HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.): SECTION A : HIV IN PREGNANCY: Appropriate interventions to reduce mother-to-child transmission: Nutritional interventions

HIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.)

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EXECUTIVE SUMMARY

INTRODUCTION

SECTION A : HIV IN PREGNANCY

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Epidemiology of HIV

Susceptibility of women to HIV infection

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Biological factors

Socio-cultural factors

Effect of pregnancy on the natural history of HIV infection

Effect of HIV infection on pregnancy

Mother-to-child transmission

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Factors affecting mother-to-child transmission of HIV-1

Interventions to prevent mother-to-child transmission of HIV

Appropriate interventions to reduce mother-to-child transmission

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Antiretroviral therapy

Immune therapy

Nutritional interventions

Mode of delivery

Vaginal cleansing

Modification of infant feeding practice

Voluntary HIV counselling and testing in pregnancy

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Testing of antenatal women

Counselling before and after HIV testing in pregnancy

Counselling about pregnancy-related issues

SECTION B : MANAGEMENT OF HIV-POSITIVE PREGNANT WOMEN

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Antenatal care

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Obstetrical management

Examination and investigations

Medical treatment during pregnancy

Antiretroviral therapy

Care during labour and delivery

Postpartum care

Care of neonates

SECTION C : INFECTION CONTROL MEASURES

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Universal precautions

Risks of needlestick injuries

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Management of needlestick injuries and other accidental blood exposure

REFERENCES

Nutritional interventions

Following the finding that mothers with low serum levels of vitamin A were more likely to transmit HIV to their children¹⁹⁵, supplementation of vitamin A has been suggested as a preventive treatment. Several randomized controlled trials of vitamin A and other micronutrients are in progress (Table 3). The potential advantages of micronutrient supplementation would be the low price, possible other nutritional and health benefits for the mother and the fact that the intervention could be implemented simply without the need for HIV testing. Vitamin A deficiency has also been associated with increased viral loads in breast milk, and any reduction following supplementation would also be of benefit in breastfeeding women¹⁵⁹. Other micronutrients such as Zinc and Selenium have also been suggested as possible preventive agents.

A randomized controlled trial in the United Republic of Tanzania showed that multivitamin supplementation in HIV positive pregnant women decreased the risk of low birth weight by 44%, severe preterm birth (under 34 weeks gestation) by 39% and small size for gestational age at birth by 43%. Vitamin A supplementation had no effect on these variables. The multivitamin supplementation, but not vitamin A, resulted in significant increases in CD4+, CD8 and CD3 counts. The effect on mother-to-child transmission in this study has yet to be determined²⁹⁵. Preliminary reports from other vitamin A intervention trials suggest little benefit on transmission from vitamin A supplementation alone.