J Acquir Immune Defic Syndr

ObjectiveIn 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.MethodsThe 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.ResultsIn 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, p0.1). In subsample infants, interventions were not associated with impaired iron status (all p-values>0.1).ConclusionsMaternal 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.SIP 22-09 U48-DP001944-01/DP/NCCDPHP CDC HHSUnited States/D43 TW001039/TW/FIC NIH HHSUnited States/U48DP001944/ACL HHSUnited States/R03 HD057775/HD/NICHD NIH HHSUnited States/SIP 13-01 U48-CCU409660-09/PHS HHSUnited States/SIP 26-04 U48-DP000059-01/DP/NCCDPHP CDC HHSUnited States/R24 TW007988/TW/FIC NIH HHSUnited States/R03 HD057637/HD/NICHD NIH HHSUnited States/P30-AI50410/AI/NIAID NIH HHSUnited States/R24 HD050924/HD/NICHD NIH HHSUnited States/P2C HD050924/HD/NICHD NIH HHSUnited States/U48 DP000059/DP/NCCDPHP CDC HHSUnited States/2-D43TW01039-06/TW/FIC NIH HHSUnited States/P30 AI050410/AI/NIAID NIH HHSUnited States