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SARA Project, Academy for Educational Development, Washington, DC and * Department of Nutrition, University of North Carolina, Chapel Hill, NC
3To whom correspondence should be addressed. E-mail: epiwoz{at}aed.org.
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ABSTRACT |
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 TOP ABSTRACT LITERATURE CITED |
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KEY WORDS: • HIV/AIDS • mother-to-child HIV transmission • women • Africa • Asia
The Society for International Nutrition Research sponsored a symposium titled "Women’s Voices, Women’s Choices: The Challenge of Nutrition and HIV/AIDS in Asia and Africa" at Experimental Biology 2004 to highlight the challenges facing HIV-positive women living in resource-poor settings of Asia and Africa, when it comes to the everyday decisions they are forced to make about their own health and nutrition, and the health and nutrition of their children. The papers presented at the symposium, and found in this Journal of Nutrition supplement, include new data from qualitative research, clinical trials, and behavioral interventions, and embody a cross section of the HIV epidemic. The countries represented include Malawi, South Africa, Tanzania, and Zimbabwe, where urban antenatal HIV-prevalence rates range from 17 to 32% and about 5 million women are already living with HIV/AIDS, and India, where HIV-prevalence is relatively low (2%), but, due to its large population, an estimated 1.5 million women are HIV infected (1).
The issue of nutrition and HIV/AIDS is addressed here from an intergenerational perspective, examining nutrition issues among infected women and their children. The challenging issue of postnatal HIV transmission through breast-feeding is also addressed. Infant feeding choices are considered to be a nutritional concern because of the vast implications that not breast-feeding and early breast-feeding cessation have on the nutritional well-being of HIV-exposed children, as well as due to the positive contribution of breast-feeding to child nutrition and survival worldwide (2).
Why are we interested in women?
We have chosen to focus on women because they are shouldering much of the burden of HIV infection in the developing world in terms of their numbers and in their responsibilities for providing food and care for orphans and other family members who become sick or die from HIV/AIDS. As shown in Table 1, in all countries represented in this symposium, except India and the United States, the number of women infected with HIV exceeds that of men. Several studies have also shown that women are becoming infected at younger ages then men because of their social vulnerability. For example, a recent national survey of 15- to 24-y-old adults in South Africa reported that the HIV prevalence rate in females was 3 times higher (15.5%) than the rate in males (4.8%) (3).
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As a result of these expanding PMTCT programs, it is often women who are the first to learn about HIV in the family. As a result of this knowledge, women are often the ones to be accused of bringing HIV to the family, even when their husbands are also infected, and the consequences are sometimes severe, including beatings, abandonment, and social rejection. Although HIV-infected fathers are equally responsible for the fate of their children, it is the women who experience the daily fear and, often, the blame for passing on the virus to their offspring. And it is the woman’s nutrition, health status, and her own survival, not that of her husband, that largely determine whether her child will escape HIV, grow well, and reach appropriate developmental milestones.
Nutrition and HIV infection
HIV infection affects nutrition through increases in resting-energy expenditure; reductions in dietary intake, nutrient malabsorption, and loss; and complex metabolic alterations that culminate in weight loss and wasting common in AIDS (6–8). The effect of HIV on nutritional status begins early in the course of the infection, even before an individual may be aware that he or she is infected with the virus (9,10).
Nutrition is an important component of comprehensive care for the HIV-infected woman, and it is particularly important in resource-limited settings where malnutrition and food insecurity are endemic. Preexisting malnutrition (i.e., malnutrition that occurs before HIV infection) may exacerbate the effects of HIV, because the immune system is already compromised. In fact, the cellular effects of malnutrition on the immune system are similar to those of HIV and include decreases in CD4 T cells, suppression of delayed hypersensitivity, and abnormal B-cell responses (11). For many years, these conditions were known as "nutritionally acquired immune deficiency syndrome" (12).
