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

Citation

Widen, Elizabeth M.; Bentley, Margaret E.; Chasela, Charles S.; Kayira, Dumbani; Flax, Valerie L.; Kourtis, Athena P.; Ellington, Sascha R.; Kacheche, Zebrone; Tegha, Gerald; & Jamieson, Denise J., et al. (2015). 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. Journal of Acquired Immune Deficiency Syndromes, 69(3), 319-328. PMCID: PMC4506710

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 (via 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 2004-2010. HIV-infected mothers (CD4>200 cells/ul) 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 (RR): 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-values>0.1).
CONCLUSIONS: Maternal ARV treatment with protease inhibitors is associated with maternal tissue iron depletion; but LNS mitigates adverse effects. ARVs do not appear to influence infant iron status; however, extended use needs to be evaluated.

URL

http://dx.doi.org/10.1097/QAI.0000000000000588

Reference Type

Journal Article

Year Published

2015

Journal Title

Journal of Acquired Immune Deficiency Syndromes

Author(s)

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

PMCID

PMC4506710

ORCiD

Adair - 0000-0002-3670-8073
Bentley - 0000-0002-1220-0208
Flax - 0000-0003-0200-3355