Details:

Alternative Title:
J Acquir Immune Defic Syndr
Publisher's site:
http://dx.doi.org/10.1097/QAI.0000000000000588
Personal Author:
Widen, Elizabeth M ; Bentley, Margaret E ; Chasela, Charles S ; Kayira, Dumbani ; Flax, Valerie L ; ... More +
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 Less -
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.


Subject:
[+]
Anti-HIV Agents
Article
Breast Feeding
Dietary Supplements
Drug Administration Schedule
Female
Hemoglobins
HIV Infections
Humans
Infant
Infant, Newborn
Iron
Iron, Dietary
Longitudinal Studies
Male

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 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 ; ... More +
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 Less -
Place as Subject:
Malawi
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:6c89662719e75c620573be20940cb353410669f6fbdc30a26fc4475f0e4c067e
File Type:

Supporting Files

• 	NIHMS664808-supplement-Online_Supplemental_Material.docx	docx
  	nihms664808.nxml	xml
  	nihms664808f1.gif	gif
  	nihms664808f1.jpg	jpeg

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