The impact of nutritional status on HIV susceptibility and disease progression is difficult to study, and knowledge in this area is still limited. A systematic review of the literature is now underway by the WHO Technical Advisory Group on Nutrition and HIV/AIDS. Early studies demonstrated that reduced body cell mass and decreased serum albumin levels were associated with shorter survival in AIDS patients, independent of the CD4 cell count (13,14). Moderate (<5%) and severe (5–10%) weight loss over a 4-mo period were associated with subsequent increased risk of opportunistic infections and death in community-based research studies in the United States (15). Other studies showed that clinical outcome was poorer and risk of death was higher in HIV-infected patients with compromised micronutrient intake or status (16–21).
Deficiencies of vitamins and minerals, such as vitamins A, B-complex, C, E, and selenium and zinc, which are needed by the immune system to fight infection, are commonly observed in people living with HIV in all settings (22–25). Deficiencies of antioxidant vitamins and minerals contribute to oxidative stress, a condition that may accelerate immune cell death (26,27) and may increase the rate of HIV replication (28–30).
Short-term micronutrient supplementation has been shown to improve body weight and body cell mass (31); to reduce HIV RNA levels (32); to improve CD4 cell counts (32); and to reduce the incidence of opportunistic infections (33) and hospitalization (34) in small studies of male and female adults with AIDS, including those on antiretroviral treatment. A larger placebo-controlled randomized trial in 481 antiretroviral naïve HIV-positive men and women, carried out in Thailand, found that daily micronutrient supplementation for 1 y reduced mortality in those with baseline CD4 cell counts <200 x 106/L. Supplementation had no effect on CD4 cell count or plasma viral load (35). The article by Wafaie Fawzi (36) contained in this supplement summarizes the literature on micronutrient intervention trials and HIV.
Women’s nutrition and HIV
An HIV-infected woman’s nutritional status prior to and during pregnancy influences her own health and survival, as well as the health and the survival of her newborn children. The physiological changes that occur during pregnancy require extra nutrients for adequate gestational weight gain to support the growth and the development of the fetus (37). For women who are malnourished, daily energy-protein supplementation during pregnancy may improve maternal weight gain, increase infant birth weight, and reduce the risks of stillbirth and perinatal mortality (38).
HIV infection increases energy requirements (39). These additional needs, coupled with the nutritional consequences of common HIV-related illnesses and infections (e.g., diarrhea, tuberculosis, appetite loss), place HIV-infected pregnant and lactating women at greater nutritional risk than uninfected pregnant and lactating women. A meta-analysis of 31 studies reported that intrauterine growth retardation, preterm delivery (<37 wk), and low birth weight (<2500 g) were more common in infants born to HIV-positive compared with HIV-negative mothers (40). The effects of HIV infection on pregnancy outcomes are likely to be more pronounced in women with symptomatic HIV infection, as observed by Coley et al. (41) in Tanzania. Preterm delivery and low birth weight are associated with an increased risk of mother-to-child HIV transmission (42–44).
Wasting during pregnancy may be more common in HIV-infected women than in the general population (45). High plasma viral load has been associated with lower lean and fat body mass in pregnancy (46). Several studies conducted in Africa indicate that an HIV-infected mother’s nutritional status, measured by BMI, mid upper arm circumference, and/or weight loss, is an important predictor of mortality during the postnatal period (47,48).
The article by Bentley and colleagues (49) from Malawi explores issues about maternal nutrition, breast-feeding, and HIV to develop a clinical trial to study if providing adequate nutrition to HIV-infected breast-feeding women can prevent weight loss and nutritional depletion associated with both HIV infection and lactation.
Nutrition and mother-to-child transmission of HIV
Malnutrition during pregnancy results in low fetal stores of some nutrients, which impair immune function and fetal growth and may make the young infant more vulnerable to HIV. Furthermore, poor nutrition during pregnancy may impair the integrity of the placenta, the genital mucosal barrier, and the gastrointestinal tract. In each of these cases, transmission of HIV from mother to infant may be facilitated, although data confirming these relationships, independent of maternal HIV disease progression, are limited (50).
