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

Elizabeth M. Widen; Margaret E. Bentley; Charles S. Chasela; Dumbani Kayira; Valerie L. Flax; Athena P. Kourtis; Sascha R. Ellington; Zebrone Kacheche; Gerald Tegha; Denise J. Jamieson; Charles M. van der Horst; Lindsay H. Allen; Setareh Shahab-Ferdows; Linda S. Adair; Breastfeeding, Antiretrovirals and Nutrition (BAN) Study Team

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

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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

Elizabeth M. Widen, Margaret E. Bentley, Charles S. Chasela, Dumbani Kayira, Valerie L. Flax, Athena P. Kourtis, Sascha R. Ellington, Zebrone Kacheche, Gerald Tegha, Denise J. Jamieson, …

JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, Vol.69(3), pp.319-328

07/01/2015

DOI: 10.1097/QAI.0000000000000588

PMCID: PMC4506710

PMID: 25723140

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https://www.ncbi.nlm.nih.gov/pmc/articles/4506710View

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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/L) 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.

Immunology

Infectious Diseases

Life Sciences & Biomedicine

Science & Technology

Details

Title: Subtitle: 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
Creators: Elizabeth M. Widen - University of North Carolina at Chapel Hill
Margaret E. Bentley - University of North Carolina at Chapel Hill
Charles S. Chasela - University of the Witwatersrand
Dumbani Kayira - UNC Project, Fac Hlth Sci, Lilongwe, Malawi
Valerie L. Flax - University of North Carolina at Chapel Hill
Athena P. Kourtis - Centers for Disease Control and Prevention
Sascha R. Ellington - Centers for Disease Control and Prevention
Zebrone Kacheche - UNC Project, Fac Hlth Sci, Lilongwe, Malawi
Gerald Tegha - UNC Project, Fac Hlth Sci, Lilongwe, Malawi
Denise J. Jamieson - Centers for Disease Control and Prevention
Charles M. van der Horst - University of North Carolina at Chapel Hill
Lindsay H. Allen - Western Human Nutrition Research Center
Setareh Shahab-Ferdows - Western Human Nutrition Research Center
Linda S. Adair - University of North Carolina at Chapel Hill
Breastfeeding, Antiretrovirals and Nutrition (BAN) Study Team
Resource Type: Journal article
Publication Details: JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, Vol.69(3), pp.319-328
DOI: 10.1097/QAI.0000000000000588
PMID: 25723140
PMCID: PMC4506710
NLM abbreviation: J Acquir Immune Defic Syndr
ISSN: 1525-4135
eISSN: 2331-6993
Publisher: Lippincott Williams & Wilkins
Number of pages: 10
Grant note: GlaxoSmithKline Abbott Laboratories
Language: English
Date published: 07/01/2015
Academic Unit: Obstetrics and Gynecology; VPMA - Administration
Record Identifier: 9984446419302771

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