Multivitamins limit HIV transmission through breastfeeding for some women

Among women who are immunologically or nutritionally compromised, multivitamin supplementation – excluding vitamin A – reduces the risk of HIV transmission through breastfeeding, according to a report in the 27 September issue of AIDS.

HIV-1 transmission through breastfeeding has been associated with poor maternal micronutrient status, the authors explain, but an earlier study showed that multivitamin supplementation had no statistically significant effect on HIV transmission through the intrauterine or intrapartum routes or through breastfeeding up to six weeks postpartum.

Dr. Wafaie Fawzi from Harvard School of Public Health in Boston, Massachusetts and colleagues examined the effects of maternal supplementation with vitamin A or multivitamins excluding A in approximately 1000 HIV-infected pregnant women in Tanzania. Outcomes were transmission through breastfeeding after six weeks of age and child mortality in the first two years of life.

“To our knowledge,” the investigators write, “this is the first randomized study to examine the effect of maternal multi-micronutrient supplements on infant health [in the setting of HIV infection].”

Multivitamin use had no effect on the overall HIV-1 transmission rate, the authors report, but total child mortality was lower among the multivitamin group than among those who did not receive multivitamins.

Vitamin A supplementation was associated with a 33% higher risk of HIV-1 transmission through breastfeeding compared with the no-vitamin-A arm, the report indicates, though vitamin A use had no effect on infant mortality by 24 months.

In women with low total lymphocyte counts, the researchers note, multivitamin use was associated with a 63% lower HIV transmission rate and with a 70% better chance of infant survival to 24 months.

Moreover, multivitamin use was associated with a reduction in mortality among children who were HIV-negative at birth, the results indicate, but not among those who were HIV-positive at birth.

“Vitamins B, C and E provided to HIV-positive women during pregnancy and lactation are likely to reduce the risks of mortality and other adverse effects among children born to these women,” Dr. Fawzi told Reuters Health.

“There are efforts in many developing countries to encourage early weaning by HIV-positive women—at about six months,” Dr. Fawzi explained. “By this age, the benefits of breastfeeding are thought likely to be outweighed by the risks of transmission. So the approach would be to provide multivitamins for the duration of breastfeeding as well as during pregnancy.”

Dr. Fawzi stressed the need to maintain efforts to get antiretroviral therapy to women in developing countries. “Meanwhile, low-cost interventions, such as micronutrients, could be beneficial in alleviating some of the adverse effects of HIV-infection.”