Lipid-soluble vitamins A, D, and E in HIV-infected pregnant women in Tanzania.
OBJECTIVE
There is limited published research examining lipid-soluble vitamins in human immunodeficiency virus (HIV)-infected pregnant women, particularly in resource-limited settings.


METHODS
This is an observational analysis of 1078 HIV-infected pregnant women enrolled in a trial of vitamin supplementation in Tanzania. Baseline data on sociodemographic and anthropometric characteristics, clinical signs and symptoms, and laboratory parameters were used to identify correlates of low plasma vitamin A (<0.7 micromol/l), vitamin D (<80 nmol/l) and vitamin E (<9.7 micromol/l) status. Binomial regression was used to estimate risk ratios and 95% confidence intervals.


RESULTS
Approximately 35, 39 and 51% of the women had low levels of vitamins A, D and E, respectively. Severe anemia (hemoglobin <85 g/l; P<0.01), plasma vitamin E (P=0.02), selenium (P=0.01) and vitamin D (P=0.02) concentrations were significant correlates of low vitamin A status in multivariate models. Erythrocyte Sedimentation Rate (ESR) was independently related to low vitamin A status in a nonlinear manner (P=0.01). The correlates of low vitamin D status were CD8 cell count (P=0.01), high ESR (ESR >81 mm/h; P<0.01), gestational age at enrollment (nonlinear; P=0.03) and plasma vitamins A (P=0.02) and E (P=0.01). For low vitamin E status, the correlates were money spent on food per household per day (P<0.01), plasma vitamin A concentration (nonlinear; P<0.01) and a gestational age <16 weeks at enrollment (P<0.01).


CONCLUSIONS
Low concentrations of lipid-soluble vitamins are widely prevalent among HIV-infected women in Tanzania and are correlated with other nutritional insufficiencies. Identifying HIV-infected persons at greater risk of poor nutritional status and infections may help inform design and implementation of appropriate interventions.
Mehta
S
S
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. smehta@hsph.harvard.edu
Spiegelman
D
D
Aboud
S
S
Giovannucci
E L
EL
Msamanga
G I
GI
Hertzmark
E
E
Mugusi
F M
FM
Hunter
D J
DJ
Fawzi
W W
WW
D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology / Q000209:etiology; D001361:Avitaminosis / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D001799:Blood Sedimentation; D018414:CD8-Positive T-Lymphocytes / Q000378:metabolism; D002452:Cell Count; D004032:Diet / Q000191:economics; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000097:blood* / Q000150:complications; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D009752:Nutritional Status; D011247:Pregnancy; D015995:Prevalence; D012044:Regression Analysis; D012643:Selenium / Q000097:blood; D013636:Tanzania / Q000453:epidemiology; D014801:Vitamin A / Q000097:blood*; D014802:Vitamin A Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology; D014810:Vitamin E / Q000097:blood*; D014811:Vitamin E Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology; D055815:Young Adult
D006454:Hemoglobins; D014801:Vitamin A; D014807:Vitamin D; D014810:Vitamin E; D012643:Selenium