TY - JOUR
T1 - Plasma micronutrient concentrations are altered by antiretroviral therapy and lipid-based nutrient supplements in lactating HIV-infected Malawian women
AU - Flax, Valerie L.
AU - Adair, Linda S.
AU - Allen, Lindsay H.
AU - Shahab-Ferdows, Setarah
AU - Hampel, Daniela
AU - Chasela, Charles S.
AU - Tegha, Gerald
AU - Daza, Eric J.
AU - Corbett, Amanda
AU - Davis, Nicole L.
AU - Kamwendo, Deborah
AU - Kourtis, Athena P.
AU - van der Horst, Charles M.
AU - Jamieson, Denise J.
AU - Bentley, Margaret E.
AU - Adair, Linda
AU - Ahmed, Yusuf
AU - Ait-Khaled, Mounir
AU - Albrecht, Sandra
AU - Bangdiwala, Shrikant
AU - Bayer, Ronald
AU - Bentley, Margaret
AU - Bramson, Brian
AU - Bobrow, Emily
AU - Boyle, Nicola
AU - Butera, Sal
AU - Chasela, Charles
AU - Chavula, Charity
AU - Chimerang'ambe, Joseph
AU - Chigwenembe, Maggie
AU - Chikasema, Maria
AU - Chikhungu, Norah
AU - Chilongozi, David
AU - Chiudzu, Grace
AU - Chome, Lenesi
AU - Cole, Anne
AU - Corneli, Amy
AU - Dow, Anna
AU - Duerr, Ann
AU - Eliya, Henry
AU - Ellington, Sascha
AU - Eron, Joseph
AU - Farr, Sherry
AU - Ferguson, Yvonne Owens
AU - Fiscus, Susan
AU - Flax, Valerie
AU - Fokar, Ali
AU - Galvin, Shannon
AU - Guay, Laura
AU - Heilig, Chad
AU - BAN Study Team
N1 - Publisher Copyright:
© 2015 American Society for Nutrition.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - 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 < 0.001), 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: -12%, 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 = 0.007). 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.
AB - 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 < 0.001), 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: -12%, 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 = 0.007). 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.
KW - HIV mothers
KW - Highly active antiretroviral therapy
KW - Lipid-based nutrient supplements
KW - Micronutrient
UR - http://www.scopus.com/inward/record.url?scp=84938906963&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84938906963&partnerID=8YFLogxK
U2 - 10.3945/jn.115.212290
DO - 10.3945/jn.115.212290
M3 - Article
C2 - 26156797
AN - SCOPUS:84938906963
SN - 0022-3166
VL - 145
SP - 1950
EP - 1957
JO - Journal of Nutrition
JF - Journal of Nutrition
IS - 8
ER -