"Maternal Vitamin A Deficiency and Mother-to-Child Transmission of HIV-1."

Semba, Richard D.; Miotti, Paolo; Chiphangwi, John D.; Saah, Alfred J.; Canner, Joseph K.; Dallabetta, Gina; Hoover, Donald R.

doi:10.2307/2138065

Cited by 61 publications

(85 citation statements)

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“…In sub-Saharan Africa, the prevalence of maternal anaemia is higher than in developed countries [31] and is commonly caused by micronutrient deficiencies, sickle-cell disease, malaria, hookworm and other infections including HIV [32,33]. Mechanisms by which anaemia may increase MTCT could include non-specific immune deficiency associated with iron deficiency [34,35], and higher shedding of HIV in blood, breast milk or lower genital tract secretions, as has been described for low serum retinol [9,10,36] and selenium levels [37]. Anaemia may be, but is not always, associated with malnutrition and immune deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Maternal RNA viral load [2,6,7], low CD4 cell count [7,8], malnutrition [9,10] and low birth weight [7,8,11] have been reported as independent risk factors for mother-tochild transmission (MTCT). In addition to these risk factors, common infections in sub-Saharan Africa such as syphilis [8] and helminth infections [12] have also been suggested to impact MTCT.…”

Section: Introductionmentioning

confidence: 99%

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Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

et al. 2008

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Malaria infection may impact on mother-to-child transmission (MTCT) of HIV-1. Prevention of malaria in pregnancy could thus potentially affect MTCT of HIV. We studied the impact of intermittent preventive treatment during pregnancy (IPTp) on HIV-1 MTCT in southern Mozambique. MethodsA total of 207 HIV-positive Mozambican pregnant women were enrolled in the study as part of a randomized placebo-controlled trial of two-dose sulfadoxine-pyrimethamine (SP) IPTp in women receiving single-dose nevirapine to prevent MTCT of HIV. HIV RNA viral load, maternal anaemia and peripheral and placental malaria were assessed at delivery. Infant HIV status was determined by DNA polymerase chain reaction (PCR) at 1 month of age. ResultsThere were 19 transmissions of HIV in 153 mother-infant pairs. IPTp with SP did not have a significant impact on MTCT (11.8% in the SP group vs. 13.2% in the placebo group; P 5 0.784) or on maternal HIV RNA viral load [16 312 (interquartile range {IQR} 4076-69 296) HIV-1 RNA copies/mL in the SP group vs. 18 274 (IQR 5471-74 104) copies/mL in the placebo group; P 5 0.715]. In multivariate analysis, maternal HIV RNA viral load [adjusted odds ratio (AOR) 19.9; 95% confidence interval (CI) 2.3-172; P 5 0.006] and anaemia (haematocrit o33%; AOR 7.5; 95% CI 1.7-32.4; P 5 0.007) were independent risk factors for MTCT. Placental malaria was associated with a decrease in MTCT (AOR 0.23; 95% CI 0.06-0.89; P 5 0.034). ConclusionsIPTp with SP was not associated with a significant impact on MTCT of HIV. Maternal anaemia was an independent risk factor for MTCT.Keywords: anaemia, intermittent preventive treatment, mother-to-child transmission, placental malaria, pregnancy Received: 18 February 2008, accepted 15 May 2008 Introduction HIV/AIDS and malaria infections are two of the most important global health problems of our time, and strongly overlap in sub-Saharan Africa [1]. The detrimental effects of this interaction may be especially relevant during pregnancy, with adverse outcomes for both the mother and the infant [2,3].Vertical transmission of HIV occurs at an approximate rate of 25-40% in untreated breast feeding populations [4,5]. Maternal RNA viral load [2,6,7] [6,7,11], it has been suggested that malaria, by increasing the replication of HIV, may increase the risk of MTCT [2,6]. However, studies assessing the impact of placental malaria (PM) on MTCT have produced conflicting results, suggesting either that PM could increase MTCT or that low-density PM parasitaemia could decrease MTCT [6,7,17,18]. Pregnant women are especially susceptible to malaria infection, which is associated with considerable maternal and infant morbidity and mortality. The World Health Organization recommends that pregnant women in stable transmission areas receive intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) and sleep under insecticide-treated nets (ITNs). However, the efficacy of the concomitant use of these two interventions has not been evaluated. IPTp consists of the provision of two doses, at le...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

et al. 2008

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“…Vitamin A de®ciency is common in Malawi Chirambo et al, 1986;Semba et al, 1994) where studies have been conducted in children and adults but not in adolescents. Vitamin A supplementation for children and for women following delivery became government policy in Malawi in 1992Malawi in (M'manga, 1994.…”

Section: Introductionmentioning

confidence: 99%

A community based study of vitamin A and vitamin E status of adolescent girls living in the Shire valley, Southern Malawi

Fazio-Tirrozzo

Brabin

et al. 1998

Eur J Clin Nutr

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Objective: To assess vitamin A and E status and anaemia in non-pregnant Malawian adolescent girls. Design: A cross-sectional study in rural village communities in the Shire Valley, Southern Malawi. Subjects: Adolescent girls, n 118, aged between 10 and 19 y, 112 of whom were unmarried. Methods: Socio-demographic information was collected by questionnaire, heights and weights were measured. Vitamin A was assessed by the Modi®ed Relative Dose Response (MRDR) test, in addition to serum retinol values. Blood samples were collected 4±5 h after administration of 3,4-didehydroretinyl acetate. Retinol and atocopherol levels were measured by HPLC. Serum retinol results for non-pregnant girls were compared with values for 43 adolescent pregnant girls which were available from a previous study. Results: 26.6% of non-pregnant girls had serum retinol values`0.70 mmol/L; 40.2% had an MRDR ratio b 0.060. In 59.3%, serum tocopherol levels were`11.5 mmol/L and the tocopherol/cholesterol ratio was`2.2 in 23.9%. 11.3% had a haemoglobin ! 12 g/dl. Vitamin A levels were signi®cantly related to age, and younger girls were more likely to be de®cient. Signi®cant correlations were found between serum retinol, MRDR values and serum tocopherol. Girls with a low body mass index for age had tocopherol cholesterol ratios`2.2. Low serum retinol values occurred signi®cantly more often in stunted girls (P 0.01). Serum retinol values of adolescent pregnant girls were signi®cantly lower than those of non-pregnant adolescents (P 0.002). Conclusions: Vitamin A and E de®ciency and anaemia were common in adolescent non-pregnant girls, and thought to partly result from increased growth requirements. Girls who become pregnant at an early age are at risk of depletion of their nutritional reserves. Measures to reduce nutritional de®ciencies before the ®rst pregnancy are needed.

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“…54,55 Some have reported that micronutrient deficiencies were common even among HIV-infected subjects on anti-retroviral drugs. 56,57 Low serum micronutrient levels, consistent with deficiency have been reported among HIV-infected subjects in Ethiopia 57 pregnant women in Malawi, 57,58 and in children in Uganda. 59 Low serum zinc levels were reported by several authors in HIV infected adults.…”

Section: Impact Of Trace Elements Deficiencies In Hiv Infectionmentioning

confidence: 67%

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"Maternal Vitamin A Deficiency and Mother-to-Child Transmission of HIV-1."

Cited by 61 publications

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Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

A community based study of vitamin A and vitamin E status of adolescent girls living in the Shire valley, Southern Malawi

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"Maternal Vitamin A Deficiency and Mother-to-Child Transmission of HIV-1."

Cited by 61 publications

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Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria*

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria*

A community based study of vitamin A and vitamin E status of adolescent girls living in the Shire valley, Southern Malawi

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Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria^*