Low serum retinol, used as an indicator of vitamin A status, is associated with shedding of HIV in genital-tract secretions and in breast milk (51,52). Low serum retinol was also associated with a greater risk of cervical disease in HIV-infected women (53). However, serum retinol declines during the acute phase response to infection, and supplementation trials are needed to determine the impact of vitamin A on HIV disease.
In clinical trials, daily vitamin A supplementation with 10,000 IU of retinyl palmitate had no effect on vaginal HIV shedding among nonpregnant women in Mombasa, Kenya (54), nor on maternal antenatal and postnatal morbidity in a study in Durban, South Africa (55). In contrast, researchers conducting a randomized trial among HIV-positive pregnant women in Dar es Salaam, Tanzania, reported that daily vitamin A supplementation increased viral shedding in the lower genital tract (56).
Studies in Tanzania found that daily multivitamin supplementation (with vitamins B, C, and E) during pregnancy and breast-feeding reduced the incidence of fetal death, severe premature delivery (before 34 wk), small size for gestational age, and low birth weight (57), improved the immune status of infants (58), prevented HIV transmission among nutritionally and immunologically vulnerable women, i.e., those at greatest risk of passing HIV to their children (59), increased CD4 cell counts, and delayed HIV disease progression (60).
HIV and infant feeding
The HIV epidemic has challenged health systems and public health programs throughout the world, and balancing the risks of HIV transmission during breast-feeding with the risks of not breast-feeding in settings where access to safe replacement foods, health care, and support are limited is one of the most difficult issues facing HIV-affected families today. Risk factors for HIV transmission during breast-feeding include maternal factors such as viral load in blood (5) and breast milk (61); maternal immune status (62); breast health (63); and nutritional status, including hemoglobin and serum retinol levels, and nutrition-related birth outcomes (43,44,59). Infant risk factors include breast-feeding duration (64); type of breast-feeding (65); and presence of oral lesions (66).
The current WHO recommendations on infant feeding by HIV-infected mothers state (67):
When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life. To minimize HIV transmission risk, breastfeeding should be discontinued as soon as feasible, taking into account local circumstances, the individual woman’s situation and the risks of replacement feeding (including infections other than HIV and malnutrition).
Although this guidance sounds straightforward and sensible, making the decision to breast-feed or to practice replacement feeding involves complex concepts that are difficult to assess and are highly variable over time. WHO-recommended feeding options for HIV-infected mothers include exclusive breast-feeding, feeding with heat-treated human milk or milk from a milk bank, wet-nursing by an HIV-negative woman, early breast-feeding cessation, and exclusive replacement feeding with commercial or home-prepared infant formula (68).
Symposium articles from India (69), South Africa (70), and Zimbabwe (71) describe women’s choices and their experience with making difficult infant feeding decisions in the context of HIV. What is common to all settings is the desire of women to make the best possible choice for themselves and their children. What varies are the levels of support they receive for infant feeding, the environments they live in, and their personal voices as they express their concerns, aspirations, and approaches to facing a future living with HIV.
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FOOTNOTES |
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2 Funding for the preparation of this paper was provided by US Agency for International Development’s (USAID) Bureau for Africa, Office of Sustainable Development through the Support for Analysis and Research in Africa (SARA) project of the Academy for Educational Development under the terms of Contract AOT-C-00–99-00237–00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID, the Academy for Educational Development, or the University of North Carolina.
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LITERATURE CITED |
|---|
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TOPABSTRACTLITERATURE CITED |
|---|
1. Joint United Nations Programme on HIV/AIDS (UNAIDS) (2002) Report on the Global HIV/AIDS Epidemic 2002 UNAIDS Geneva, Switzerland.
