The goals of the study are to determine whether improving maternal nutritional status through antenatal micronutrient supplementation will reduce mother-to-child transmission of HIV and reduce infant mortality. We propose to conduct a randomized, double-masked, placebo-controlled clinical trial of daily micronutrient supplementation for HIV-infected pregnant women in Malawi, Africa. Maternal nutritional status may contribute to the generally higher mother-to-child transmission rates observed in developing countries compared to developed countries. Among nutritional factors which could affect vertical transmission, vitamin A may be important due to its role in immunity and in maintaining the integrity of epithelial surfaces. Our studies demonstrate that vitamin A deficiency is common in HIV-infected pregnant women, and that maternal vitamin A deficiency is associated with increased vertical transmission of HIV and increased infant mortality. Our studies suggest that vitamin A and provitamin A supplementation of pregnant women may reduce infant mortality. The temporal relationship between vitamin A deficiency during pregnancy and increased vertical transmission of HIV and increased infant mortality suggests that correcting vitamin A or other micronutrient levels during pregnancy may decrease mother-to-child transmission of HIV and decrease infant mortality.
The specific aims are to determine whether daily antenatal micronutrient supplementation for HIV-infected women can reduce mother-to-child transmission of HIV and infant mortality.
Aims will be met through a clinical trial utilizing a factorial design to measure the effect of antenatal vitamin A and multivitamin (C and B complex) supplementation on mother-to-child transmission of HIV. The study will be conducted using the infrastructure and trained personnel established by NIH-sponsored ICAR and PAVE projects at Queen Elizabeth Central Hospital in Blantyre, Malawi. If daily micronutrient supplementation to HIV- infected pregnant women is demonstrated to reduce mother-to-child transmission of HIV and reduce infant mortality, this may allow a simple, inexpensive, and practical means to reduce the number of infants born with HIV infection in the world and to improve infant survival.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD032247-03
Application #
2403437
Study Section
AIDS and Related Research Study Section 2 (ARRB)
Program Officer
Nugent, Robert
Project Start
1995-07-01
Project End
1999-06-30
Budget Start
1997-07-01
Budget End
1999-06-30
Support Year
3
Fiscal Year
1997
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Ophthalmology
Type
Schools of Medicine
DUNS #
045911138
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Semba, Richard D; Ndugwa, Christopher; Perry, Robert T et al. (2005) Effect of periodic vitamin A supplementation on mortality and morbidity of human immunodeficiency virus-infected children in Uganda: A controlled clinical trial. Nutrition 21:25-31
Dancheck, Barbara; Nussenblatt, Veronique; Ricks, Michelle O et al. (2005) Breast milk retinol concentrations are not associated with systemic inflammation among breast-feeding women in Malawi. J Nutr 135:223-6
Semba, Richard D; de Pee, Saskia; Panagides, Dora et al. (2004) Risk factors for xerophthalmia among mothers and their children and for mother-child pairs with xerophthalmia in Cambodia. Arch Ophthalmol 122:517-23
Semba, Richard D; Bloem, Martin W (2004) Measles blindness. Surv Ophthalmol 49:243-55
van Lettow, Monique; Fawzi, Wafaie W; Semba, Richard D (2003) Triple trouble: the role of malnutrition in tuberculosis and human immunodeficiency virus co-infection. Nutr Rev 61:81-90
Semba, R D; de Pee, S; Panagides, D et al. (2003) Risk factors for nightblindness among women of childbearing age in Cambodia. Eur J Clin Nutr 57:1627-32
Totin, Dana; Ndugwa, Christopher; Mmiro, Francis et al. (2002) Iron deficiency anemia is highly prevalent among human immunodeficiency virus-infected and uninfected infants in Uganda. J Nutr 132:423-9
Semba, Richard D; Juul, Sandra E (2002) Erythropoietin in human milk: physiology and role in infant health. J Hum Lact 18:252-61
Nussenblatt, Veronique; Mukasa, Gelasius; Metzger, Amy et al. (2002) Relationship between carotenoids and anaemia during acute uncomplicated Plasmodium falciparum malaria in children. J Health Popul Nutr 20:205-14
Allen, Shannen K; Semba, Richard D (2002) The trachoma menace in the United States, 1897-1960. Surv Ophthalmol 47:500-9

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