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.
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. smehta@hsph.harvard.edu
S
S
Mehta
D
D
Spiegelman
S
S
Aboud
E L
EL
Giovannucci
G I
GI
Msamanga
E
E
Hertzmark
F M
FM
Mugusi
D J
DJ
Hunter
W W
WW
Fawzi
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