Your browser doesn't support javascript.
loading
Effects of a single large dose of vitamin A, given during the postpartum period to HIV-positive women and their infants, on child HIV infection, HIV-free survival, and mortality.
Humphrey, Jean H; Iliff, Peter J; Marinda, Edmore T; Mutasa, Kuda; Moulton, Lawrence H; Chidawanyika, Henry; Ward, Brian J; Nathoo, Kusum J; Malaba, Lucie C; Zijenah, Lynn S; Zvandasara, Partson; Ntozini, Robert; Mzengeza, Faith; Mahomva, Agnes I; Ruff, Andrea J; Mbizvo, Michael T; Zunguza, Clare D.
Afiliação
  • Humphrey JH; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. jhumphrey@zvitambo.co.zw
J Infect Dis ; 193(6): 860-71, 2006 Mar 15.
Article em En | MEDLINE | ID: mdl-16479521
BACKGROUND: Low maternal serum retinol level is a risk factor for mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). Multiple-large-dose vitamin A supplementation of HIV-positive children reduces mortality. The World Health Organization recommends single-large-dose vitamin A supplementation for postpartum women in areas of prevalent vitamin A deficiency; neonatal dosing is under consideration. We investigated the effect that single-large-dose maternal/neonatal vitamin A supplementation has on MTCT, HIV-free survival, and mortality in HIV-exposed infants. METHODS: A total of 14,110 mother-infant pairs were enrolled < or =96 h after delivery, and both mother and infant, mother only, infant only, or neither received vitamin A supplementation in a randomized, placebo-controlled trial with a 2 x 2 factorial design. All but 4 mothers initiated breast-feeding. A total of 4495 infants born to HIV-positive women were included in the present analysis. RESULTS: Neither maternal nor neonatal vitamin A supplementation significantly affected postnatal MTCT or overall mortality between baseline and 24 months. However, the timing of infant HIV infection modified the effect that supplementation had on mortality. Vitamin A supplementation had no effect in infants who were polymerase chain reaction (PCR) positive [corrected] for HIV at baseline. In infants who were PCR negative at baseline and PCR positive at 6 weeks, neonatal supplementation reduced mortality by 28% (P=.01), but maternal supplementation had no effect. In infants who were PCR negative at 6 weeks, all 3 vitamin A regimens were associated with ~2-fold higher mortality (P< or =.05). CONCLUSIONS: Targeted vitamin A supplementation of HIV-positive children prolongs their survival. However, postpartum maternal and neonatal vitamin A supplementation may hasten progression to death in breast-fed children who are PCR negative at 6 weeks. These findings raise concern about universal maternal or neonatal vitamin A supplementation in HIV-endemic areas.
Assuntos
Buscar no Google
Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Vitamina A / Deficiência de Vitamina A / Infecções por HIV / Mortalidade Infantil / Transmissão Vertical de Doenças Infecciosas Tipo de estudo: Clinical_trials / Risk_factors_studies Limite: Female / Humans / Infant / Newborn / Pregnancy Idioma: En Revista: J Infect Dis Ano de publicação: 2006 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos
Buscar no Google
Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Vitamina A / Deficiência de Vitamina A / Infecções por HIV / Mortalidade Infantil / Transmissão Vertical de Doenças Infecciosas Tipo de estudo: Clinical_trials / Risk_factors_studies Limite: Female / Humans / Infant / Newborn / Pregnancy Idioma: En Revista: J Infect Dis Ano de publicação: 2006 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos