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. (1st July 2015)

• Record Type: Journal Article
• Authors: 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.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 69:Number 3(2015:Mar.)
• Publication Date: 2015-07-01
• Subjects: iron -- breastfeeding -- lipid-based nutrient supplement -- antiretrovirals -- maternal -- infant; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000000588
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : 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 (through 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 to 2010. HIV-infected mothers (CD4 >200 cells/μL) 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: 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 > 0.1). Conclusions: Maternal ARV treatment with protease inhibitors is associated with maternal tissue iron depletion; but LNS mitigates adverse effects. ARVs do not seem to influence infant iron status; however, extended use needs to be evaluated. Abstract : Supplemental Digital Content is Available in the Text.