Antiretroviral therapy provided to HIV-infected Malawian women in a randomized trial diminishes the positive effects of lipid-based nutrient supplements on breast-milk B vitamins

Abstract

Background: Little information is available on B vitamin concentrations in human milk or on how they are affected by maternal B vitamin deficiencies, antiretroviral therapy, or maternal supplementation.

Objective: The objective was to evaluate the effects of antiretroviral therapy and/or lipid-based nutrient supplements (LNSs) on B vitamin concentrations in breast milk from HIV-infected women in Malawi.

Design: Breast milk was collected from 537 women recruited within the Breastfeeding, Antiretrovirals, and Nutrition study at 2 or 6 wk and 24 wk postpartum. Women were assigned to receive antiretrovirals and LNSs, antiretrovirals only, LNSs only, or a control. Antiretrovirals and LNSs were given to the mothers from weeks 0 to 28. The antiretrovirals were zidovudine/lamivudine and nelfinavir or lopinavir/ritonavir. LNSs provided 93-118% of the Recommended Dietary Allowances of thiamin, riboflavin, niacin, pyridoxine, and vitamin B-12. Infants were exclusively breastfed.

Results: LNSs increased milk concentrations of all vitamins except thiamin, whereas antiretrovirals lowered concentrations of nicotinamide, pyridoxal, and vitamin B-12. Although antiretrovirals alone had no significant effect on riboflavin concentrations, they negatively affected the LNS-induced increase in this vitamin. Thiamin was not influenced by the study interventions. Concentrations of all B vitamins were much lower than usually accepted values.

Conclusions: All B vitamins were low in milk, and all but thiamin were increased by maternal supplementation with LNSs. Antiretrovirals alone decreased concentrations of some B vitamins in milk. When LNS was given in addition to antiretrovirals, the negative effect of antiretrovirals offset the positive effect of LNSs for all vitamins except thiamin. This trial was registered at clinicaltrials.gov as NCT00164762.

Keywords: B vitamins; antiretrovirals; breast milk; human milk; ultraperformance liquid chromatography tandem mass spectrometry.

© 2015 American Society for Nutrition.

Figures

FIGURE 1

Relative mean concentrations and 95% CIs of B vitamins in the treatment groups. Main effects (LNS − no LNS; ARV – no ARV) and interactions between LNS, ARV, and time were tested by mixed-model repeated-measures ANOVA. No interactions with time were significant. Significant main effects of LNS: **P < 0.01, ***P < 0.001. Significant main effects of ARVs: ++P < 0.01, +++P < 0.001. §Significant ARV × LNS interaction: pairwise comparisons were adjusted for multiple comparisons with Tukey-Kramer’s test, LNS significantly increased riboflavin concentrations (P < 0.0001 when compared with the control and ARV groups; P = 0.015 when compared with the ARV + LNS group), and no significant differences were observed between the 3 remaining groups. Control group: n = 177; LNS group: n = 185; ARV group: n = 85; ARV + LNS group: n = 91. ARV, antiretroviral; LNS, lipid-based nutrient supplement.