2. Jones, G., Steketee, R. W., Black, R. E., Bhutta, Z. A. & Morris, S. S., the Bellagio Child Survival Study Group (2003) How many child deaths can we prevent this year?. Lancet 362:65-71.[Medline]
3. University of Witwatersrand Reproductive Health Research Unit & LoveLife (2003) Report on HIV and Sexual Behavior among Young South Africans: A National Survey of 15–24 Year Olds 2003 University of Witwatersrand Reproductive Health Research Unit Johannesburg, South Africa.
4. Royce, R. A., Seña, A., Cates, W., Jr & Cohen, M. S. (1997) Sexual transmission of HIV. N. Engl. J. Med. 336:1072-1078.
5. Richardson, B. A., John-Stewart, G. C., Hughes, J. P., Nduati, R., Mbori-Ngacha, D., Overbaugh, J. & Kreiss, J. K. (2003) Breast-milk infectivity in human immunodeficiency virus type 1-infected mothers. J. Infect. Dis. 187:736-740.[Medline]
6. Melchior, J. C., Salmon, D., Rigaud, D., Leport, C., Bouvet, E., Detruchis, P., Vilde, J. L., Vachon, F., Coulaud, J. P. & Apfelbaum, M. (1991) Resting energy expenditure is increased in stable, malnourished HIV-infected patients. Am. J. Clin. Nutr. 53:437-441.
7. Mulligan, K., Tai, V. & Schambelan, M. (1997) Energy expenditure in human immunodeficiency virus infection. N. Engl. J. Med. 336:70-71.
8. Grunfeld, C., Pang, M., Shimizu, L., Shigenaga, J. K., Jensen, P. & Feingold, K. R. (1992) Resting energy expenditure, caloric intake, and short-term weight change in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Am. J. Clin. Nutr. 55:455-460.
9. Beach, R. S., Mantero-Atienza, E., Shor-Posner, G., Javier, J. J., Szapocznik, J., Morgan, R., Sauberlich, H. E., Cornwell, P. E., Eisdorfer, C. & Baum, M. K. (1992) Specific nutrient abnormalities in asymptomatic HIV-1 infection. AIDS 6:701-708.[Medline]
10. Bogden, J. D., Kemp, F. W., Han, S., Li, W., Bruening, K., Denny, T., Oleske, J. M., Lloyd, J. & Baker, H., et al (2000) Status of selected nutrients and progression of human immunodeficiency virus type 1 infection. Am. J. Clin. Nutr. 72:809-815.
11. Gorbach, S. L., Knox, T. A. & Roubenoff, R. (1993) Interactions between nutrition and infection with human immunodeficiency virus. Nutr. Rev. 51:226-234.[Medline]
12. Scrimshaw, N. S., Taylor, C. E. & Gordon, J. E. (1968) Interactions of nutrition and infection. Monogr. Ser. World Health Organ. 57:3-329.[Medline]
13. Kotler, D., Tierney, A. R., Wang, J. & Pierson, R. N., Jr (1989) Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS. Am. J. Clin. Nutr. 50:444-447.
14. Suttmann, U., Ockenga, J., Selberg, O., Hoogestraat, L., Deicher, H. & Muller, M. J. (1995) Incidence and prognostic value of malnutrition and wasting in human immunodeficiency virus-infected outpatients. J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 8:239-246.[Medline]
15. Wheeler, D. A., Gilbert, C. L., Launer, C. A., Muurahainen, N., Elion, R. A., Abrams, D. I. & Bartsch, G. E. (1998) Weight loss as a predictor of survival and disease progression in HIV infection. J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 18:80-85.[Medline]
16. Tang, A. M., Graham, N. M. & Saah, A. J. (1996) Effects of micronutrient intake on survival in human immunodeficiency virus type 1 infection. Am. J. Epidemiol. 143:1244-1256.
17. Tang, A. M., Graham, N. M., Chandra, R. K. & Saah, A. J. (1997) Low serum vitamin B-12 concentrations are associated with faster human immunodeficiency virus type 1 (HIV-1) disease progression. J. Nutr. 127:345-351.
