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Objective To examine the relationships between maternal knowledge and concern about HIV status, adoption of preventive practices and risk of acquiring HIV in Zimbabwe. Methods Knowledge and behavioural data were collected via interview from 2595 mothers enrolled in ZVITAMBO, a randomized trial of postpartum vitamin A supplementation that also offered education on safer infant feeding and sexual practices. Mothers were tested for HIV at delivery; those uninfected at baseline were retested during study follow-up. Logistic regression methods were used to identify variables associated with adoption of preventive behaviours and, for HIV-negative mothers, their relationship to risk of acquiring HIV post-delivery. Results A total of 518 mothers (20%) reported practicing safer sex and 289 mothers (11%) reported modifying their feeding behaviour because of HIV. Fear of transmitting HIV (50.4%) and protecting the baby's health (30.9%) were the most frequently cited reasons for behaviour change. Forty-nine HIV-negative mothers acquired HIV during the first postpartum year. After taking into account other significant covariates, mothers who were concerned about their own HIV status were 1.9 times more likely (95% CI: 1.05–3.52; P = 0.03), and those reporting safer sex practices were 58% less likely to become infected (adjusted odds ratio: 0.42; 95% CI: 0.17–1.04; P = 0.06). Married women who reported practicing abstinence to prevent HIV were 3.2 times more likely to become infected than non-abstaining mothers ( P = 0.01), while there were no new HIV infections among abstaining single mothers. Conclusions Greater emphasis should be given to safer sex practices among women who test negative in mother-to-child HIV prevention programmes. [ABSTRACT FROM AUTHOR]

Objectives: The relationship between Fe status and HIV infection is complex and poorly understood. While anaemia is a major complication of HIV infection, higher Fe stores may be associated with disease progression. There is limited and conflicting data available from Africa. Design: Cross-sectional and prospective cohort study. Setting, subjects and methods: We examined the association between postpartum Fe status (Hb, serum ferritin (SF) and transferrin receptor (TfR)) and viral load (VL) and HIV-related mortality in 643 HIV-positive Zimbabwean women over a period of 12 months. Results: In non-anaemic women a log10 increase in SF was associated with a 2·3-fold increase in VL (P=0·019); this association was absent in anaemic women. In prospective analyses, a log10 increase in SF was associated with a 4-fold increase in mortality by 12 months (P=0η002). Hb was negatively associated with VL (P=0·001) and mortality (P=0·047). The adverse associations between SF and both VL and mortality were found at SF concentrations >45 μg/l (P<0·05). Controlling for α1 acid glycoprotein, a marker of inflammation, attenuated the association between both SF and VL and mortality, but these remained significant. Conclusions: These results are consistent with the hypothesis that high Fe stores have adverse consequences in HIV infection. If adverse consequences are real, our data suggest that they occur at SF concentrations exceeding those consistent with adequate Fe nutriture. [ABSTRACT FROM AUTHOR]

Objectives:The acute phase response (APR) influences indicators of iron status. A recent WHO/CDC consultation recommended concurrent measurement of α-1-acid-glycoprotein (AGP) in surveys to control for the APR, and aid in interpreting iron status. They proposed further exploratory analyses using AGP. We examined whether the APR (measured by AGP) influences the expected relationships between iron status indicators in an HIV-infected population.Subjects:We measured hemoglobin (Hb), serum ferritin (SF), transferrin receptor (TfR), erythropoietin (EPO) and AGP in a cross-sectional survey of 643 HIV-positive Zimbabwean women.Results:SF was significantly higher in APR-positive (AGP>1 g/l) women (P<0.001), in whom there was no association between SF and Hb. TfR was inversely associated with Hb, in both APR-positive and APR-negative women (P<0.001). However, among anemic women (Hb<110 g/l), APR-positive women had marginally lower TfR concentrations (P=0.053). There was no difference in EPO response to decreasing Hb among APR-positive and APR-negative women.Conclusions:AGP captured the influence of the APR on iron indicators and their relationships with each other. The APR influenced SF and its relationship with Hb as expected. TfR behaved unexpectedly. Although TfR has been promoted as an iron indicator that is uninfluenced by the APR, TfR concentrations were depressed among anemic APR-positive women. Because TfR reflects iron deficiency and erythropoietic activity, pro-inflammatory cytokines associated with the APR may be inhibiting erythropoeisis, which is reflected by lower TfR concentrations. We support the WHO/CDC recommendation that AGP is a useful indicator to assess the influence of the APR on iron status indicators.European Journal of Clinical Nutrition (2009) 63, 787–793; doi:10.1038/ejcn.2008.33; published online 28 May 2008 [ABSTRACT FROM AUTHOR]