Two studies were recently performed on HIV infected mothers in Tanzania to determine whether Vitamin A and beta-carotene contributed to an increased viral load in breast milk as well as a higher risk of contracting a breast infection known as (subclinical) mastitis or milk fever.

Both trials were performed on 1 078 HIV-positive women who received one of four different supplements: Vitamin A and beta-carotene, B-complex vitamins and vitamins C and E,

 a multivitamin and Vitamin A or a placebo.In the first study, the proportion of breast milk samples with detectable viral load was significantly higher in a group of 594 women who took regimens with Vitamin A and beta-carotene than in the other groups.

No significant differences were noted between the women who took multivitamins and those who took the placebo.In the second study, the subclinical mastitis of 674 women was assessed by the sodium to potassium ratio in breast milk.

The researchers noted a 45%  increased risk of severe subclinical mastitis - an infection in the breasts that causes swelling, discomfort and pain - in those that took Vitamin A and beta-carotene.Compared to the placebo group, and the women taking the vitamins not containing Vitamin A and beta-carotene, 33%  of the women had a higher risk of subclinical mastitis and 75% had a higher risk of severe subclinical mastitis.

Although for women with CD4+ T-cell counts of more than 350, the use of multivitamins increased their risk of subclinical mastitis by 49%, whereas it had no effect on women with lower counts.Epidemiologist Eduardo Villamor, a member of both study teams said when the breasts become inflamed from mastitis, the inflammatory response leads junctions in the mammary epithelium to open and allow extracellular fluid to flow from plasma to milk, explaining the higher viral load.

Villamor also noted that there are now “strong arguments to consider the implications of supplementation to pregnant or lactating women who are HIV-positive. It does not look like a safe intervention for them.”Most doctors recommend either breastfeeding while taking antiretrovirals or formula feeding, where breastfeeding has the most advantages.

Because the nutrients that the mother consumes make their way into her milk, the correct diet and supplements that mothers need to be taking should be discussed with their health practitioner first.

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