title: Effect of vitamin supplements on HIV shedding in breast milk.
abstract: BACKGROUND
  Supplementation in lactating HIV-1-infected women with preformed vitamin A and β-carotene (VA/BC) increases the risk of mother-to-child transmission of HIV through breastfeeding. Identifying a biological mechanism to explain this unexpected finding would lend support to a causal effect.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the effect of VA/BC or multivitamin (B complex, vitamin C, and vitamin E) supplementation of HIV-infected women on HIV shedding in breast milk during the first 2 y postpartum.
  
  
  METHODS
  We quantified viral (cell-free) and proviral (cell-associated) HIV loads in breast-milk samples collected ≤15 d after delivery and every 3 mo thereafter from 594 Tanzanian HIV-1-infected women who participated in a randomized trial. Women received 1 of the following 4 daily oral regimens in a 2 × 2 factorial fashion during pregnancy and throughout the first 2 y postpartum: multivitamin, VA/BC, multivitamin including VA/BC, or placebo.
  
  
  RESULTS
  The proportion of breast-milk samples with detectable viral load was significantly higher in women who received VA/BC (51.3%) than in women who were not assigned to VA/BC (44.8%; P = 0.02). The effect was apparent ≥6 mo postpartum (relative risk: 1.34; 95% CI: 1.04, 1.73). No associations with proviral load were observed. The multivitamin had no effects. In observational analyses, β-carotene but not retinol breast-milk concentrations were significantly associated with an increased viral load in milk.
  
  
  CONCLUSIONS
  VA/BC supplementation in lactating women increases the HIV load in breast milk. This finding contributes to explaining the adverse effect of VA/BC on mother-to-child transmission. β-Carotene appears to have an effect on breast-milk viral load, independent of preformed vitamin A. This trial was registered at clinicaltrials.gov as NCT00197756.
authors.affiliation: Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA. villamor@umich.edu
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villamor
authors.forename: Irene N
authors.initials: IN
authors.lastname: Koulinska
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
authors.forename: Clare
authors.initials: C
authors.lastname: Murrin
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Bosch
authors.forename: Karim P
authors.initials: KP
authors.lastname: Manji
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D001942:Breast Feeding / Q000009:adverse effects; D019587:Dietary Supplements; D005260:Female; D006678:HIV / Q000187:drug effects / Q000302:isolation & purification*; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D008895:Milk, Human / Q000821:virology*; D011247:Pregnancy; D012307:Risk Factors; D013636:Tanzania; D019562:Viral Load; D017201:Virus Shedding / Q000187:drug effects*; D014801:Vitamin A / Q000009:adverse effects / Q000494:pharmacology*; D014815:Vitamins / Q000494:pharmacology*; D019207:beta Carotene / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D014815:Vitamins; D019207:beta Carotene; D014801:Vitamin A