Randomized trial of vitamin supplements in relation to transmission of HIV-1 through breastfeeding and early child mortality

Wafaie W. Fawzi, Gernard I. Msamanga, David Hunter, Boris Renjifo, Gretchen Antelman, Heejung Bang, Karim Manji, Saidi Kapiga, Davis Mwakagile, Max Essex, Donna Spiegelman

Research output: Contribution to journalArticlepeer-review

167 Scopus citations


Background: HIV-1 transmission through breastfeeding is a global problem and has been associated with poor maternal micronutrient status. Methods: A total of 1078 HIV-infected pregnant women from Tanzania were randomly assigned to vitamin A or multivitamins excluding A from approximately 20 weeks' gestation and throughout lactation. Results: Multivitamins excluding A had no effect on the total risk of HIV-1 transmission (RR 1.04, 95% Cl 0.82-1.32, P= 0.76). Vitamin A increased the risk of transmission (RR 1.38, 95% Cl 1.09-1.76, P = 0.009). Multivitamins were associated with non-statistically significant reductions in transmission through breastfeeding, and mortality by 24 months among those alive and not infected at 6 weeks. Multivitamins significantly reduced breastfeeding transmission in infants of mothers with low baseline lymphocyte counts (RR 0.37; 95% Cl 0.16-0.85, P = 0.02) compared with infants of mothers with higher counts (RR 0.99, 95% Cl 0.68-1.45, P = 0.97; P-for-interaction 0.03). Multivitamins also protected against transmission among mothers with a high erythrocyte sedimentation rate (P-for-interaction 0.06), low hemoglobin (P-for-interaction 0.06), and low birthweight babies (P-for-interaction 0.04). Multivitamins reduced death and prolonged HIV-free survival significantly among children born to women with low maternal immunological or nutritional status. Vitamin A alone increased breastfeeding transmission but had no effect on mortality by 24 months. Conclusion: Vitamin A increased the risk of HIV-1 transmission. Multivitamin (B, C, and E) supplementation of breastfeeding mothers reduced child mortality and HIV-1 transmission through breastfeeding among immunologically and nutritionally compromised women. The provision of these supplements to HIV-infected lactating women should be considered.

Original languageEnglish (US)
Pages (from-to)1935-1944
Number of pages10
Issue number14
StatePublished - Sep 27 2002
Externally publishedYes


  • Breastfeeding
  • Death
  • HIV infection
  • Pregnancy
  • Tanzania
  • Vertical transmission
  • Vitamin

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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