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Randomized Controlled Trial
. 2015 Jul 1;69(3):319-28.
doi: 10.1097/QAI.0000000000000588.

Antiretroviral Treatment Is Associated With Iron Deficiency in HIV-Infected Malawian Women That Is Mitigated With Supplementation, but Is Not Associated With Infant Iron Deficiency During 24 Weeks of Exclusive Breastfeeding

Elizabeth M Widen  1 , Margaret E Bentley, Charles S Chasela, Dumbani Kayira, Valerie L Flax, Athena P Kourtis, Sascha R Ellington, Zebrone Kacheche, Gerald Tegha, Denise J Jamieson, Charles M van der Horst, Lindsay H Allen, Setareh Shahab-Ferdows, Linda S Adair; BAN Study Team
Collaborators, Affiliations
Randomized Controlled Trial

Antiretroviral Treatment Is Associated With Iron Deficiency in HIV-Infected Malawian Women That Is Mitigated With Supplementation, but Is Not Associated With Infant Iron Deficiency During 24 Weeks of Exclusive Breastfeeding

Elizabeth M Widen et al. J Acquir Immune Defic Syndr. .

Erratum in

  • J Acquir Immune Defic Syndr. 2015 Aug 15;69(5):e184

Abstract

Objective: In resource-limited settings without safe alternatives to breastfeeding, the WHO recommends exclusive breastfeeding and antiretroviral (ARV) prophylaxis. Given the high prevalence of anemia among HIV-infected women, mothers and their infants (through fetal iron accretion) may be at risk of iron deficiency. We assessed the effects of maternal micronutrient-fortified lipid-based nutrient supplements (LNS) and maternal ARV treatment or infant ARV prophylaxis on maternal and infant iron status during exclusive breastfeeding from birth to 24 weeks.

Methods: The Breastfeeding, Antiretrovirals, and Nutrition study was a randomized controlled trial conducted in Lilongwe, Malawi, from 2004 to 2010. HIV-infected mothers (CD4 >200 cells/μL) and their infants were randomly assigned to 28-week interventions: maternal LNS/maternal ARV (n = 424), maternal LNS/infant ARV (n = 426), maternal LNS (n = 334), maternal ARV (n = 425), infant ARV (n = 426), or control (n = 334). Longitudinal models tested intervention effects on hemoglobin (Hb). In a subsample (n = 537) with multiple iron indicators, intervention effects on Hb, transferrin receptors (TfR), and ferritin were tested with linear and Poisson regression.

Results: In longitudinal models, LNS effects on maternal and infant Hb were minimal. In subsample mothers, maternal ARVs were associated with tissue iron depletion (TfR >8.3 mg/L) (risk ratio: 3.1, P < 0.01), but not in ARV-treated mothers receiving LNS (P = 0.17). LNS without ARVs was not associated with iron deficiency or anemia (P > 0.1). In subsample infants, interventions were not associated with impaired iron status (all P > 0.1).

Conclusions: Maternal ARV treatment with protease inhibitors is associated with maternal tissue iron depletion; but LNS mitigates adverse effects. ARVs do not seem to influence infant iron status; however, extended use needs to be evaluated.

Trial registration: ClinicalTrials.gov NCT00164736.

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Conflict of interest statement

Author disclosure: C.M. van der Horst received grant support from Abbott Laboratories and GlaxoSmithKline. No other conflicts of interest were reported.

Conflicts of interest

The University of North Carolina received grant support from Abbott Laboratories and GlaxoSmithKline. All other authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
(A) Mean maternal hemoglobin (g/L) values according to BAN study arm from birth to 24 weeks among HIV-infected Malawian mothers in the longitudinal sample (n=569 in the control arm; n=315 in the mARV arm; n=573 in the mLNS arm; n=308 in the maternal ARV-LNS arm). (B) Mean infant hemoglobin (g/L) values according to BAN study arm from birth to 24 weeks among HIV-exposed Malawian infants in the longitudinal sample. BAN Study, Malawi, 2004-2010. (n=341 in the mLNS-mARV arm; n=339 in the mARV arm; n=369 in the mLNS-iARV arm; n=356 in the iARV arm; n=255 in the mLNS arm; n=267 in the control arm). mLNS-mARV, maternal LNS/maternal ARV; mARV, maternal ARV; mLNS-iARV, maternal LNS/infant ARV; iARV, infant ARV; mLNS, maternal LNS; C, control. BAN, Breastfeeding, Antiretroviral and Nutrition; LNS, lipid-based nutrient supplement; ARV, antiretroviral drug.
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References

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