Vitamins, Breast Milk HIV Shedding and Child Health

Summary

Principal Investigator: E Villamor
Affiliation: Harvard University
Country: USA
Abstract: We have shown that supplementation with vitamins B, C, and E during pregnancy and lactation to HIV-infected women is related to lower rates of breastfeeding transmission among women in advanced stage of disease, whereas vitamin A supplementation is associated with an overall increased risk. Given that vitamin A supplementation to lactating women of unknown HIV status is becoming a widespread public health practice in many developing countries, it is urgent to identify the biological mechanisms that underlie the adverse effect of vitamin A on HIV transmission. One potential explanatory mechanism is that vitamin supplements might affect the shedding of cell-free and/or cell-associated HIV in breast milk. Preliminary analyses support this notion. We propose to examine the effect of vitamin supplements (A vs. no A and multivitamins (B, C, and E) vs. no multivitamins) administered during pregnancy and lactation to HIV-1 infected women on HIV-1 viral and proviral load in breast milk, in a sub-sample of 771 women who participated in a randomized clinical trial in Tanzania. This effect will be ascertained at three time points: delivery (n=592), 3 months after delivery (n=570), and 6 months after delivery (n=516). We will also study other mechanisms to explain the effect of vitamin supplements on breastfeeding transmission; these include 1) the effect of supplements on the risk of sub-clinical mastitis as measured by the Na/K ratio, and 2) the effect of retinoic acid and/or beta-carotene on expression of CCR5 and viral replication in vitro. Next, we propose to examine the effect of vitamin supplements on the concentration of vitamins A, B12, and E in breast milk at delivery, 3, and 6 moths thereafter, and the associations between the concentration of these vitamins in breast milk and child morbidity and mortality during the first two years. Finally, we propose to examine the associations between HIV viral and proviral load in breast milk and the risk of post-natal transmission of HIV. A significant advantage of this proposal is that it would allow us to examine various relevant research questions using data and biological samples that have been already collected and appropriately stored in the context of a large ongoing trial with high rates of follow-up and compliance.
Funding Period: 2004-09-15 - 2009-08-31
more information: NIH RePORT

Top Publications

  1. ncbi Effects of vitamin a supplementation on immune responses and correlation with clinical outcomes
    Eduardo Villamor
    Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA
    Clin Microbiol Rev 18:446-64. 2005
  2. ncbi Transmission of cell-free and cell-associated HIV-1 through breast-feeding
    Irene N Koulinska
    Harvard School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA 02115, USA
    J Acquir Immune Defic Syndr 41:93-9. 2006
  3. ncbi Long-chain n-6 polyunsaturated fatty acids in breast milk decrease the risk of HIV transmission through breastfeeding
    Eduardo Villamor
    Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
    Am J Clin Nutr 86:682-9. 2007
  4. ncbi Effect of vitamin supplementation on breast milk concentrations of retinol, carotenoids and tocopherols in HIV-infected Tanzanian women
    A L Webb
    Department of Nutrition, Harvard School of Public Health, Boston, MA 2115, USA
    Eur J Clin Nutr 63:332-9. 2009
  5. ncbi Subclinical mastitis, cell-associated HIV-1 shedding in breast milk, and breast-feeding transmission of HIV-1
    Serpil Kantarci
    Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
    J Acquir Immune Defic Syndr 46:651-4. 2007

Scientific Experts

  • E Villamor
  • Irene N Koulinska
  • A L Webb
  • Serpil Kantarci
  • J Furtado
  • W W Fawzi
  • H Campos
  • C Murrin
  • S Aboud
  • Said Aboud
  • Wafaie W Fawzi
  • Max Essex
  • Beth Chaplin
  • Wafaie Fawzi
  • Gernard Msamanga
  • Boris Renjifo

Detail Information

Publications5

  1. ncbi Effects of vitamin a supplementation on immune responses and correlation with clinical outcomes
    Eduardo Villamor
    Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA
    Clin Microbiol Rev 18:446-64. 2005
    ..Additional studies with these age groups are needed...
  2. ncbi Transmission of cell-free and cell-associated HIV-1 through breast-feeding
    Irene N Koulinska
    Harvard School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA 02115, USA
    J Acquir Immune Defic Syndr 41:93-9. 2006
    ..CONCLUSION: A reduction in milk CAV and CFV loads might significantly decrease HIV-1 transmission by breast-feeding...
  3. ncbi Long-chain n-6 polyunsaturated fatty acids in breast milk decrease the risk of HIV transmission through breastfeeding
    Eduardo Villamor
    Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
    Am J Clin Nutr 86:682-9. 2007
    ..Breastfeeding accounts for a sizable proportion of infant HIV infections. Some fatty acids (FAs) are potent immunomodulators with virucidal activity, and their primary source in breastfed children is breast milk...
  4. ncbi Effect of vitamin supplementation on breast milk concentrations of retinol, carotenoids and tocopherols in HIV-infected Tanzanian women
    A L Webb
    Department of Nutrition, Harvard School of Public Health, Boston, MA 2115, USA
    Eur J Clin Nutr 63:332-9. 2009
    ..We examined the impact of vitamin supplementation during pregnancy and lactation on breast milk concentrations of retinol, carotenoids and tocopherols during the first year postpartum among 626 HIV-infected Tanzanian women...
  5. ncbi Subclinical mastitis, cell-associated HIV-1 shedding in breast milk, and breast-feeding transmission of HIV-1
    Serpil Kantarci
    Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
    J Acquir Immune Defic Syndr 46:651-4. 2007
    ..It is unclear whether this association is mediated by increased cell-free virus (CFV) versus cell-associated virus (CAV) HIV shedding in breast milk...