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

Mucosal integrity (slide 18)Studies show that the disruption of the epithelial integrity of the mucous membranesof the intestine or mouth of the infant increases the risk of transmission (Ekpini et al1997). Mixed feeding, allergic reactions to complementary foods, and infectiousillness can damage the intestine and increase risk of transmission (Bobat et al 1997;Ryder et al 1991; Tess et al. 1998b). Oral thrush in an infant may also be associatedwith MTCT.Breastfeeding duration (slides 19, 20)The first positive PCR cannot differentiate whether transmission occurred during latepregnancy, labor and delivery, or the early post-natal period. Studies suggest thatthe risk of transmission declines with the age of the infant. It is difficult, however,to ascribe increased risk only to breastfeeding duration and the age factor, asfeeding patterns change over time. Breastmilk intake is gradually decreased, whichreduces exposure to the virus but also causes the infant to become increasinglyvulnerable to other infections. **Strong evidenceMaternal nutritional status (slides 21, 22)Malnutrition during pregnancy may increase the risk of MTCT (Semba 1997). VitaminA deficiency may impair T and B cell function, resulting in an increased maternalviral load and reduced antibody concentrations. Vitamin A deficiency could alsoresult from advanced HIV disease. Both malnutrition and vitamin A deficiencycontribute to MTCT.A study of 1,075 HIV-infected pregnant women in Tanzania showed that takingmultivitamins, not vitamin A supplements, improved birth outcomes (reduced risk oflow birth weight, severe pre-term birth, and small size for gestational age) (Fawzi etal 1998). Taking multivitamins, not vitamin A, significantly increased CD4, CD8, andCD3 counts. No conclusions were drawn from the findings on vertical transmission. *Limited evidence.A study in Kenya (Nduati et al 2000a) showed that HIV-infected mothers whobreastfed lost more weight and were more likely to die in the 2 years followingdelivery than HIV-infected mothers who did not breastfeed. Another study in South193