Breasttnilk micronutrient concentrations in HIV infection

HIV infection is associated with serum levels of several micronutrients, including vitamins A and B6, but the influence of HIV infection on breastmilk concentrations of these nutrients has not been investigated. We assessed 59 HIV-1 positive (HIV + ) and 121 uninfected (HIV-) lactating women at 6 weeks post-partum in Blantyre, Malawi. Vitamin A was measured in maternal serum, milk and infant serum; vitamin B6 was measured in milk only. Analyses of physical exam and health history variables revealed no confounders with serostatus for any of the outcome measures. In bivariate analyses of the three retinols, only maternal serum retinol K20 ug/dL] diff8ered significantly by HIV serostatus IRR = 13.5 ; 95% CI 3.2-57.0]. Women were divided into three groups for further analysis: HIV-, HIV + with >20% CD4 cells, and HIV+ with <20% CD4 cells. Only maternal serum retinol differed by %CD4 among HIV+ dyads. HIV + mothers below and above 20% CD4 had lower mean serum retinol compared to HIV- mothers [HIV-: 37.5 ug/dL, HIV+ >20% CD4: 31.12 ug/dL, HIV+ <20% CD4, 17.73 ug/dL]. Mean breastmilk B6 was comparable for both HIV+ and HIV- women (73.3 and 68.8 ng/mL, respectively) and was lower than values reported in developing countries. HIV + women <20% CD4 had lower mean milk B6 (44.7 ng/mL) compared to either HIV+ women >20% CD4 (78.8 ng/mL) or HIV- women (68.8 ng/mL). HIV infection is therefore associated with maternal micronutrient status and may affect infant vitamin B6 status through its effect on breastmilk concentrations.