The effect of antenatal vitamin A and beta-carotene supplementation on gutintegrity of infants of HIV-infected South African women

Background: Vitamin A is important for protection against diarrhea, and sup plements may benefit gut function of infants of HIV-infected mothers. Methods: We studied 238 infants of HIV-infected South African women partici pating in a randomized, double-blind, placebo-controlled trial of vitamin A during pregnancy (1.5 mg retinyl palmitate and 30 mg beta -carotene daily) plus 60 mg retinyl palmitate at delivery. The placebo group received ident ical placebo capsules at the same times. When infants were 1, 6, and 14 wee ks of age, lactulose/mannitol dual sugar intestinal permeability tests were performed. Results: Maternal vitamin A supplementation did not significantly affect in fant gut permeability in the group as a whole at any time. By multiple regr ession analysis, HIV infection of the infant by 14 weeks was significantly associated with increased gut permeability at both 6 and 14 weeks. After co ntrolling for birth weight, gestational age, current weight, feeding mode a nd recent morbidity, there was a trend toward an interaction between vitami n A supplementation and HIV infection (P =0.086) at 14 weeks. Vitamin A mad e no difference to gut permeability of uninfected infants (lactulose/mannit ol ratio for vitamin A group: 0.11, 95% confidence interval [Cl] 0.08, 0.15 , n = 73 and for placebo group: 0.09, 95% CI0.06, 0.12, n = 76), but largel y prevented the increase in the ratio of HIV-infected infants (vitamin A gr oup: 0.17, 95% CI0.13, 0.23, n = 23; placebo group: 0.50, 95% CI 0.37, 0.68 , n = 20). The effects on the lactulose/mannitol ratio were related to chan ges in lactulose, not mannitol, excretion. Vitamin A supplementation was as sociated with significantly lower lactulose excretion at 1 and 14 weeks, su ggesting the major effect of vitamin A was on maintaining the integrity of gut tight junctions. Conclusions: Vitamin A supplementation of HIV-infected pregnant women may p revent the deterioration in gut integrity in the subgroup of their infants who themselves become infected. Improving vitamin A status of HIV-infected infants may decrease their gastrointestinal morbidity.