Nutrition and HIV/AIDS: A Training Manual - Linkages Project

of malnutrition, which increases the risk of mother-to-child transmission (MTCT) ofHIV.Semba et al (1994) and Nduati (1995) have shown that vitamin A deficiency, even inmild and moderate forms, is independently associated with HIV viral load in blood,genital secretions, and breastmilk, increasing the risk of MTCT. Vitamin A deficiencyis common among African populations, including women.Randomized placebo-controlled studies have been carried out in Africa by Coutsoudiset al (1999) and Fawzi et al (1998) on the impact of vitamin A supplementation andother vitamin supplements on vertical HIV transmission. None of these studies hasshown a benefit of vitamin A supplementation in reducing vertical HIV transmissionduring pregnancy or the intrapartum period. However, the studies found a markeddecrease in prenatal mortality and an increase in birth weight that was associatedwith vitamin A supplementation in pregnancy.Caution must be exercised with regard to vitamin A supplementation. A 2002 studyin Tanzania by Fawzi et al found that vitamin A supplementation of HIV-infectedpregnant women from 20 weeks gestation and throughout lactation actuallyincreased the risk of vertical transmission of HIV through breastfeeding. On theother hand, though the results were not statistically significant, providing HIVinfected,immunologically and nutritionally compromised breastfeeding motherswith a multivitamin that did not contain vitamin A was associated with a decrease inHIV-1 transmission through breastfeeding and in child mortality. Given theseresearch findings, Fawzi suggests that providing multivitamins to HIV-infectedlactating women may improve their child’s health. WHO does not recommend dailyvitamin A supplementation during breastfeeding, and such supplementation is notadvised for HIV-infected women. A multivitamin should contain less than 800micrograms or 2500 IU of vitamin A per day.Providing multivitamin supplementation to HIV-infected women during pregnancyhas shown decreased adverse pregnancy outcomes and increased T-cell counts(Fawzi et al 1998). In yet another study giving multivitamin supplements dailyduring pregnancy to HIV-infected women improved weight gain among these women(Villamor et al 2002). These studies suggest that providing a daily multivitamin toHIV-infected women as part of their care is beneficial.129