Pre- and post-natal macronutrient supplementation for HIV-positive women in Tanzania: Effects on infant birth weight and HIV transmission

Albert Magohe, Todd Mackenzie, Josephine Kimario, Zohra Lukmanji, Kristy Hendricks, John Koethe, Nyasule Majura Neke, Susan Tvaroha, Ruth Connor, Richard Waddell, Isaac Maro, Mecky Matee, Kisali Pallangyo, Muhammad Bakari, C Fordham von Reyn, DarDar-2 Study Team, Albert Magohe, Todd Mackenzie, Josephine Kimario, Zohra Lukmanji, Kristy Hendricks, John Koethe, Nyasule Majura Neke, Susan Tvaroha, Ruth Connor, Richard Waddell, Isaac Maro, Mecky Matee, Kisali Pallangyo, Muhammad Bakari, C Fordham von Reyn, DarDar-2 Study Team

Abstract

Objective: To determine if a protein-calorie supplement (PCS) plus a micronutrient supplement (MNS) improves outcomes for HIV-infected lactating women and their infants.

Design: Randomized, controlled trial.

Setting: Dar es Salaam, Tanzania.

Subjects, participants: Pregnant HIV-infected women enrolled in PMTCT programs who intended to breastfeed for 6 months.

Intervention: Randomization 1:1 to administration of a PCS plus MNS versus MNS alone among 96 eligible women beginning in the third trimester and continuing for 6 months of breast-feeding.

Main outcome measure(s): Primary: infant weight at 3 months. Secondary: maternal BMI at 6 months.

Results: PCS resulted in significant increases in daily energy intake compared to MNS at all time points (range of differences: +388-719 Kcal); and increases in daily protein intake (range of differences: +22-33 gm). Infant birth weight (excluding twins) was higher in the PCS than MNS groups: 3.30 kg vs 3.04 kg (p = 0.04). Infant weight at 3 months did not differ between PCS and MNS groups: 5.63 kg vs 5.99 kg (p = 0.07). Maternal BMI at 6 months did not differ between PCS and MNS groups: 24.3 vs 23.8 kg/m2 (p = 0.68). HIV transmission occurred in 0 infants in the PCS group vs 4 in the MNS group (p = 0.03).

Conclusions: In comparison to MNS the PCS + MNS intervention was well tolerated, increased maternal energy and protein intake, and increased infant birth weight, but not weight at 3 months or maternal BMI at 6 months. Reduced infant HIV transmission in the PCS + MNS group was observed.

Trial registration: Clinical Trials.Gov NCT01461863.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Consort diagram.
Fig 1. Consort diagram.

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