Fawzi W W, Msamanga G, Hunter D, Urassa E, Renjifo B, Mwakagile D, Hertzmark E, Coley J, Garland M, Kapiga S, Antelman G, Essex M, Spiegelman D
Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
J Acquir Immune Defic Syndr. 2000 Mar 1;23(3):246-54. doi: 10.1097/00126334-200003010-00006.
Observational studies suggest that poor nutritional status among HIV-infected pregnant women is associated with a higher risk of vertical transmission of HIV.
We randomized 1083 pregnant women infected with HIV-1 in a double-blind, placebo-controlled trial to examine the effects of supplements of vitamin A and/or multivitamins (excluding vitamin A) using a 2-x-2 factorial design. We report the effects of the supplements on HIV infection defined using polymerase chain reaction (PCR), or death up to 6 weeks postpartum.
Of babies in the multivitamin arm 38, (10.1%) were HIV-positive at birth compared with 24 (6.6%) in the no-multivitamin arm (relative risk [RR] = 1.54; 95% CI, 0.94-2.51; p = .08). Of babies born to mothers in the vitamin A arm, 38 (10.0%) were HIV-positive at birth compared with 24 (6.7%) in the no-vitamin A arm (RR, 1.49; 95% CI, 0.91-2.43; p = 0.11). Neither multivitamins nor vitamin A had an effect on HIV status at 6 weeks among those who were HIV-negative at birth (RR = 1.04; 95% CI, 0.65-1.66; p = 0.88) and (RR = 1.30; 95% CI, 0.80-2.09; p = .29, respectively). Similarly, neither supplement was associated with being either HIV-infected or dead at birth (RR, 0.98; 95% CI, 0.76-1.27; p = .89 and RR, 1.01; 95% CI, 0.78-1.31; p = .95, respectively. A beneficial effect of multivitamins on birth weight was limited to babies who were HIV-negative at birth; babies in the multivitamin arm weighed +94 g more compared with those in the no-multivitamin arm (p = .02). Among babies who were HIV-positive at birth, the corresponding difference was -31 g (p = .82).
Vitamin A and multivitamins did not affect the risk of vertical transmission of HIV in utero nor during the intrapartum and early breastfeeding periods. Multivitamins resulted in a significant improvement in birth weight of babies who were HIV-negative at birth but had no effect among those who were HIV-positive. The effect of vitamin supplements on HIV transmission through breastfeeding and on clinical progression of HIV disease is yet to be ascertained.
观察性研究表明，感染艾滋病毒的孕妇营养状况不佳与艾滋病毒垂直传播风险较高有关。
我们在一项双盲、安慰剂对照试验中，将1083名感染HIV-1的孕妇随机分组，采用2×2析因设计来研究维生素A和/或多种维生素（不含维生素A）补充剂的效果。我们报告了补充剂对使用聚合酶链反应（PCR）定义的艾滋病毒感染或产后6周内死亡的影响。
多种维生素组的婴儿中，38名（10.1%）出生时艾滋病毒呈阳性，而无多种维生素组为24名（6.6%）（相对风险[RR]=1.54；95%可信区间，0.94 - 2.51；p = 0.08）。维生素A组母亲所生的婴儿中，38名（10.0%）出生时艾滋病毒呈阳性，而无维生素A组为24名（6.7%）（RR = 1.49；95%可信区间，0.91 - 2.43；p = 0.11）。对于出生时艾滋病毒呈阴性的婴儿，多种维生素和维生素A在6周时对艾滋病毒状态均无影响（RR = 1.04；95%可信区间，0.65 - 1.66；p = 0.88）和（RR = 1.30；95%可信区间，0.80 - 2.09；p = 0.29）。同样，两种补充剂均与出生时感染艾滋病毒或死亡无关（RR，0.98；95%可信区间，0.76 - 1.27；p = 0.89和RR，1.01；95%可信区间，0.78 - 1.31；p = 0.95）。多种维生素对出生体重的有益影响仅限于出生时艾滋病毒呈阴性的婴儿；多种维生素组的婴儿比无多种维生素组的婴儿体重重94克（p = 0.02）。在出生时艾滋病毒呈阳性的婴儿中，相应差异为 - 31克（p = 0.82）。
维生素A和多种维生素在子宫内、分娩期及早期母乳喂养期间均未影响艾滋病毒垂直传播风险。多种维生素使出生时艾滋病毒呈阴性的婴儿出生体重显著增加，但对出生时艾滋病毒呈阳性的婴儿无影响。维生素补充剂对通过母乳喂养传播艾滋病毒及艾滋病毒疾病临床进展的影响尚待确定。
