Villamor E, Koulinska IN, Aboud S, et al. Effect of vitamin supplements on HIV shedding in breast milk. Am J Clin Nutr 2010 Aug 25. [Epub ahead of print]
DOI: 10.3945/ajcn.2010.29339
http://www.ajcn.org/cgi/content/abstract/ajcn.2010.29339v1
http://www.ajcn.org/cgi/rapidpdf/ajcn.2010.29339v1
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Am J Clin Nutr. 2010 Aug 25. [Epub ahead of print]
Effect of vitamin supplements on HIV shedding in breast milk.
Villamor E, Koulinska IN, Aboud S, Murrin C, Bosch RJ, Manji KP, Fawzi WW.
Departments of Environmental Health Sciences and Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI and Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Abstract
BACKGROUND: Supplementation in lactating HIV-1-infected women with preformed vitamin A and beta-carotene (VA/BC) increases the risk of mother-to-child transmission of HIV through breastfeeding. Identifying a biological mechanism to explain this unexpected finding would lend support to a causal effect.
OBJECTIVE: The aim of the study was to evaluate the effect of VA/BC or multivitamin (B complex, vitamin C, and vitamin E) supplementation of HIV-infected women on HIV shedding in breast milk during the first 2 y postpartum.
DESIGN: We quantified viral (cell-free) and proviral (cell-associated) HIV loads in breast-milk samples collected </=15 d after delivery and every 3 mo thereafter from 594 Tanzanian HIV-1-infected women who participated in a randomized trial. Women received 1 of the following 4 daily oral regimens in a 2 x 2 factorial fashion during pregnancy and throughout the first 2 y postpartum: multivitamin, VA/BC, multivitamin including VA/BC, or placebo.
RESULTS: The proportion of breast-milk samples with detectable viral load was significantly higher in women who received VA/BC (51.3%) than in women who were not assigned to VA/BC (44.8%; P = 0.02). The effect was apparent >/=6 mo postpartum (relative risk: 1.34; 95% CI: 1.04, 1.73). No associations with proviral load were observed. The multivitamin had no effects. In observational analyses, beta-carotene but not retinol breast-milk concentrations were significantly associated with an increased viral load in milk.
CONCLUSIONS: VA/BC supplementation in lactating women increases the HIV load in breast milk. This finding contributes to explaining the adverse effect of VA/BC on mother-to-child transmission. beta-Carotene appears to have an effect on breast-milk viral load, independent of preformed vitamin A. This trial was registered at clinicaltrials.gov as NCT00197756.
PMID: 20739426
Note:
Data is from from a randomized, controlled trial of 1,078 HIV-infected women in Dar es Salaam, Tanzania, who received one of four regimens: vitamin A and beta-carotene (5,000 IU and 30 mg, respectively); B-complex vitamins along with vitamins C and E; a multivitamin plus vitamin A and beta-carotene; or placebo.