Effects of Vitamin A Supplementation on Viral Load in HIV-1-Infected Pregnant Women

The World Health Organization recommends high-dose vitamin A administration to lactating women in the first 8 postpartum weeks to improve infant nutritional status. Of concern however are reports suggesting that vitamin A supplementation in women infected with HIV-1 may increase the viral load thereby accelerating disease progression and transmission. To investigate this issue plasma samples were obtained from 24 HIV-infected women delivering at King Edward Hospital in Durban South Africa at the time of delivery and 1 week later. Women were enrolled in the study at 28-32 weeks of pregnancy and administered either 5000 IU of retinyl palmitate and 30 mg of beta-carotene (12 women) or a placebo (12 women) until delivery and 200000 IU of retinyl palmitate at delivery to boost the vitamin A content of breast milk. At delivery both the HIV viral load and the mean absolute CD4 counts were lower--but not significantly--in the vitamin A-treated group. A week after vitamin A treatment at delivery there was no increase in viral load in the treatment group but this parameter increased significantly (p = 0.02) in the placebo group. The mean change in viral load was not statistically different between groups however. These preliminary findings confirm the advisability of continuing vitamin A intervention trials to reduce vertical transmission of HIV-1 in developing countries.