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In HIV-infected populations from developing countries, it is unclear what proportion of anemia is attributable to iron deficiency (ID) and whether high body iron stores worsen HIV disease progression. We therefore evaluated these research questions in 584 HIV-infected Tanzanian women. Hemoglobin (Hb), serum ferritin (SF), serum transferrin receptor (sTfR), and C-reactive protein (CRP) concentrations were evaluated between 13 and 43 wk after women gave birth. ID was defined as SF or sTfR outside normal ranges, and ID anemia (IDA) as ID plus low Hb. In multivariate Cox regression models, the association between SF and HIV disease progression was assessed. Participants received iron + folate supplements during pregnancy. Hb (r = -0.159; P = 0.0001), SF (r = 0.355; P < 0.0001), and sTfR/log SF index (r = -0.119; P = 0.004) were related to CRP, whereas sTfR (r = 0.029; P = 0.48) was not. Prevalence estimates were 39.7% for ID and 23.6% for IDA. ID was associated with 48.9% of anemia cases. Categories of SF were not significantly associated with HIV-related mortality or progression to stage 4. Nevertheless, SF > 150.0 [micro]g/L was related to a nonsignificantly elevated risk of progression to stage 4 (rate ratio = 1.78; 95% Cl = 0.68-4.64; P = 0.24) compared with SF < 12.0 [micro]g/L. In HIV-infected, parous women from sub-Saharan Africa, ID is of moderately high prevalence and is an important underlying cause of anemia. High storage iron does not appear to be related to HIV disease progression in this population, but more research on the role of iron during HIV disease is needed.

A double-blind trial in Tanzania randomly assigned pregnant women who were negative for human immunodeficiency virus (HIV) infection to receive daily multivitamins or placebo. Findings reveal that multivitamin supplementation reduced the incidence of low birth weight and small-for-gestational-age births but had no significant effects on prematurity or fetal death, indicating that multivitamins should be considered for all pregnant women in developing countries.

The effect of depression on HIV disease progression is investigated among HIV-positive Tanzanian women. The results have shown that depression is very common among HIV-infected Tanzanian women and it increases the risk of disease progression.

The relation between cell-free virus (CFV) and cell-associated virus (CAV) in breast milk is analyzed to study the transmission of HIV-1 infections to infants through breast-feeding using the viral RNA and proviral DNA data. The results show that the antiretroviral therapy given to the mother reduces the viral load in plasma and their milk can significantly decrease such transmission.

A study was conducted to examine the association of anemia with mortality and disease progression among a cohort of women with HIV in Dares Salaam, Tanzania. Adjusted models indicated that anemia was associated with an increased risk of all-cause mortality and AIDS-related mortality, independent of CD4 cell count, World Health Organization clinical stage, age, pregnancy, vitamin supplementation, and body mass index.

The association of HIV-1 disease progression with pregnancy and live birth incidence in a cohort of HIV-1-positive women in Dar es Salaam, Tanzania is examined and the other determinants of fertility in this population are identified. Pregnancy and live birth rates decline dramatically with progression of HIV-1 disease.

Hypertension during pregnancy increases fetal growth retardation, preterm deliveries, and perinatal deaths, and yet its causes remain unclear. In HIV-infected women, preterm birth additionally increases the risk of HIV transmission to the infant. Oxidative stress and endothelial cell dysfunction of the placenta have been implicated in the development of hypertension during pregnancy. Vitamin intake can reduce oxidative stress and improve endothelial function. We therefore evaluated the effect of multivitamin (20 mg thiamine, 20 mg riboflavin, 25 mg B-6, 50[mu]g B-12, 500 mg C, 30 mg E, and 0.8 mg folic acid) and vitamin A supplements (30 mg/3-carotene plus 5000 IU preformed vitamin A)in relation to hypertension during pregnancy (systolic blood pressure [greater than or equal to] 140 mm Hg or diastolic blood pressure [less than or equal to] 90 mm Hg at any time during pregnancy). In a double-blind, placebo-controlled, randomized, clinical trial, conducted among 1078 HIV-positive pregnant Tanzanian women, those who received multivitamins were 38% less likely to develop hypertension during pregnancy than those who did not [relative risk (RR) = 0.62, 95% CI 0.40-0.94, P - 0.03]. There was no overall effect of vitamin A on hypertension during pregnancy (RR = 1.00, 95% CI 0.66-1.51, P = 0.98). Hypertension during pregnancy was more likely in women with high baseline systolic blood pressure (>120 vs. [less than or equal to]120 mm Hg) (RR = 6.02, 95% CI 2.59-13.97, P < 0.001), and those with higher mid-upper arm circumference (RR = 1.12, 95% CI 1.04-1.19, P = 0.002). Taking multivitamins containing vitamins B, C, and E during pregnancy may be an inexpensive and effective strategy to improve the health of the mother and baby. KEY WORDS: * multivitamins * hypertension during pregnancy * randomized controlled trial

The association between selenium status during pregnancy and pregnancy outcomes, mother-to-child-transmission (MTCT) of HIV, and child mortality is investigated. The results suggest that adequate selenium status is beneficial for some but not all pregnancy outcomes and that further studies are needed to understand the role of selenium status better.

Wasting during pregnancy, as measured by weight loss and low weight gain, is examined to find whether it is associated with increased mother-to-child transmission (MTCT) of HIV-1. The causes of wasting during pregnancy are identified to find clues for new strategies to prevent MTCT.

