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Lipid-soluble vitamins A, D, and E in HIV-infected pregnant women in Tanzania

European Journal of Clinical Nutrition volume 64, pages 808–817 (2010)Cite this article

Subjects

Abstract

Background/Objectives:

There is limited published research examining lipid-soluble vitamins in human immunodeficiency virus (HIV)-infected pregnant women, particularly in resource-limited settings.

Subjects/Methods:

This is an observational analysis of 1078 HIV-infected pregnant women enrolled in a trial of vitamin supplementation in Tanzania. Baseline data on sociodemographic and anthropometric characteristics, clinical signs and symptoms, and laboratory parameters were used to identify correlates of low plasma vitamin A (<0.7 μmol/l), vitamin D (<80 nmol/l) and vitamin E (<9.7 μmol/l) status. Binomial regression was used to estimate risk ratios and 95% confidence intervals.

Results:

Approximately 35, 39 and 51% of the women had low levels of vitamins A, D and E, respectively. Severe anemia (hemoglobin <85 g/l; P<0.01), plasma vitamin E (P=0.02), selenium (P=0.01) and vitamin D (P=0.02) concentrations were significant correlates of low vitamin A status in multivariate models. Erythrocyte Sedimentation Rate (ESR) was independently related to low vitamin A status in a nonlinear manner (P=0.01). The correlates of low vitamin D status were CD8 cell count (P=0.01), high ESR (ESR >81 mm/h; P<0.01), gestational age at enrollment (nonlinear; P=0.03) and plasma vitamins A (P=0.02) and E (P=0.01). For low vitamin E status, the correlates were money spent on food per household per day (P<0.01), plasma vitamin A concentration (nonlinear; P<0.01) and a gestational age <16 weeks at enrollment (P<0.01).

Conclusions:

Low concentrations of lipid-soluble vitamins are widely prevalent among HIV-infected women in Tanzania and are correlated with other nutritional insufficiencies. Identifying HIV-infected persons at greater risk of poor nutritional status and infections may help inform design and implementation of appropriate interventions.

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Acknowledgements

We thank the mothers and children, and field teams, including physicians, nurses, midwives, supervisors, lab staff and the administrative staff, who made the study possible; and Muhimbili Medical Centre, Muhimbili University College of Health Sciences, and the National AIDS Control Program in Dar es Salaam for their institutional support. This study was supported by the National Institute of Child Health and Human Development (NICHD R01 32257), the Fogarty International Center (NIH D43 TW00004) and the Harvard School of Public Health.

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Authors and Affiliations

  1. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    S Mehta, D Spiegelman, E L Giovannucci, E Hertzmark, D J Hunter & W W Fawzi

  2. Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

    S Mehta, E L Giovannucci, D J Hunter & W W Fawzi

  3. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    D Spiegelman

  4. Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    S Aboud

  5. Department of Medicine, Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA

    E L Giovannucci & D J Hunter

  6. Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    G I Msamanga

  7. Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    F M Mugusi

  8. Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA

    W W Fawzi

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Mehta, S., Spiegelman, D., Aboud, S. et al. Lipid-soluble vitamins A, D, and E in HIV-infected pregnant women in Tanzania. Eur J Clin Nutr 64, 808–817 (2010). https://doi.org/10.1038/ejcn.2010.76

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