@article{50dbd54cbce24d5596afda9def9260b8,
title = "Milk Calcium and Phosphorus in Ugandan Women with HIV on Tenofovir-Based Antiretroviral Therapy",
abstract = "Background: Breastfed infants depend on human milk calcium and phosphorus for bone mineral accretion and growth. We reported greater mobilization of bone mineral and delayed skeletal recovery in lactating Ugandan women with HIV initiated on tenofovir-based antiretroviral therapy during pregnancy compared to HIV-uninfected counterparts in the Gumba Study. However, it is unknown if these disruptions in maternal bone metabolism affect milk mineral concentrations. Research Aim: To compare concentrations and patterns of change in milk calcium and phosphorus between lactating women with and without HIV. Methods: A longitudinal observational study was conducted to compare milk mineral concentrations between women with HIV receiving tenofovir-based ART and uninfected women in the Gumba Study. Milk collected at 2, 14, 26, and 52 weeks lactation was analyzed for calcium and phosphorus. Sodium and potassium were measured at 2 and 14 weeks to detect sub-clinical mastitis. Differences in milk composition between 84 women with HIV and 81 uninfected women were investigated. Results: Women with HIV had higher milk calcium than uninfected women at 14 weeks. The percent difference was +10.2% (SE = 3.0, p =.008) and there was a tendency to greater values at 2 and 26 weeks. Milk calcium decreased in both groups during lactation (p ≤.001) but was more pronounced in women with HIV. The magnitude of change within individuals in the 1st year of lactation from 2 to 52 weeks was −28.3% (SE 3.9) versus −16.5% (SE 3.5), p for interaction =.05. Differences in milk phosphorus and calcium-to-phosphorus ratio were smaller and mostly not significant. Conclusions: Participants with HIV on tenofovir-based antiretroviral therapy had altered milk mineral composition. Studies are needed to investigate mechanisms and health implications for the woman and infant.",
keywords = "Africa, HIV, Uganda, antiretroviral therapy (ART), lactation, milk composition, mother-to-child transmission, tenofovir",
author = "Florence Nabwire and Hamill, {Matthew M.} and Fowler, {Mary Glenn} and Adeodata Kekitiinwa and Ann Prentice",
note = "Funding Information: We acknowledge all the participants, staff in Uganda (Baylor-Uganda, and Makerere University Johns Hopkins University Research Collaboration) for their contribution to the study, and to the staff in the NBH and NBA laboratories at the MRC Elsie Widdowson Laboratory for laboratory analysis. We also thank Dr Josaphat Byamugisha (Makerere University, Kampala, Uganda) for his contribution to the methodology for the Gumba cohort study. Special acknowledgment is made to the late Dr Gail Ruth Goldberg (MRC Nutrition and Bone Health Research Group, Cambridge, UK) for her contribution to the Gumba cohort study: conceptualization, methodology, funding acquisition, and supervision. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was jointly funded by the Medical Research Council (MRC) (programme code U105960371) and the Department for International Development (DFID) under the MRC/DFID Concordat agreement; and the Alborada Trust through The Cambridge in Africa Programme. FN{\textquoteright}s PhD tuition fees and stipend were funded by the Gates Cambridge Scholarship at the University of Cambridge. For the purposes of Open Access, the author (AP) has applied a Creative Commons Attribution (CC BY) license to any Author Accepted Manuscript version arising. Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was jointly funded by the Medical Research Council (MRC) (programme code U105960371) and the Department for International Development (DFID) under the MRC/DFID Concordat agreement; and the Alborada Trust through The Cambridge in Africa Programme. FN{\textquoteright}s PhD tuition fees and stipend were funded by the Gates Cambridge Scholarship at the University of Cambridge. For the purposes of Open Access, the author (AP) has applied a Creative Commons Attribution (CC BY) license to any Author Accepted Manuscript version arising. Publisher Copyright: {\textcopyright} The Author(s) 2023.",
year = "2023",
month = may,
doi = "10.1177/08903344221146472",
language = "English (US)",
volume = "39",
pages = "288--299",
journal = "Journal of Human Lactation",
issn = "0890-3344",
publisher = "SAGE Publications Inc.",
number = "2",
}