title: A lipid-based nutrient supplement mitigates weight loss among HIV-infected women in a factorial randomized trial to prevent mother-to-child transmission during exclusive breastfeeding.
abstract: BACKGROUND
  Breastfeeding increases metabolic demands on the mother, and excessive postnatal weight loss increases maternal mortality.
  
  
  OBJECTIVE
  We evaluated the efficacy of a lipid-based nutrient supplement (LNS) for prevention of excess weight loss in breastfeeding, HIV-infected women.
  
  
  METHODS
  The BAN (Breastfeeding, Antiretrovirals, and Nutrition) Study was a randomized controlled trial in Lilongwe, Malawi. At delivery, HIV-infected mothers and their infants were randomly assigned according to a 2-arm (with and without LNS) by 3-arm (maternal triple-antiretroviral prophylaxis, infant-nevirapine prophylaxis, or neither) factorial design. The 28-wk LNS intervention provided daily energy (700 kcal), protein (20 g), and micronutrients (except for vitamin A) to meet lactation needs. Women were counseled to breastfeed exclusively for 24 wk and to wean by 28 wk. Weight change (0-28 wk) was tested in an intent-to-treat analysis by using 2-factor ANOVA and with longitudinal mixed-effects models.
  
  
  RESULTS
  At delivery, the LNS (n = 1184) and control (n = 1185) groups had similar mean weights and BMIs. Women receiving the LNS had less 0-28-wk weight loss (-1.97 compared with -2.56 kg, P = 0.003). This difference remained significant after adjustment for maternal antiretroviral drug therapy and baseline BMI. Women receiving antiretroviral drugs had more weight loss than did those not receiving antiretroviral drugs (-2.93 compared with -1.90 kg, P < 0.001). The benefit of the LNS for reducing weight loss was observed both in those receiving antiretroviral drugs (-2.56 compared with -3.32 kg, P = 0.019) and in those not receiving antiretroviral drugs (-1.63 compared with -2.16 kg, P = 0.034).
  
  
  CONCLUSIONS
  The LNS reduced weight loss among HIV-infected, breastfeeding women, both in those taking maternal antiretroviral prophylaxis to prevent postnatal HIV transmission and in those not receiving antiretroviral prophylaxis. Provision of an LNS may benefit HIV-infected, breastfeeding women in resource-limited settings. This trial was registered at clinicaltrials.gov as NCT00164762.
authors.affiliation: UNC Project, Lilongwe, Malawi.
authors.forename: Dumbani
authors.initials: D
authors.lastname: Kayira
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Bentley
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wiener
authors.forename: Chimwemwe
authors.initials: C
authors.lastname: Mkhomawanthu
authors.forename: Caroline C
authors.initials: CC
authors.lastname: King
authors.forename: Phindile
authors.initials: P
authors.lastname: Chitsulo
authors.forename: Maggie
authors.initials: M
authors.lastname: Chigwenembe
authors.forename: Sascha
authors.initials: S
authors.lastname: Ellington
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.forename: Athena P
authors.initials: AP
authors.lastname: Kourtis
authors.forename: Charles
authors.initials: C
authors.lastname: Chasela
authors.forename: Martin
authors.initials: M
authors.lastname: Tembo
authors.forename: Beth
authors.initials: B
authors.lastname: Tohill
authors.forename: Ellen G
authors.initials: EG
authors.lastname: Piwoz
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: Charles
authors.initials: C
authors.lastname: van der Horst
authors.forename: Linda
authors.initials: L
authors.lastname: Adair
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D001942:Breast Feeding; D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D015497:HIV-1 / Q000472:pathogenicity; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008055:Lipids / Q000008:administration & dosage; D008137:Longitudinal Studies; D008295:Malawi / Q000453:epidemiology; D019829:Nevirapine / Q000008:administration & dosage; D011247:Pregnancy; D015431:Weight Loss; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D008055:Lipids; D019829:Nevirapine