title: Effect of selenium supplementation on HIV-1 RNA detection in breast milk of Tanzanian women.
abstract: OBJECTIVE
  Selenium supplementation for women infected with HIV may increase genital shedding of HIV-1, however, to our knowledge, no studies have examined the effect on viral shedding in breast milk. The aim of this study was to determine the effect of selenium supplementation on HIV-1 RNA detection in breast milk of HIV-infected women.
  
  
  METHODS
  HIV-infected pregnant women enrolled at 12 to 27 wk gestation in a randomized, double-blind, placebo-controlled trial of daily selenium (200 μg as selenomethionine) had cell-free HIV-1 RNA quantified in breast milk at 4 to 9 wk postpartum. All participants received high-dose multivitamins containing vitamin B complex, C, and E as standard of care.
  
  
  RESULTS
  The proportion of women with detectable (>50 copies/mL) HIV-1 RNA in breast milk appeared to be increased in the selenium group (36.4%) compared with those in the placebo group (27.5%) among the total cohort (N = 420), but results were borderline statistically significant (relative risk [RR], 1.32; 95% confidence interval [CI], 1.00-1.76; P = 0.05). In secondary analyses, the proportion of women with detectable HIV-1 RNA in breast milk was significantly greater in the selenium group (37.8%) compared with placebo group (27.5%) among women who did not receive highly active antiretroviral therapy (HAART; RR, 1.37; 95% CI, 1.03-1.82; P = 0.03). This relationship was primarily due to a significant effect of selenium among primiparous women (RR, 2.24; 95% CI, 1.30-3.86; P < 0.01), but not multiparous women (RR, 1.14; 95% CI, 0.81-1.59; P = 0.54) (P-value for interaction = 0.02). Too few women received HAART in this study (n = 12) to establish the effect of selenium supplementation.
  
  
  CONCLUSIONS
  Selenium supplementation appears to increase HIV-1 RNA detection in breast milk among primiparous women not receiving HAART. Safety studies among pregnant women on HAART need to be conducted before administering selenium-containing supplements.
authors: Department of Global Health, Harvard School of Public Health, Boston, MA, USA. Electronic address: Csudfeld@mail.harvard.edu.
authors: Christopher R
authors: CR
authors: Sudfeld
authors: Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors: Said
authors: S
authors: Aboud
authors: Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; UNICEF West and Central Africa Regional Office, Dakar, Senegal.
authors: Roland
authors: R
authors: Kupka
authors: Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors: Ferdinand M
authors: FM
authors: Mugusi
authors: Department of Global Health, Harvard School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors: Wafaie W
authors: WW
authors: Fawzi
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D001942:Breast Feeding; D019587:Dietary Supplements / Q000009:adverse effects*; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D008895:Milk, Human / Q000821:virology*; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology; D012367:RNA, Viral / Q000032:analysis*; D012643:Selenium / Q000008:administration & dosage / Q000009:adverse effects*; D013636:Tanzania; D019562:Viral Load; D055815:Young Adult
chemical_list: D012367:RNA, Viral; D012643:Selenium
keywords: HIV; Micronutrients; Milk; Randomized controlled trial; Selenium