HIV-1 infection is having a devastating impact on people in developing countries. Poor nutrition and HIV-related adverse health outcomes contribute to a vicious cycle that may be slowed down by using nutritional interventions, including vitamins and minerals. Among children, periodic supplementation with vitamin A starting at 6 mo of age has been shown to be beneficial in reducing mortality and morbidity among both HIV-infected and uninfected children. Limited data exist on the role of other nutrient supplements among children. Among HIV-infected adults, the safety and the efficacy of vitamin A supplements need further study, although adequate dietary intake of this essential nutrient is recommended. Multivitamin supplements were efficacious in reducing adverse pregnancy outcomes and early childhood infections, and is currently provided to pregnant HIV-infected pregnant women in many programs. The efficacy of such supplements among HIV-negative pregnant women needs further study. Daily multivitamin supplements were found to reduce HIV disease progression among men and women in several observational studies and randomized trials, and to provide an important low-cost intervention that could be provided to adults in early stages of HIV disease to prolong the time before antiretroviral therapy is recommended. Next, research priorities include examining the roles of minerals, including selenium, in HIV infection, as well as determining the safety and the efficacy of micronutrient supplements among individuals who are advanced in their disease and who are receiving antiretroviral therapy. KEY WORDS: * HIV infection * vitamins * zinc * selenium * mortality

Selenium deficiency has been implicated in accelerated disease progression and poorer survival among populations infected with HIV in developed countries, yet these associations remain unexamined in developing countries. Among 949 HIV-1-infected Tanzanian women who were pregnant, we prospectively examined the association between plasma selenium levels and survival and CD4 counts over time. Over the 5.7-y median follow-up time, 306 of 949 women died. In a Cox multivariate model, lower plasma selenium levels were significantly associated with an increased risk of mortality (P-value, test for trend = 0.01). Each 0.1 [micro]mol/L increase in plasma selenium levels was related to a 5% (95% CI = 0%-9%) decreased risk of mortality. Plasma selenium levels were not associated with time to progression to CD4 cell count < 200 cells/[mm.sup.3] but were weakly and positively related to CD4 cell count in the first years of follow up. Selenium status may be important for clinical outcomes related to HIV disease in sub-Saharan Africa. KEY WORDS: * HIV/AIDS * selenium * mortality * CD[4.sup.+] * Tanzania

For pregnant women it is necessary to know their HIV status in order to administer timely treatment to reduce transmission of the virus. The site at which recruitment occurs is a significantly factor in determining a woman's odds of accepting HIV testing.

HIV infection is a global public health problem, particularly in Africa. Concurrently, micronutrient deficiencies and adverse pregnancy outcomes are prevalent in the same settings. Supplements containing B complex and vitamins C and E were efficacious in reducing adverse pregnancy outcomes, including fetal loss, low birth weight, and prematurity among HIV-infected women; the generalizability of this finding to uninfected women is being examined. There is little encouragement from published studies to provide pre-natal vitamin A supplements in HIV infection, particularly in light of significantly higher risk of mother-to-child transmission observed in one trial The efficacy and safety of prenatal zinc and selenium supplements on these outcomes need to be examined in randomized trials. Keywords: HIV, pregnancy, vitamin, zinc, selenium

In a prospective study of 1002 pregnant, HIV-1 infected Tanzanian women, we examined the incidence of fetal death, preterm delivery, low birth weight (LBW), and small for gestational age (SGA) births in relation to maternal anthropometry at the first prenatal visit, weight loss, and low weight gain during pregnancy. Anthropometric measurements were obtained monthly during the 2nd and 3rd trimesters. Low maternal height and weight at the first visit were significantly related to lower mean birth weight and increased risk of SGA, but not to preterm delivery. Maternal stature < 150 cm was significantly related to fetal death. Weight loss during pregnancy, defined as a negative slope of the regression of weight measurements on the week of gestation, occurred in 10% of the women. It was related to increased relative risk (RR) of fetal death (RR = 1.83, 95% CI = 0.93, 3.57), preterm delivery (RR = 1.85, 95% CI = 1.40, 2.44), and LBW (RR = 2.85, 95% CI = 1.69, 4.79) after adjusting for multivitamin supplementation, height, primiparity, baseline weight, malaria, CD4 cell count, HIV disease stage, and intestinal parasitoses. The significant association with fetal death was stronger for weight loss during the 2nd trimester, whereas increased risks of preterm delivery and LBW were higher for weight loss during the 3rd. Similar but weaker associations were found with low weight gain during pregnancy (slope < 25th percentile). We conclude that poor anthropometric status at the first prenatal visit and weight loss during pregnancy among HIV-1 infected women are strong risk factors for adverse pregnancy outcomes. J. Nutr. 134: 1424-1431, 2004. KEY WORDS: * HIV * weight gain during pregnancy * fetal loss * birth weight * preterm delivery

Research has been conducted on HIV-1 transmission via breastfeeding by HIV-infected women in Dar es Salaam, Tanzania. Results demonstrate that the rate of HIV-1 breastfeeding transmission is high and that antiviral drugs given to these mothers may reduce HIV-1 transmission risk through breastfeeding.

Research has been conducted on the predictors of plasma HIV-1 RNA viral load among HIV-1 seropositive pregnant women. Results demonstrate that prevention of malaria among the people living with HIV-1 should be given high priority.

Vitamin supplements do not prevent an HIV-infected pregnant woman from transmitting the virus to her baby. This was the conclusion of a study of 1,083 pregnant women who were randomly assigned to receive a multivitamin, vitamin A alone, or no vitamins.