A new study led by researchers at the UNC Gillings School of Global Public Health highlights the nutritional impacts of antiretroviral therapy on HIV-infected breastfeeding women. The World Health Organization currently recommends that pregnant and breastfeeding HIV-infected women initiate lifelong therapy for the prevention of mother-to-child transmission, but little is known about how the drugs affect the women’s nutritional status.
Dr. Valerie L. Flax, research assistant professor of nutrition at the UNC and fellow at UNC’s Carolina Population Center, is lead author of the study, published online July 8 in the Journal of Nutrition.
The paper presents data for about 700 women, a subset of the Breastfeeding, Antiretrovirals and Nutrition Study (BAN), a large randomized controlled trial conducted in Lilongwe, Malawi. Although previous studies had shown that supplemental nutrients had improved the hematologic status of people living with HIV, it was not known whether such supplementation would benefit lactating women who were taking antiretrovirals.
The authors examined the association of a peanut-based, micronutrient-fortified supplement and a protease inhibitor-based antiretroviral regimen on the mothers’ blood concentrations of micronutrients. Use of the antiretrovirals was associated with lower folate levels and higher levels of iron deficiency and retinol-binding protein, a substance that indicates vitamin A levels, which are necessary for normal immune function and vision.
Supplementation increased concentrations of folate and vitamin B12, while antiretroviral therapy diminished the benefits of supplementation on these micronutrients. The biological mechanisms by which antiretrovirals reduce micronutrient concentrations or diminish the effects of supplementation are unknown, but could be related to poor absorption – due to drug-related changes in the intestines. The influence of antiretrovirals on folate and iron status in pregnant and breastfeeding HIV-infected women on lifelong therapy warrants further research, since these nutrients are essential for normal fetal and infant growth and development.
“Our findings have implications for about 1 million women around the world who participate in programs to prevent mother-to-child HIV transmission,” Dr. Flax said. “The study confirms that we need to understand the nutritional impacts of long-term antiretroviral combinations, as those treatments may have unintended consequences for HIV-infected women and their children.”
Other Gillings School-affiliated co-authors of the study are Dr. Linda S. Adair, professor of nutrition; Dr. Margaret E. Bentley, Carla Smith Chamblee Distinguished Professor of Nutrition; Mr. Eric J. Daza, doctoral student in biostatistics; and alumna Dr. Nicole L. Davis, now an epidemiologist at the Centers for Disease Control and Prevention’s Women’s Health and Fertility Branch. Drs. Adair and Bentley also are fellows at Carolina Population Center.
Other UNC co-authors are Dr. Amanda Corbett, clinical associate professor in the Eshelman School of Pharmacy, and Dr. Charles M. van der Horst, professor in the School of Medicine.
Additional co-authors are from the UNC Project in Lilongwe, Malawi; USDA, Western Human Nutrition Research Center, in Davis, Calif.; Centers for Disease Control and Prevention; and University of Witwatersrand (South Africa) School of Public Health.