title: Antiretroviral therapy provided to HIV-infected Malawian women in a randomized trial diminishes the positive effects of lipid-based nutrient supplements on breast-milk B vitamins.
abstract: BACKGROUND
  Little information is available on B vitamin concentrations in human milk or on how they are affected by maternal B vitamin deficiencies, antiretroviral therapy, or maternal supplementation.
  
  
  OBJECTIVE
  The objective was to evaluate the effects of antiretroviral therapy and/or lipid-based nutrient supplements (LNSs) on B vitamin concentrations in breast milk from HIV-infected women in Malawi.
  
  
  METHODS
  Breast milk was collected from 537 women recruited within the Breastfeeding, Antiretrovirals, and Nutrition study at 2 or 6 wk and 24 wk postpartum. Women were assigned to receive antiretrovirals and LNSs, antiretrovirals only, LNSs only, or a control. Antiretrovirals and LNSs were given to the mothers from weeks 0 to 28. The antiretrovirals were zidovudine/lamivudine and nelfinavir or lopinavir/ritonavir. LNSs provided 93-118% of the Recommended Dietary Allowances of thiamin, riboflavin, niacin, pyridoxine, and vitamin B-12. Infants were exclusively breastfed.
  
  
  RESULTS
  LNSs increased milk concentrations of all vitamins except thiamin, whereas antiretrovirals lowered concentrations of nicotinamide, pyridoxal, and vitamin B-12. Although antiretrovirals alone had no significant effect on riboflavin concentrations, they negatively affected the LNS-induced increase in this vitamin. Thiamin was not influenced by the study interventions. Concentrations of all B vitamins were much lower than usually accepted values.
  
  
  CONCLUSIONS
  All B vitamins were low in milk, and all but thiamin were increased by maternal supplementation with LNSs. Antiretrovirals alone decreased concentrations of some B vitamins in milk. When LNS was given in addition to antiretrovirals, the negative effect of antiretrovirals offset the positive effect of LNSs for all vitamins except thiamin. This trial was registered at clinicaltrials.gov as NCT00164762.
authors.affiliation: USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA; Department of Nutrition, University of California, Davis, CA; lindsay.allen@ars.usda.gov.
authors.forename: Lindsay H
authors.initials: LH
authors.lastname: Allen
authors.affiliation: USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA; Department of Nutrition, University of California, Davis, CA;
authors.forename: Daniela
authors.identifier: http://orcid.org/0000-0003-0288-7680
authors.initials: D
authors.lastname: Hampel
authors.affiliation: USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA;
authors.forename: Setareh
authors.initials: S
authors.lastname: Shahab-Ferdows
authors.affiliation: USDA/Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA; Department of Nutrition, University of California, Davis, CA;
authors.forename: Emily R
authors.initials: ER
authors.lastname: York
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC;
authors.forename: Linda S
authors.initials: LS
authors.lastname: Adair
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC;
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Flax
authors.affiliation: the UNC Project, Lilongwe, Malawi; and.
authors.forename: Gerald
authors.initials: G
authors.lastname: Tegha
authors.affiliation: the UNC Project, Lilongwe, Malawi; and Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Chasela
authors.affiliation: the UNC Project, Lilongwe, Malawi; and.
authors.forename: Debbie
authors.initials: D
authors.lastname: Kamwendo
authors.affiliation: CDC, Atlanta, GA;
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC;
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Bentley
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004041:Dietary Fats / Q000008:administration & dosage; D019587:Dietary Supplements; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007774:Lactation / Q000187:drug effects*; D008295:Malawi; D039382:Maternal Nutritional Physiological Phenomena / Q000187:drug effects*; D008895:Milk, Human / Q000737:chemistry*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced / Q000517:prevention & control; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D014803:Vitamin B Complex / Q000032:analysis* / Q000037:antagonists & inhibitors / Q000378:metabolism / Q000627:therapeutic use; D014804:Vitamin B Deficiency / Q000139:chemically induced / Q000517:prevention & control; D014944:World Health Organization; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D004041:Dietary Fats; D014803:Vitamin B Complex
keywords: B vitamins; antiretrovirals; breast milk; human milk; ultraperformance liquid chromatography tandem mass spectrometry