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Micronutrients and vertical transmission of HIV-1^1,2,3

¹ From the Departments of Nutrition (MLD and WWF) and Epidemiology (WWF), Harvard School of Public Health, Boston.

ABSTRACT Vertical transmission of HIV from mother to infant can occur during pregnancy, at the time of delivery, or post-natally through breast-feeding and is a major factor in the continu-ing spread of HIV infection. Inadequate nutritional status may increase the risk of vertical HIV transmission by influencing mater-nal and child factors for transmission. The potential effects on these factors include impaired systemic immune function in preg-nant women, fetuses, and children; an increased rate of clinical, immunologic, and virologic disease progression; impaired epithe-lial integrity of the placenta and genital tract; increased viral shed-ding in breast milk from inflammation of breast tissue; increased risk of low birth weight and preterm birth; and impaired gastroin-testinal immune function and integrity in fetuses and children. Micronutrient deficiencies are prevalent in many HIV-infected pop-ulations, and numerous studies have reported that these deficien-cies impair immune responses, weaken epithelial integrity, and are associated with accelerated HIV disease progression. Although low serum vitamin A concentrations were shown to be associated with an increased risk of vertical HIV transmission in prospective cohort studies, randomized, placebo-controlled trials have reported that vitamin A and other vitamin supplements do not appear to have an effect on HIV transmission during pregnancy or the intrapartum period. However, the ability of prenatal and postpartum micronu-trient supplements to reduce transmission during the breast-feeding period is still unknown. Am J Clin Nutr 2002;75:959-70.

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