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Do Vitamins Reduce Transmission of HIV from Mother to Child?
Introduction:HIV is an infection that results from the failure of the immune system. HIV can be transmitted through the transfer of bodily fluids including semen, blood, vaginal fluids, and breast milk. It can also be transmitted from a mother to a child during pregnancy and at childbirth. Eventually most HIV carriers obtain Aids and die due to the increasing failure of the immune system. Since the discovery of Aids in 1981, the numbers of patients have greatly increased, killing more than 25 million people. Most of these deaths occur in underdeveloped countries, particularly seen in Africa.
In Africa, HIV/ AIDS statistics are astounding. Women are hit the hardest by HIV/ AIDS; by extension, the children of HIV positive mothers fall victim to the virus. Mills, Wu, Seely, and Guyatt (2005) explain the following:
In Africa, 55% of HIV-1-positive adults are women, most of childbearing age . Data from antenatal clinics show that in several parts of southern Africa, more than 30% of pregnant women are infected with HIV-1. The fastest growth has been in South Africa, where the prevalence of infection in adults increased from 5% in 1990, to over 25% in 2002 . Mother-to-child transmission (MTCT) of HIV-1 can occur during pregnancy, delivery, and post-partum through breastfeeding. In observational cohort studies, the cumulative rates of transmission are between 25% and 45% of all children born to HIV-1-infected mothers in Africa. (pages 1-2)
The MTCT problem crosses borders. The internationalization of the problem raises additional concerns.
In the developing world, it is not uncommon to see MTCT accounting for 5–10% of new HIV cases each year. In the developed world, antiretroviral (ARV) drugs make MTCT rates lower. The expense of ARV's energizes the search for cheaper treatments (Mills et al., 2005). “Observational studies demonstrating an association between low biochemical and dietary levels of micronutrients and MTCT have fueled the hypothesis that micro-nutrient supplementation, particularly with Vitamin A and multivitamin combinations, may reduce vertical transmission” (Mills et al., 2005, page 2). Mills, Wu, Seely, and Guyatt preliminarily think that “vitamin supplementation may reduce vertical transmission through either intrapartum or breastfeeding routes by reducing HIV viral load in lower genital tract secretions and in breast milk” (2005, page 2). What do studies show? Do multivitamin combinations, particularly multivitamin combinations with Vitamin A reduce MTCT of HIV
Results: In analyzing studies, the work of Mills, Wu, Seely, and Guyatt serve as a good starting point. Mills, Wu, Seely, and Guyatt provide results of trial-based analyses from a host of African countries. Results are not favorable. Three trials on Vitamin A are conducted. Of the three trials on Vitamin A, two suggest no difference in MTCT. The third trial is even more depressing. With the largest amount of participants (1078), the third Vitamin A trial indicates an increased MTCT risk (Mills et al., 2005). These results are not encouraging, but before giving up on Vitamin A as a possible alternative treatment, one should look at other studies. By taking a holistic approach, this compilation of studies may understate or overlook positives from other more specific studies.
The second study up for analysis is credited to Kuhn, Coutsoudis, Archary, Clerici, Crovella, Rossi, Segat, and Trabattoni. This study takes place in Durban, South Africa, and it involves mannose-binding lectin (MBL-2) allele variants. MBL-2 allele variants are associated with immunity. MBL-2 variants are correlated with HIV infection; with this as a premise for testing, the study ensues. Two groups make up the study. Of 225 infants, 108 receive Vitamin A and beta-carotene, while 117 receive a placebo. The placebo group exhibited an increased risk of HIV transmission. The group treated with Vitamin A and beta-carotene, however, exhibited a decreased risk of HIV transmission. Kuhn, Coutsoudis, Archary, Clerici, Crovella, Rossi, Segat, and Trabattoni (2006) observe a potential breakthrough in HIV/ AIDS treatment: MBL-2 variants with Vitamin A and beta-carotene decrease the risk of MTCT.
A trial was performed to determine the effects of vitamin A supplementation in children with HIV infection that was obtained through mother-to-child transmission in Durban, South Africa. The trial randomly selected 118 infants born to HIV-infected women to either a vitamin A supplementation or a placebo. The Vitamin A was provided to the subjects at 1 and 3 months of age, at 6 and 9 months, and at 12 and 15 months. The results showed that morbidity from diarrhea, a common cause of death seen in children that are HIV carrriers, decreased almost 50% after taking a Vitamin A supplement.
Another trial that was conducted in conducted in Uganda selected 181 HIV-infected children at 6 months and randomly provided them with the vitamin A supplementation or placebo every 3 months starting at the age of 15 months and ending at 36 months. After turning 15 months, the children were then for an average of 17.8 months. Through this study, it was found that children in vitamin A group had a lower chance of dying when compared to the children in the placebo group.
In a study conducted at Queen Elizabeth Central Hospital in Blantyre, Malawi, 474 HIV-infected mothers and their infants were selected to be followed from the beginning of the mother’s pregnancy until the child reached 12 months. The Infant’s HIV status was then able to be determined. The mother and infant’s health status was then monitored through regular follow-up. The results concluded that 69.2% of HIV-infected pregnant women had serum vitamin A levels consistent with deficiency (less than 1.05 mol/L). The HIV positive mothers were divided into 4 groups, those with vitamin A levels less than 0.70, between 0.70 and 1.05, between 1.05 and 1.40, and less than or equal to 1.40 mol/L. The mother-to-child transmission rates of HIV for each group were 32.4%, 25.2%, 16.0% and 7.2%. These results showed that infant mortality was significantly higher among those born to vitamin A- deficient mothers, contributing to mother-to-child transmission of HIV, higher infant mortality, as well as higher maternal mortality.
Conclusion: When it comes to the effects of Vitamin A on MTCT of HIV, one can only conclude that the results are inconclusive. Several studies purport to have found a correlation between Vitamin A and MTCT, but an equally large number of studies denounces the correlation between Vitamin A and MTCT.
Edward J Mills, P. W. (2005). Vitamin supplementation for prevention of mother-to-child transmission of HIV and pre-term delivery: a systematic review of randomized trial including more than 2800 women. AIDS Research and Therapy, 2 (4), 1-7. (pages correspond to pdf; HYPERLINK "http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1131887&blobtype=pdf" )
Kuhn L, C. A. (2006). Synergy between mannose-binding lectin gene polymorphisms and supplementation with vitamin A influences susceptibility to HIV infection in infants born to HIV-positive mothers. The American Journal of Clinical Nutrition , 84 (3), 610-615.
Mehta S, F. W.(2007). Effects of vitamins, including vitamin A, on HIV/AIDS patients. Vitamins and Hormones , 75, 355-383.
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