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.
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