Plasma and breast-milk selenium in HIV-infected Malawian mothers are positively associated with infant selenium status but are not associated with maternal supplementation: results of the Breastfeeding, Antiretrovirals, and Nutrition study.
BACKGROUND
Selenium is found in soils and is essential for human antioxidant defense and immune function. In Malawi, low soil selenium and dietary intakes coupled with low plasma selenium concentrations in HIV infection could have negative consequences for the health of HIV-infected mothers and their exclusively breastfed infants.


OBJECTIVE
We tested the effects of lipid-based nutrient supplements (LNS) that contained 1.3 times the Recommended Dietary Allowance of sodium selenite and antiretroviral drugs (ARV) on maternal plasma and breast-milk selenium concentrations.


METHODS
HIV-infected Malawian mothers in the Breastfeeding, Antiretrovirals, and Nutrition study were randomly assigned at delivery to receive: LNS, ARV, LNS and ARV, or a control. In a subsample of 526 mothers and their uninfected infants, we measured plasma and breast-milk selenium concentrations at 2 or 6 (depending on the availability of infant samples) and 24 wk postpartum.


RESULTS
Overall, mean (± SD) maternal (range: 81.2 ± 20.4 to 86.2 ± 19.9 μg/L) and infant (55.6 ± 16.3 to 61.0 ± 15.4 μg/L) plasma selenium concentrations increased, whereas breast-milk selenium concentrations declined (14.3 ± 11.5 to 9.8 ± 7.3 μg/L) from 2 or 6 to 24 wk postpartum (all P < 0.001). Compared with the highest baseline selenium tertile, low and middle tertiles were positively associated with a change in maternal plasma or breast-milk selenium from 2 or 6 to 24 wk postpartum (both P < 0.001). With the use of linear regression, we showed that LNS that contained selenium and ARV were not associated with changes in maternal plasma and breast-milk selenium, but maternal selenium concentrations were positively associated with infant plasma selenium at 2 or 6 and 24 wk postpartum (P < 0.001) regardless of the study arm.


CONCLUSIONS
Selenite supplementation of HIV-infected Malawian women was not associated with a change in their plasma or breast-milk selenium concentrations. Future research should examine effects of more readily incorporated forms of selenium (ie, selenomethionine) in HIV-infected breastfeeding women.
Carolina Population Center (VLF, MEB, EJD, and LSA), Departments of Nutrition (VLF, MEB, and LSA) and Biostatistics (EJD), and Division of Infectious Diseases, School of Medicine (AF and CMvdH), University of North Carolina, Chapel Hill, NC; the USDA-Agriculture Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, ND (GFC); the University of North Carolina Project, Lilongwe, Malawi (CSC, D Kayira, GT, and D Kamwendo); the Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Parktown, South Africa (CSC); and the US CDC, Atlanta, GA (APK and DJJ).
Valerie L
VL
Flax
Margaret E
ME
Bentley
Gerald F
GF
Combs
Charles S
CS
Chasela
Dumbani
D
Kayira
Gerald
G
Tegha
Debbie
D
Kamwendo
Eric J
EJ
Daza
Ali
A
Fokar
Athena P
AP
Kourtis
Denise J
DJ
Jamieson
Charles M
CM
van der Horst
Linda S
LS
Adair
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002657:Child Development; D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007774:Lactation / Q000097:blood / Q000378:metabolism*; D008295:Malawi; D039382:Maternal Nutritional Physiological Phenomena; D008895:Milk, Human / Q000737:chemistry*; D009752:Nutritional Status; D012643:Selenium / Q000097:blood / Q000172:deficiency / Q000378:metabolism* / Q000627:therapeutic use; D018038:Sodium Selenite / Q000008:administration & dosage; D055815:Young Adult
D044966:Anti-Retroviral Agents; D012643:Selenium; D018038:Sodium Selenite