Effects of a single large dose of vitamin A, given during the postpartum period to HIV-positive women and their infants, on child HIV infection, HIV-free survival, and mortality

Jean H. Humphrey, Peter J. Iliff, Edmore T. Marinda, Kuda Mutasa, Lawrence H. Moulton, Henry Chidawanyika, Brian J. Ward, Kusum J. Nathoo, Lucie C. Malaba, Lynn S. Zijenah, Partson Zvandasara, Robert Ntozini, Faith Mzengeza, Agnes I. Mahomva, Andrea J. Ruff, Michael T. Mbizvo, Clare O. Zunguza

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Low maternal serum retinol level is a risk factor for mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). Multiple-large-dose vitamin A supplementation of HIV-positive children reduces mortality. The World Health Organization recommends single-large-dose vitamin A supplementation for postpartum women in areas of prevalent vitamin A deficiency; neonatal dosing is under consideration. We investigated the effect that single-large-dose maternal/neonatal vitamin A supplementation has on MTCT, HIV-free survival, and mortality in HIV-exposed infants. Methods. A total of 14,110 mother-infant pairs were enrolled ≤96 h after delivery, and both mother and infant, mother only, infant only, or neither received vitamin A supplementation in a randomized, placebo-controlled trial with a 2 × 2 factorial design. All but 4 mothers initiated breast-feeding. A total of 4495 infants born to HIV-positive women were included in the present analysis. Results. Neither maternal nor neonatal vitamin A supplementation significantly affected postnatal MTCT or overall mortality between baseline and 24 months. However, the timing of infant HIV infection modified the effect that supplementation had on mortality. Vitamin A supplementation had no effect in infants who were polymerase chain reaction (PCR) negative for HIV at baseline. In infants who were PCR negative at baseline and PCR positive at 6 weeks, neonatal supplementation reduced mortality by 28% (P = .01), but maternal supplementation had no effect. In infants who were PCR negative at 6 weeks, all 3 vitamin A regimens were associated with ∼2-fold higher mortality (P ≤ .05). Conclusions. Targeted vitamin A supplementation of HIV-positive children prolongs their survival. However, postpartum maternal and neonatal vitamin A supplementation may hasten progression to death in breast-fed children who are PCR negative at 6 weeks. These findings raise concern about universal maternal or neonatal vitamin A supplementation in HIV-endemic areas.

Original languageEnglish (US)
Pages (from-to)860-871
Number of pages12
JournalJournal of Infectious Diseases
Volume193
Issue number6
DOIs
StatePublished - Mar 15 2006
Externally publishedYes

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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