHSUnited States/ ; SIP 13-01 U48-CCU409660-09/PHS HHSUnited States/ ; SIP 26-04 U48-DP000059-01/DP/NCCDPHP CDC HHSUnited States/ ; R24 TW007988/TW/FIC NIH HHSUnited States/ ; R03 HD057637/HD/NICHD NIH HHSUnited States/ ; P30-AI50410/AI/NIAID NIH HHSUnited States/ ; R24 HD050924/HD/NICHD NIH HHSUnited States/ ; P2C HD050924/HD/NICHD NIH HHSUnited States/ ; U48 DP000059/DP/NCCDPHP CDC HHSUnited States/ ; 2-D43TW01039-06/TW/FIC NIH HHSUnited States/ ; P30 AI050410/AI/NIAID NIH HHSUnited States/
  More +
• Volume:
  69
• Issue:
  3
• Download URL:
  https://stacks.cdc.gov/view/cdc/34411/cdc_34411_DS1.pdf
• File Type:
  [PDF - 396.53 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6c89662719e75c620573be20940cb353410669f6fbdc30a26fc4475f0e4c067e