Serum vitamin a and perinatal transmission of hiv among a cohort of hiv-infected women in the United States

Objective To determine whether vitamin A deficiency is associated with perinatal transmission of KIV among a cohort of HIV-infected women in the United States. Methods: Women who delivered during 5/86-5/94 infants of known infection status were evaluated Third trimester serum vitamin A levels were measured using HPLC in 44 HIV-infected women who transmitted HIV to their inifants (transmitters,TR) and 89 who did not (nontraismitters, MTR). Results: 16% of theTR and 556 of the NTR had severe vitamin A deficiency (<0.70 umol/l): 23% of trsTR and 24% of the NTTR had marginal deficiency (0.70-I.CK umol/l). Perinatal transmission was associated with severe vitamin A deficiency (p=0.05), ruptured membrane of ≥4 hours (p=0.05) and gestatonal age <37 weeks (p=0.02) by umvariate analysis. CD4⁺ count (stratified at 200 and 500 cels/ul), type of delivery, age. body mass index and race were not associated with transmission. Two (5%) of theTR and six (796) of the NTR took zidovudJne some time during the pregnancy. In a multivariate logistic regression model severe vitemin A deficiency (OR_acj 3.69; 95% Ch 1.04-13.25) and gestational age <37 weeks (OR_adj 2.58:95% Cl:1.03-6.43) were independently associated with transmission after controlling for CD4⁺ count and duration of ruptured membrane. Conclusion: Increased risk of perinatal transmission was associated with severe vitamin A deficiency among this cohort consistent with results among African women. It is unknown whether maternal vitamin A deficiency plays a true rote in perinatal transmission or is a marker for increased risk of transmission. Clinical trials are in progress to determine whether antenatal vitamin A supplementation will reduce perinatal transmission.