Abstract
ObjectiveSelenium supplementation for women infected with HIV may increase genital shedding of HIV-1, however, to our knowledge, no studies have examined the effect on viral shedding in breast milk. The aim of this study was to determine the effect of selenium supplementation on HIV-1 RNA detection in breast milk of HIV-infected women. MethodsHIV-infected pregnant women enrolled at 12 to 27 wk gestation in a randomized, double-blind, placebo-controlled trial of daily selenium (200 μg as selenomethionine) had cell-free HIV-1 RNA quantified in breast milk at 4 to 9 wk postpartum. All participants received high-dose multivitamins containing vitamin B complex, C, and E as standard of care. ResultsThe proportion of women with detectable (>50 copies/mL) HIV-1 RNA in breast milk appeared to be increased in the selenium group (36.4%) compared with those in the placebo group (27.5%) among the total cohort (N = 420), but results were borderline statistically significant (relative risk [RR], 1.32; 95% confidence interval [CI], 1.00–1.76; P = 0.05). In secondary analyses, the proportion of women with detectable HIV-1 RNA in breast milk was significantly greater in the selenium group (37.8%) compared with placebo group (27.5%) among women who did not receive highly active antiretroviral therapy (HAART; RR, 1.37; 95% CI, 1.03–1.82; P = 0.03). This relationship was primarily due to a significant effect of selenium among primiparous women (RR, 2.24; 95% CI, 1.30–3.86; P < 0.01), but not multiparous women (RR, 1.14; 95% CI, 0.81–1.59; P = 0.54) (P-value for interaction = 0.02). Too few women received HAART in this study (n = 12) to establish the effect of selenium supplementation. ConclusionsSelenium supplementation appears to increase HIV-1 RNA detection in breast milk among primiparous women not receiving HAART. Safety studies among pregnant women on HAART need to be conducted before administering selenium-containing supplements.
Highlights
Micronutrient deficiencies are common in HIV-infected individuals, among pregnant and lactating women due to additional nutritional demands [1]
In this study we examined the effect of selenium supplementation on HIV-1 RNA detection in breast milk at 4–9 weeks postpartum among HIV-infected women enrolled in a randomized clinical trial conducted in Dar es Salaam, Tanzania [3]
Breast milk samples at 4–9 weeks postpartum for detection of HIV-1 RNA were available for 420 women (50.4%)
Summary
Micronutrient deficiencies are common in HIV-infected individuals, among pregnant and lactating women due to additional nutritional demands [1]. Selenium is an essential micronutrient which plays a role in antioxidant defense and supports immune system functioning [2, 3]. Randomized controlled trials determined selenium supplementation may provide modest benefits for HIV-infected adults including decreased diarrhea incidence and hospitalizations and possibly improved survival of children born to HIV-infected pregnant women [1,2,3,4,5]. Selenium supplementation may have some adverse effects. An observational study suggests selenium may increase genital tract shedding of HIV-1 RNA in pregnant women, which may lead to increased mother to child transmission (MTCT) of HIV [6]. No studies have examined the effect of selenium supplements on breast milk shedding of HIV-1 to determine if selenium provision may increase risk MTCT during the breastfeeding period
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