18. Tang, A. M., Graham, N. M., Semba, R. D. & Saah, A. J. (1997) Association between serum vitamin A and E levels and HIV-1 disease progression. AIDS 11:613-620.[Medline]
19. Semba, R. D., Caiaffa, W. T., Graham, N. M., Cohn, S. & Vlahov, D. (1995) Vitamin A deficiency and wasting as predictors of mortality in human immunodeficiency virus-infected injection drug users. J. Infect. Dis. 171:1196-1202.[Medline]
20. Baum, M. K., Shor-Posner, G., Lu, Y., Rosner, B., Sauberlich, H. E., Fletcher, M. A., Szapocznik, J., Eisdorfer, C., Buring, J. E. & Hennekens, C. H. (1995) Micronutrients and HIV-1 disease progression. AIDS 9:1051-1056.[Medline]
21. Baum, M. K., Shor-Posner, G., Lai, S., Zhang, G., Lai, H., Fletcher, M. A., Sauberlich, H. & Page, J. B. (1997) High risk of HIV-related mortality is associated with selenium deficiency. J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 15:370-374.[Medline]
22. Kupka, R. & Fawzi, W. W. (2002) Zinc nutrition and HIV infection. Nutr Rev 60:69-79.[Medline]
23. Semba, R. D. & Tang, A. M. (1999) Micronutrients and the pathogenesis of human immunodeficiency virus infection. Br. J. Nutr. 81:181-189.[Medline]
24. Friis, H., Gomo, E., Koestel, P., Ndhlovu, P., Nyazema, N., Krarup, H. & Michaelsen, K. F. (2001) HIV and other predictors of serum folate, serum ferritin, and hemoglobin in pregnancy: a cross-sectional study in Zimbabwe. Am. J. Clin. Nutr. 73:1066-1073.
25. Friis, H., Gomo, E., Koestel, P., Ndhlovu, P., Nyazema, N., Krarup, H. & Michaelsen, K. F. (2001) HIV and other predictors of serum beta-carotene and retinol in pregnancy: a cross-sectional study in Zimbabwe. Am. J. Clin. Nutr. 73:1058-1065.
26. Banki, K., Hutter, E., Gonchoroff, N. J. & Perl, A. (1998) Molecular ordering in HIV-induced apoptosis. Oxidative stress, activation of caspases, and cell survival are regulated by transaldolase. J. Biol. Chem. 273:11944-11953.
27. Romero-Alvira, D. & Roche, E. (1998) The keys of oxidative stress in acquired immune deficiency syndrome apoptosis. Med. Hypotheses 51:169-173.[Medline]
28. Allard, J. P., Aghdassi, E., Chau, J., Tam, C., Kovacs, C. M., Salit, I. E. & Walmsley, S. L. (1998) Effects of vitamin E and C supplementation on oxidative stress and viral load in HIV-infected subjects. AIDS 12:1653-1659.[Medline]
29. Rosenberg, Z. F. & Foci, A. S. (1990) Immunopathogenic mechanisms of HIV infection: cytokine induction of HIV expression. Immunol. Today 11:176-180.[Medline]
30. Schwarz, K. B. (1996) Oxidative stress during viral infection: a review. Free Radic. Biol. Med. 21:641-649.[Medline]
31. Shabert, J. K., Winslow, C., Lacey, J. M. & Wilmore, D. W. (1999) Glutamine-antioxidant supplementation increases body cell mass in AIDS patients with weight loss: a randomized, double-blind controlled trial. Nutrition 15:860-864.[Medline]
32. Müller, F., Svardal, A. M., Nordøy, I., Berge, R. K., Aukrust, P. & Frøland, S. S. (2000) Virological and immunological effects of antioxidant treatment in patients with HIV infection. Eur. J. Clin. Invest. 30:905-914.[Medline]
33. Mocchegiani, E. & Muzzioli, M. (2000) Therapeutic application of zinc in human immunodeficiency virus against opportunistic infections. J. Nutr. 130:1424S-1431S.
