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Meta-Analysis
. 2017 Sep 7;9(9):CD003648.
doi: 10.1002/14651858.CD003648.pub4.

Vitamin A supplements for reducing mother-to-child HIV transmission

Charles S Wiysonge  1 , Valantine N Ndze, Eugene J Kongnyuy, Muki S Shey
Affiliations
Meta-Analysis

Vitamin A supplements for reducing mother-to-child HIV transmission

Charles S Wiysonge et al. Cochrane Database Syst Rev. .

Abstract

Background: Strategies to reduce the risk of mother-to-child transmission of the human immunodeficiency virus (HIV) include lifelong antiretroviral therapy (ART) for HIV-positive women, exclusive breastfeeding from birth for six weeks plus nevirapine or replacement feeding plus nevirapine from birth for four to six weeks, elective Caesarean section delivery, and avoiding giving children chewed food. In some settings, these interventions may not be practical, feasible, or affordable. Simple, inexpensive, and effective interventions (that could potentially be implemented even in the absence of prenatal HIV testing programmes) would be valuable. Vitamin A, which plays a role in immune function, is one low-cost intervention that has been suggested in such settings.

Objectives: To summarize the effects of giving vitamin A supplements to HIV-positive women during pregnancy and after delivery.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) up to 25 August 2017, and checked the reference lists of relevant articles for eligible studies.

Selection criteria: We included randomized controlled trials conducted in any setting that compared vitamin A supplements to placebo or no intervention among HIV-positive women during pregnancy or after delivery, or both.

Data collection and analysis: At least two review authors independently assessed study eligibility and extracted data. We expressed study results as risk ratios (RR) or mean differences (MD) as appropriate, with their 95% confidence intervals (CI), and conducted random-effects meta-analyses. This is an update of a review last published in 2011.

Main results: Five trials met the inclusion criteria. These were conducted in Malawi, South Africa, Tanzania, and Zimbabwe between 1995 and 2005 and none of the participants received ART. Women allocated to intervention arms received vitamin A supplements at a variety of doses (daily during pregnancy; a single dose immediately after delivery, or daily doses during pregnancy plus a single dose after delivery). Women allocated to comparison arms received identical placebo (6601 women, 4 trials) or no intervention (697 women, 1 trial). Four trials (with 6995 women) had low risk of bias and one trial (with 303 women) had high risk of attrition bias.The trials show that giving vitamin A supplements to HIV-positive women during pregnancy, the immediate postpartum period, or both, probably has little or no effect on mother-to-child transmission of HIV (RR 1.07, 95% CI 0.91 to 1.26; 4428 women, 5 trials, moderate certainty evidence) and may have little or no effect on child death by two years of age (RR 1.06, 95% CI 0.92 to 1.22; 3883 women, 3 trials, low certainty evidence). However, giving vitamin A supplements during pregnancy may increase the mean birthweight (MD 34.12 g, 95% CI -12.79 to 81.02; 2181 women, 3 trials, low certainty evidence) and probably reduces the incidence of low birthweight (RR 0.78, 95% CI 0.63 to 0.97; 1819 women, 3 trials, moderate certainty evidence); but we do not know whether vitamin A supplements affect the risk of preterm delivery (1577 women, 2 trials), stillbirth (2335 women, 3 trials), or maternal death (1267 women, 2 trials).

Authors' conclusions: Antepartum or postpartum vitamin A supplementation, or both, probably has little or no effect on mother-to-child transmission of HIV in women living with HIV infection and not on antiretroviral drugs. The intervention has largely been superseded by ART which is widely available and effective in preventing vertical transmission.

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Conflict of interest statement

Charles S Wiysonge has no known conflicts of interest. Valantine N Ndze has no known conflicts of interest. Eugene J Kongnyuy has no known conflicts of interest. Muki S Shey has no known conflicts of interest.

Figures

1
1
PRISMA flow diagram
2
2
ʽRisk of bias' graph: review authors' judgements about each ʽRisk of bias' item presented as percentages across all included trials
3
3
ʽRisk of bias' summary: review authors' judgements about each ʽRisk of bias' item for each included trial
1.1
1.1. Analysis
Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 1 HIV infection status of the child.
1.2
1.2. Analysis
Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 2 Mean birthweight.
1.3
1.3. Analysis
Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 3 Low birthweight.
1.4
1.4. Analysis
Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 4 Child death by two years of age.
1.5
1.5. Analysis
Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 5 Preterm delivery.
1.6
1.6. Analysis
Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 6 Stillbirth.
1.7
1.7. Analysis
Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 7 Maternal death.
1.8
1.8. Analysis
Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 8 Postpartum CD4 count.
See this image and copyright information in PMC

Update of

References

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Duggan 2012 {published data only}
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References to other published versions of this review

Kongnyuy 2009
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