The importance of micronutrient status in the vertical transmission of HIV and pregnancy outcome

Over a million children have been infected with HIV as a result of vertical transmission and approximately 1600 are newly infected each day. The majority of these children and their families live in developing regions that have inadequate access to healthcare and cannot afford antiretroviral therapy. Finding inexpensive alternatives that decrease the incidence of HIV vertical transmission is of utmost importance to the public health of these regions. Micronutrients, particularly vitamin A, have been implicated in reducing the negative birth outcomes and vertical transmission of HIV in infected pregnancies in several trials. Possible mechanisms by which these micronutrients confer their positive effect include enhancing immune function in both mother and fetus/infant, decreasing viral shedding during delivery and decreasing viral shedding into breast milk during lactation. Each of these mechanisms functions to improve the birth outcomes and reduce the morbidity and mortality of infants born to HIV infected mothers. Reports on the efficacy of micronutrient supplementation on pregnancy outcomes and vertical transmission of HIV are inconclusive, but due to the clinical importance that such a finding would have, this subject merits further investigation and contemplation