34. Burbano, X., Miguez-Burbano, M. J., McCollister, K., Zhang, G., Rodriguez, A., Ruiz, P., Lecusay, R. & Shor-Posner, G. (2002) Impact of a selenium chemoprevention clinical trial on hospital admissions of HIV-infected participants. HIV Clin. Trials 3:483-491.[Medline]
35. Jiamton, S., Pepin, J., Suttent, R., Filteau, S., Mahakkanukrauh, B., Hanshaoworakul, W., Chaisilwattana, P., Suthipinittharm, P., Shetty, P. & Jaffar, S. (2003) A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangkok. AIDS 17:2461-2469.[Medline]
36. Fawzi, W., Msamanga, G., Spiegelman, D. & Hunter, D. J. (2005) Studies of vitamins and minerals and HIV transmission and disease progression. J. Nutr. 135:938-944.
37. National Academy of Sciences (1989) Recommended Dietary Allowances 10th ed. 1989 National Academy Press Washington, DC.
38. Ceesay, S. M., Prentice, A. M., Cole, T. J., Foord, F., Weaver, L. T., Poskitt, E. M. & Whitehead, R. G. (1997) Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial. Br. Med. J. 315:786-790.
39. WHO (2003) Nutrient requirements for people living with HIV/AIDS. Report of a Technical Consultation. May 13–15, 2003 2003 WHO Geneva, Switzerland.
40. Brocklehurst, P. & French, R. (1998) The association between maternal HIV infection and perinatal outcome: a systematic review of the literature and meta-analysis. Br. J. Obstet. Gynaecol. 105:836-848.[Medline]
41. Coley, J. L., Msamanga, G. I., Fawzi, M. C., Kaaya, S., Hertzmark, E., Kapiga, S., Spiegelman, D., Hunter, D. & Fawzi, W. W. (2001) The association between maternal HIV-1 infection and pregnancy outcomes in Dar es Salaam, Tanzania. BJOG 108:1125-1133.[Medline]
42. Fawzi, W. W., Msamanga, G. I., Renjifo, B., Spiegelman, D., Urassa, E., Hashemi, L., Antelman, G., Essex, M. & Hunter, D. (2001) Predictors of intrauterine and intrapartum transmission of HIV-1 among Tanzanian women. AIDS 15:1157-1165.[Medline]
43. João, E. C., Cruz, M. L., Menezes, J. A., Matos, H. J., Calvet, G. A., d’Ippolito, M. M., Salgado, L. T., Silva, S. S., Bazin, G. R. & Braga, R. C. (2003) Vertical transmission of HIV in Rio de Janeiro, Brazil. AIDS 17:1853-1855.[Medline]
44. Ioannidis, J. P., Abrams, E. J., Ammann, A., Bulterys, M., Goedert, J. J., Gray, L., Korber, B. T., Mayaux, M. J., Mofenson, L. M., Newell, M. L., Shapiro, D. E., Teglas, J. P. & Wilfert, C. M. (2001) Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads < 1000 copies/mL. J. Infect. Dis. 183:539-545.[Medline]
45. Villamor, E., Msamanga, E., Spiegelman, D., Coley, J., Hunter, D. J., Peterson, K. E. & Fawzi, W. W. (2002) HIV status and sociodemographic correlates of maternal body size and wasting during pregnancy. Eur. J. Clin. Nutr. 56:415-424.[Medline]
46. Friis, H., Gomo, E., Nyazema, N., Ndhlovu, P., Kaestel, P., Krarup, H. & Michaelsen, K. F. (2002) HIV-1 viral load and elevated serum alpha(1)-antichymotrypsin are independent predictors of body composition in pregnant Zimbabwean women. J. Nutr. 132:3747-3753.
