A study conducted in Tanzania has demonstrated that HIV-positive pregnant women who receive a multivitamin supplement have much less risk of bearing low birth-weight babies and delivering prematurely. Furthermore, their babies are less likely to become infected with HIV (Fawzi 2003; Villamor 2002). These children are also significantly heavier at two years after continued vitamin supplementation during breastfeeding (Villamor 2005).

Providing vitamins B, C and E to these mothers significantly reduced both HIV transmission to the babies and mortality in the first two years of life, when the mothers immunological or nutritional status was poor. The study also found that women who received the multivitamin had substantial and sustained increases in CD4 and CD8 cell counts.

In contrast, providing vitamin A to the mothers appeared to increase HIV transmission rates and was therefore discontinued, although the risk of pneumonia among the babies was lower if their mothers had taken vitamin A. An earlier study had shown that vitamin A deficiency was associated with increased transmission of HIV (Fawzi 1998, 2002, Fawzi 2003).

Another placebo-controlled study from the Tanzanian group has reported that HIV-infected infants given vitamin A supplements have improved growth and weight gain compared to those given placebo. Furthermore, vitamin A supplements reduce the risk of stunting associated with persistent diarrhoea in HIV-infected infants (Villamor 2002b).

Several other groups have reported that vitamin A supplements alone have no effect on mother-to-child HIV transmission (Shey 2002). A large South African study has found that vitamin A supplements do not reduce the overall risk of mother-to-baby HIV transmission. However, women taking the supplement were less likely to have early deliveries. Furthermore, preterm babies born to these women were less likely to be HIV-infected than preterm babies born to women in the placebo group (Coutsoudis 1999).

Analysis of 334 HIV-positive mothers in Malawi found that vitamin A supplementation had no significant effect on mother-to-child transmission at six weeks and twelve months, or on breast milk viral load (Semba 1999).

The significance of these results is unclear for Europe and North America, because they may represent an improvement in nutrient status to the level normally seen in Europe and North America, so there may be no justification for supplementing at this level if dietary intake is adequate. Further supplementation may not result in a corresponding improvement in immune status.

References

Coutsoudis A et al. Randomised trial testing the effect of vitamin A supplementation on pregnancy outcomes and early mother-to-child HIV-1 transmission in Durban, South Africa. AIDS 13: 1517-1524, 1999.

Fawzi WW et al. Effect of providing vitamin supplements to human immunodefiency virus-infected lactatin mothers on the childs morbidity and CD4+ cell counts. Clin Infect Dis 36: 1053-1062, 2003.

Fawzi WW et al. Randomised trial of effects of vitamin supplements on pregnancy outcomes and T-cell counts in HIV-1 infected women in Tanzania. Lancet 351: 1477-1482, 1998.

Fawzi WW et al. Randomized trial of vitamin supplements in relation to vertical transmission of HIV-1 in Tanzania. J Acquir Immune Defic Syndr 23: 246-54, 2000.

Fawzi WW et al. Randomized trial of vitamin supplements in relation to transmission of HIV-1 through breastfeeding and early child mortality. AIDS 16: 1935-1944, 2002.

Fawzi WW et al. Effect of providing vitamin supplements to human immunodeficiency virus-infected, lactating mothers on the child's morbidity and CD4+ cell counts. Clin Infect Dis 36: 1053-1062, 2003.

Semba RD et al. Human immunodeficiency virus load in breast milk, mastitis, and mother-to-child transmission of human immunodeficiency virus type 1. J Infect Dis 180: 93-98, 1999.

Shey WI et al. Vitamin A supplementation for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database Syst Rev 3: CD003648, 2002.

Villamor E et al. Effect of multivitamin and vitamin A supplements on weight gain during pregnancy among HIV-1-infected women. Am JClin Nutr 76: 1082-1090, 2002a.

Villamor E et al. Vitamin A supplements ameliorate the adverse effect of HIV-1, malaria, and diarrheal infections on child growth. Pediatrics 109: E6, 2002b.

Villamor E et al. Vitamin supplementation of HIV-infected women improves postnatal child growth. Am J Clin Nutr 81: 880-8, 2005.