Multivitamin supplementation improves haematologic status in children born to HIV-positive women in Tanzania.
BACKGROUND
Anaemia is prevalent among children born to HIV-positive women, and it is associated with adverse effects on cognitive and motor development, growth, and increased risks of morbidity and mortality.


OBJECTIVE
To examine the effect of daily multivitamin supplementation on haematologic status and mother-to-child transmission (MTCT) of HIV through breastfeeding.


METHODS
A total of 2387 infants born to HIV-positive women from Dar es Salaam, Tanzania were enrolled in a randomized, double-blind, placebo-controlled trial, and provided a daily oral supplement of multivitamins (vitamin B complex, C and E) or placebo at age 6 weeks for 24 months. Among them, 2008 infants provided blood samples and had haemoglobin concentrations measured at baseline and during a follow-up period. Anaemia was defined as haemoglobin concentrations <11 g/dL and severe anaemia <8.5 g/dL.


RESULTS
Haemoglobin concentrations among children in the treatment group were significantly higher than those in the placebo group at 12 (9.77 vs. 9.64 g/dL, p=0.03), 18 (9.76 vs. 9.57 g/dL, p=0.004), and 24 months (9.93 vs. 9.75 g/dL, p=0.02) of follow-up. Compared to those in the placebo group, children in the treatment group had a 12% lower risk of anaemia (hazard ratio (HR): 0.88; 95% CI: 0.79-0.99; p=0.03). The treatment was associated with a 28% reduced risk of severe anaemia among children born to women without anaemia (HR: 0.72; 95% CI: 0.56-0.92; p=0.008), but not among those born to women with anaemia (HR: 1.10; 95% CI: 0.79-1.54; p=0.57; p for interaction=0.007). One thousand seven hundred fifty three infants who tested HIV-negative at baseline and had HIV testing during follow-up were included in the analysis for MTCT of HIV. No association was found between multivitamin supplements and MTCT of HIV.


CONCLUSIONS
Multivitamin supplements improve haematologic status among children born to HIV-positive women. Further trials focusing on anaemia among HIV-exposed children are warranted in the context of antiretroviral therapy.
Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02120, USA. eliu@hsph.harvard.edu
Enju
E
Liu
Christopher
C
Duggan
Karim P
KP
Manji
Roland
R
Kupka
Said
S
Aboud
Ronald J
RJ
Bosch
Rodrick R
RR
Kisenge
James
J
Okuma
Wafaie W
WW
Fawzi
D000328:Adult; D000740:Anemia / Q000188:drug therapy*; D002675:Child, Preschool; D004032:Diet / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D010919:Placebos / Q000008:administration & dosage; D011247:Pregnancy; D013636:Tanzania; D016896:Treatment Outcome; D014815:Vitamins / Q000627:therapeutic use*
D006454:Hemoglobins; D010919:Placebos; D014815:Vitamins
Tanzania; anaemia; haemoglobin; mother-to-child transmission; multivitamins; randomized controlled trial