Journal article
Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women
The Journal of nutrition, Vol.145(8), pp.1950-1957
08/01/2015
DOI: 10.3945/jn.115.212290
PMCID: 4516772
PMID: 26156797
Abstract
Background: Little is known about the influence of antiretroviral therapy with or without micronutrient supplementation on the micronutrient concentrations of HIV-infected lactating women in resource-constrained settings.
Objective: We examined associations of highly active antiretroviral therapy (HAART) and lipid-based nutrient supplements (LNS) with concentrations of selected micronutrients in HIV-infected Malawian women at 24 wk postpartum.
Methods: Plasma micronutrient concentrations were measured in a subsample (n = 690) of Breastfeeding, Antiretrovirals, and Nutrition (BAN) study participants who were randomly assigned at delivery to receive HAART, LNS, HAART+LNS, or no HAART/no LNS (control). HAART consisted of protease inhibitor-based triple therapy. LNS (140 g/d) met energy and micronutrient requirements of lactation. Multivariable linear regression tested the association of HAART and LNS, plus their interaction, with micronutrient concentrations, controlling for season, baseline viral load, and baseline CD4 count.
Results: We found significant HAART by LNS interactions for folate (P = 0.051), vitamin B-12 (P < 0.0011, and transferrin receptors (TfRs)(P = 0.085). HAART was associated with lower folate (with LNS: -27%, P < 0.001; without LNS: -12%, P = 0.040) and higher TfR concentrations (with LNS: +14%, P = 0.004; without LNS: +28%, P < 0.001), indicating iron deficiency. LNS increased folate (with HAART: +17%, P = 0.037; without HAART: +39%, P < 0.001) and decreased TfR concentrations (with HAART only: 112%, P = 0.023(. HAART was associated with lower vitamin B-12 concentrations only when LNS was present (-18%, P = 0.001), whereas LNS increased vitamin B-12 only when no HAART was present (+27%, P < 0.001). HAART, but not LNS, was associated with higher retinol-binding protein (RBP; +10%, P = 0.0071. We detected no association of HAART or LNS with selenium, ferritin, or hemoglobin.
Conclusion: The association of HAART with lower folate, iron deficiency, and higher RBP plus the attenuation of LNS effects on folate. and vitamin B-12 when combined with HAART has implications for the health of lactating HIV-infected women taking HAART in prevention of mother-to-child transmission programs. This trial was registered at clinicaltrials.gov as NCT00164736.
Details
- Title: Subtitle
- Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women
- Creators
- Valerie L. Flax - University of North Carolina at Chapel HillLinda S. Adair - University of North Carolina at Chapel HillLindsay H. Allen - Western Human Nutrition Research CenterSetarah Shahab-Ferdows - USDA ARS, Western Human Nutr Res Ctr, Davis, CA USADaniela Hampel - Western Human Nutrition Research CenterCharles S. Chasela - University of the WitwatersrandGerald Tegha - UNC Project, Lilongwe, MalawiEric J. Daza - University of North Carolina at Chapel HillAmanda Corbett - University of North Carolina at Chapel HillNicole L. Davis - University of North Carolina at Chapel HillDeborah Kamwendo - UNC Project, Lilongwe, MalawiAthena P. Kourtis - CDC FoundationCharles M. van der Horst - University of North Carolina at Chapel HillDenise J. Jamieson - CDC FoundationMargaret E. Bentley - University of North Carolina at Chapel HillBreastfeeding, Antiretrovirals and Nutrition (BAN) Study Team
- Resource Type
- Journal article
- Publication Details
- The Journal of nutrition, Vol.145(8), pp.1950-1957
- Publisher
- Elsevier
- DOI
- 10.3945/jn.115.212290
- PMID
- 26156797
- PMCID
- 4516772
- ISSN
- 0022-3166
- eISSN
- 1541-6100
- Number of pages
- 8
- Grant note
- US Agency for International Development; United States Agency for International Development (USAID) R24TW007988 / Fogarty International (the American Recovery and Reinvestment Act) Elizabeth Glaser Pediatric AIDS Foundation R24 HD050924 / Carolina Population Center ARS-0426640; 813615 / ARS; United States Department of Agriculture (USDA); USDA Agricultural Research Service OPP53107 / Bill & Melinda Gates Foundation; CGIAR SIP 13-01 U48-CCU409660-09; SIP 26-04 U48-DP000059-01; SIP 22-09 U48-DP001944-01 / Prevention Research Center's Special Interest Project of the CDC Johnson Johnson; Johnson & Johnson; Johnson & Johnson USA DHHS/NIH/FIC 2-D43 TW001039 / NIH Fogarty AIDS International Training and Research Program P30-AI50410 / University of North Carolina Center for AIDS Research World Food Program National Institute of Allergy and Infectious Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) Malawi Ministry of Health and Population United Nations Children's Fund
- Language
- English
- Date published
- 08/01/2015
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446539602771
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