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Micronutrient status during lactation in HIV-infected and HIV-uninfected South African women during the first 6 mo after delivery ^1,2,3

¹ From the Africa Centre for Health and Population Studies, Somekele, South Africa (PCP, NCR, and MLB); the Program in International Nutrition, University of California, Davis, CA (PCP and KHB); the Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA (CJC); the University of KwaZulu-Natal, Nelson R Mandela School of Medicine, Department of Paediatrics (NCR); Tufts–New England Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA (MLB); the Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom (MLB)

Background:Little information on the micronutrient status of HIV-infected (HIV-positive) breastfeeding women is available.

Objective:The objective was to compare the protein and micronutrient status of South African breastfeeding women by HIV status.

Design:Serum albumin, prealbumin, vitamin B-12, folate, retinol, -tocopherol, hemoglobin, ferritin, and zinc concentrations were compared between 92 HIV-positive and 52 HIV-uninfected (HIV-negative) mothers 6, 14, and 24 wk after delivery. C-reactive protein and ₁-acid glycoprotein were used as proxy indicators of an inflammatory process.

Results:Mean albumin and prealbumin were significantly lower in HIV-positive mothers, and a higher proportion of HIV-positive mothers had low albumin concentrations (<35 g/L). Less than 45% of the mothers were vitamin B-12 or folate sufficient. Significantly more HIV-positive (70.5%) than HIV-negative (46.2%) mothers had marginal vitamin B-12 status (P < 0.05), and mean folate concentrations were lower in HIV-positive mothers (P = 0.05). Mean serum retinol was significantly lower in HIV-positive mothers, even after control for the acute phase response. At 24 wk, 70% of both groups had an -tocopherol deficiency (<11.6 µmol/L), but no significant difference by HIV status was observed. More HIV-positive (33.3%) than HIV-negative (8.7%) mothers had anemia (P = 0.018), whereas 25% of all mothers had low serum ferritin concentrations. After the acute phase response was controlled for, zinc deficiency was more common in HIV-positive (45.0%) than in HIV-negative (25.0%) mothers (P = 0.05).

Conclusions:Deficiencies in vitamins B-12, folate, -tocopherol, ferritin, and zinc are common in South African breastfeeding mothers. HIV-positive mothers had lower mean serum concentrations of albumin, prealbumin, folate, retinol, and hemoglobin than did HIV-negative mothers.

Key Words: HIV infection • breastfeeding women • South Africa • micronutrient status