Antiretroviral Treatment Is Associated With Iron Deficiency in HIV-Infected Malawian Women That Is Mitigated With Supplementation, but Is Not Associated With Infant Iron Deficiency During 24 Weeks of Exclusive Breastfeeding

Abstract

Objective In resource-limited settings without safe alternatives to breastfeeding, the WHO recommends exclusive breastfeeding and antiretroviral (ARV) prophylaxis. Given the high prevalence of anemia among HIV-infected women, mothers and their infants (via fetal iron accretion) may be at risk of iron deficiency. We assessed the effects of maternal micronutrient-fortified lipid-based nutrient supplements (LNS) and maternal ARV treatment or infant ARV prophylaxis on maternal and infant iron status during exclusive breastfeeding from birth to 24 weeks. Methods The Breastfeeding, Antiretrovirals, and Nutrition Study was a randomized controlled trial conducted in Lilongwe, Malawi from 2004-2010. HIV-infected mothers (CD4>200 cells/ul) and their infants were randomly assigned to 28-week interventions: maternal-LNS/maternal-ARV (n=424), maternal-LNS/infant-ARV (n=426), maternal-LNS (n=334), maternal-ARV (n=425), infant-ARV (n=426), or control (n=334). Longitudinal models tested intervention effects on hemoglobin (Hb). In a subsample (n=537) with multiple iron indicators, intervention effects on Hb, transferrin receptors (TfR) and ferritin were tested with linear and Poisson regression. Results In longitudinal models, LNS effects on maternal and infant Hb were minimal. In subsample mothers, maternal ARVs were associated with tissue iron depletion (TfR>8.3 mg/L) (Risk ratio (RR): 3.1, p<0.01), but not in ARV-treated mothers receiving LNS (p=0.17). LNS without ARVs, was not associated with iron deficiency or anemia (p>0.1). In subsample infants, interventions were not associated with impaired iron status (all p-values>0.1). Conclusions Maternal ARV treatment with protease inhibitors is associated with maternal tissue iron depletion; but LNS mitigates adverse effects. ARVs do not appear to influence infant iron status; however, extended use needs to be evaluated.

Plasma Micronutrient Concentrations Are Altered by Antiretroviral Therapy and Lipid-Based Nutrient Supplements in Lactating HIV-Infected Malawian Women

“…TfR can be elevated when there is iron-deficient erythropoiesis or tissue iron deficiency without anemia (53), which may be more common in people with chronic diseases and inflammation (54). The results on ferritin, TfR, and hemoglobin reported here confirm our earlier findings from a smaller, matched mother-infant subsample of BAN study participants (55).…”

Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

“…6 Values across all prenatal visits. 7 Participants reported previous displacement during the conflict in Northern Uganda area that ended in 2006 (participant enrollment started in October 2012). 8 Data were available for 241 women.…”

“…It is also recommended that antiretroviral therapy (ART) 11 should be initiated for anyone who is living with HIV and should be continued for life (3). However, some ART regimens may propagate weight loss and concomitant shifts in body composition (4,5) and adversely affect micronutrient status (6)(7)(8). These deficits can be exacerbated during periods of higher nutritional needs such as lactation.…”

A life history approach to prenatal supplementation: Building a bridge from biological anthropology to public health and nutrition

“…The same supplement slowed postpartum weight loss among HIV positive women (Kayira et al, ). The Breastfeeding, Antiretrovirals, and Nutrition Study in Malawi likewise found that postnatal lipid‐nutrient supplement prevented iron depletion in women using antiretrovirals (Widen et al, ). In the iLiNS‐DYAD study in Ghana, low‐calorie lipid‐nutrient supplements reduced maternal anemia, increased hemoglobin, and decreased iron deficiency (Adu‐Afarwuah et al, ), and younger women finished pregnancy with lower cortisol levels if they consumed lipid‐nutrient supplements relative to multiple micronutrients (Oaks et al, ).…”