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.
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 < or =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 x 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) positive [corrected] 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< or =.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.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. jhumphrey@zvitambo.co.zw
Jean H
JH
Humphrey
Peter J
PJ
Iliff
Edmore T
ET
Marinda
Kuda
K
Mutasa
Lawrence H
LH
Moulton
Henry
H
Chidawanyika
Brian J
BJ
Ward
Kusum J
KJ
Nathoo
Lucie C
LC
Malaba
Lynn S
LS
Zijenah
Partson
P
Zvandasara
Robert
R
Ntozini
Faith
F
Mzengeza
Agnes I
AI
Mahomva
Andrea J
AJ
Ruff
Michael T
MT
Mbizvo
Clare D
CD
Zunguza
D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D018023:HIV Seronegativity; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008895:Milk, Human / Q000737:chemistry; D049590:Postpartum Period; D011247:Pregnancy; D014801:Vitamin A / Q000008:administration & dosage* / Q000009:adverse effects; D014802:Vitamin A Deficiency / Q000401:mortality / Q000517:prevention & control*
D014801:Vitamin A