47. Lindan, C. P., Allen, S., Serufilira, A., Lifson, A. R., Van de Perre, P., Chen-Rundle, A., Batungwanayo, J., Nsengumuremyi, F., Bogaerts, J. & Hulley, S. (1992) Predictors of mortality among HIV-infected women in Kigali, Rwanda. Ann. Intern. Med. 116:320-328.
48. Nduati, R., Richardson, B. A., John, G., Mbori-Ngacha, D., Mwatha, A., Ndinya-Achola, J., Bwayo, J., Onyango, F. E. & Kreiss, J. (2001) Effect of breastfeeding on mortality among HIV-1 infected women: a randomized trial. Lancet 357:1651-1655.[Medline]
49. for the BAN Formative Study Group)Bentley, M. E., Corneli, A. L., Piwoz, E., Moses, A., Nkhoma, J., Tohill, B. C., Ahmed, Y., Adair, L., Jamieson, D. J. & van der Horst, C. (2005) Perceptions of the role of maternal nutrition in HIV-positive breast-feeding women in Malawi. J. Nutr. 135:945-949.
50. Dreyfuss, M. L. & Fawzi, W. W. (2002) Micronutrients and vertical transmission of HIV-1. Am. J. Clin. Nutr. 75:959-970.
51. Nduati, R. W., John, G. C., Richardson, B. A., Overbaugh, J., Welch, M., Ndinya-Achola, J., Moses, S., Holmes, K., Onyango, F. & Kreiss, J. K. (1995) Human immunodeficiency virus type 1-infected cells in breast milk: association with immunosuppression and vitamin A deficiency. J. Infect. Dis. 172:1461-1468.[Medline]
52. Mostad, S. B., Overbaugh, J., DeVange, D. M., Welch, M. J., Chohan, B., Mandaliya, K., Nyange, P., Martin, H. L., Jr, Ndinya-Achola, J., Bwayo, J. J. & Kreiss, J. K. (1997) Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina. Lancet 350:922-927.[Medline]
53. French, A. L., Kirstein, L. M., Massad, L. S., Semba, R. D., Minkoff, H., Landesman, S., Palefsky, J., Young, M., Anastos, K. & Cohen, M. H. (2000) Association of vitamin A deficiency with cervical squamous intraepithelial lesions in human immunodeficiency virus-infected women. J. Infect. Dis. 182:1084-1089.[Medline]
54. Baeten, J. M., McClelland, R. S., Overbaugh, J., Richardson, B., Emery, S., Lavreys, L., Mandaliya, K., Bankson, D. D. & Ndinya-Achola, J. O., et al (2002) Vitamin A supplementation and human immunodeficiency virus type 1 shedding in women: results of a randomized clinical trial. J. Infect. Dis. 185:1187-91.[Medline]
55. Kennedy, C. M., Coutsoudis, A., Kuhn, L., Pillay, K., Mburu, A., Stein, Z. & Coovadia, H. (2000) Randomized controlled trial assessing the effect of vitamin A supplementation on maternal morbidity during pregnancy and postpartum among HIV-infected women. J. Acquir. Immune Defic. Syndr. 24:37-44.
