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

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

doi:10.1097/QAI.0000000000000588

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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

Published Date:

Jul 01 2015

Publisher's site:

http://dx.doi.org/10.1097/QAI.0000000000000588 New Site Icon

Source:

J Acquir Immune Defic Syndr. 69(3):319-328

Language:

English

[PDF-396.53 KB]

Details:

Personal Authors:

Widen, Elizabeth M ; Bentley, Margaret E ; Chasela, Charles S ; Kayira, Dumbani ; Flax, Valerie L ; ... More ▼

Keywords:

[+]

Pubmed ID:

25723140

Pubmed Central ID:

PMC4506710

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.

Document Type:

Journal Article

Collection(s):

CDC Public Access

Funding:

SIP 22-09 U48-DP001944-01/DP/NCCDPHP CDC HHS/United States
D43 TW001039/TW/FIC NIH HHS/United States
U48DP001944/ACL HHS/United States
R03 HD057775/HD/NICHD NIH HHS/United States
SIP 13-01 U48-CCU409660-09/PHS HHS/United States
SIP 26-04 U48-DP000059-01/DP/NCCDPHP CDC HHS/United States
R24 TW007988/TW/FIC NIH HHS/United States
R03 HD057637/HD/NICHD NIH HHS/United States
P30-AI50410/AI/NIAID NIH HHS/United States
R24 HD050924/HD/NICHD NIH HHS/United States
P2C HD050924/HD/NICHD NIH HHS/United States
U48 DP000059/DP/NCCDPHP CDC HHS/United States
2-D43TW01039-06/TW/FIC NIH HHS/United States
P30 AI050410/AI/NIAID NIH HHS/United States

Place as Subject:

Malawi

Supporting Files:

	NIHMS664808-supplement-Online_Supplemental_Material.docx	application/vnd.openxmlformats-officedocument.wordprocessingml.document
	nihms664808.nxml	text/xml
	nihms664808f1.gif	image/gif
	nihms664808f1.jpg	image/jpeg

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