56. Fawzi, W., Msamanga, G. I., Antelman, G., Xu, C., Hertzmark, E., Spiegelman, D., Hunter, D. & Anderson, D. (2004) Effect of prenatal vitamin supplementation on lower-genital levels of HIV type 1 and interleukin type 1ß at 36 weeks gestation. Clin. Infect. Dis. 38:716-722.[Medline]
57. Fawzi, W. W., Msamanga, G. I., Spiegelman, D., Urassa, E. J., McGrath, N., Mwakagile, D., Antelman, G., Mbise, R. & Herrera, G., et al (1998) 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.[Medline]
58. Fawzi, W. W., Msamanga, G. I., Wei, R., Spiegelman, D., Antelman, G., Villamor, E., Manji, K. & Hunter, D. (2003) 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.[Medline]
59. Fawzi, W. W., Msamanga, G. I., Hunter, D., Renjifo, B., Antelman, G., Bang, H., Manji, K., Kapiga, S., Mwakagile, D., Essex, M. & Spiegelman, D. (2002) Randomized trial of vitamin supplements in relation to transmission of HIV-1 through breastfeeding and early child mortality. AIDS 16:1935-1944.[Medline]
60. Fawzi, W. W., Msamanga, G. I., Spiegelman, D., Wei, R., Kapiga, S., Villamor, E., Mwakagile, D., Mugusi, F. & Hertzmark, E., et al (2004) A randomized trial of multivitamin supplements and HIV disease progression and mortality. N. Engl. J. Med. 351:23-32.
61. Rousseau, C. M., Nduati, R. W., Richardson, B. A., Steele, M. S., John-Stewart, G. C., Mbori-Ngacha, D. A., Kreiss, J. K. & Overbaugh, J. (2003) Longitudinal analysis of human immunodeficiency virus type 1 RNA in breast milk and of its relationship to infant infection and maternal disease. J. Infect. Dis. 187:741-747.[Medline]
62. Leroy, V., Karon, J. M., Alioum, A., Ekpini, E. R., Meda, N., Greenberg, A. E., Msellati, P., Hudgens, M. & Dabis, F., et al (2002) Twenty-four month efficacy of a maternal short-course zidovudine regimen to prevent mother-to-child transmission of HIV-1 in West Africa. AIDS 16:631-641.[Medline]
63. Semba, R. D., Kumwenda, N., Hoover, D. R., Taha, T. E., Quinn, T. C., Mtimavalye, L., Biggar, R. J., Broadhead, R. & Miotti, P. G., et al (1999) 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.[Medline]
64. The Breastfeeding and HIV International Transmission Study Group (2004) Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis. J. Infect. Dis. 189:2154-2166.[Medline]
65. Coutsoudis, A., Pillay, K., Kuhn, L., Spooner, E., Tsai, W. Y. & Coovadia, H. M., the South African Vitamin A Study Group (2001) Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS 15:379-387.[Medline]
66. Embree, J. E., Njenga, S., Datta, P., Nagelkerke, N. J., Ndinya-Achola, J. O., Mohammed, Z., Ramdahin, S., Bwayo, J. J. & Plummer, F. A. (2000) Risk factors for postnatal mother-child transmission of HIV-1. AIDS 14:2535-2541.[Medline]
67. WHO (2001) New Data on the Prevention of Mother-to-Child Transmission of HIV and their Policy Implications: Conclusions and Recommendations [Online]. Geneva, Switzerland. October 11–13, 2000, approved January 15, 2001. http://www.unaids.org/publications/documents/mtct [accessed January 19, 2001] 2001.
68. UNAIDS/UNICEF/WHO (2004) HIV and Infant Feeding: Guidelines for Decision-Makers. WHO/FRH/NUT/CHD/98.1.WHO/UNAIDS, Update 2004 WHO Geneva, Switzerland.
69. Shankar, A. V., Sastry, J., Erande, A., Joshi, A., Suryawanshi, N., Phadke, M. A. & Bollinger, R. C. (2005) Making the choice: the transition of global HIV and infant feeding policy to local practice among mothers in Pune, India. J. Nutr. 135:960-965.
70. Coutsoudis, A. (2005) Infant feeding dilemmas created by HIV: South African experience. J. Nutr. 135:956-959.
71. Piwoz, E. G., Iliff, P. J., Tavengwa, N., Gavin, L., Marinda, E., Lunney, K., Zunguza, C., Nathoo, K. J. & Humphrey, J. H., the ZVITAMBO Study Group (2005) An education and counseling program for preventing breast-feeding–associated HIV transmission in Zimbabwe: design and impact on maternal knowledge and behavior. J. Nutr. 135:950-955.
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