Human immunodeficiency virus (HIV) attacks the immune system that severely compromises a person’s ability to ward of infections and other diseases (1). When the virus has progressed to a stage where the body is no longer able to fight the infection, the individual will be diagnosed with Acquired Immunodeficiency Syndrome (AIDS). Transmission occurs through the person to person contact, more specifically in cases where the virus is transmitted into the recipient’s bloodstream. Vertical transmission, or mother to child transmission, presents a unique route of infection where the mechanisms differ to horizontal transmission (all other forms of HIV transmission). In mother to child transmission, ...view middle of the document...
In the absence of treatment, vertical transmission can be as high as 30-45% and in Sub-Saharan Africa, 500,000 infants acquire HIV-1 annually (2). Antiretroviral Therapy (ART) requires a high degree of compliance in order to truly contain HIV (6). Yet many individuals receiving treatment are unable to follow the strict regimen of drugs which compromises the treatments effectiveness (6). In developing countries, access is often an issue as many people live in remote areas. What is of particular concern is when conflict or natural disasters force displacement of peoples into Internally Displaced Peoples camps or Refugee camps. In these situations, it is very hard to reach people with ART (5). When living in close quarters to others, and being uprooted from their traditional villages and families, HIV+ individuals are reluctant to identify themselves fearing stigmatization. In Africa, a common drug used is Nevirapine (NVP), but studies show that adults taking NVP were twice as likely to discontinue treatment (OR 2.2, 95% confidence interval 1.9-2.6) (6).
The malnutrition infection cycle is especially applicable in the context of HIV infection as micronutrient deficiencies can increase the rate of infection and progression of a disease which further leads to nutritional deficiencies (7,8). Because this is a cycle it isn’t always clear whether certain micronutrient deficiencies are actually indicators or markers of the HIV-1 progression, or whether the dietary deficiency has caused the disease to progress (figure 1) (9).
Fig 1: Malnutrition-Disease Cycle. Reprinted from “Micronutrients and HIV Infection: A Review of Current Evidence” by H. Friis, WHO: Department of Nutrition for Health and Development. 2005.
Due to the aforementioned factors, it is important to not focus solely on HAART to combat vertical transmission. Instead, exploring micronutrients and the roles they can play in reducing transmission is crucial for the health of infants in the developing world. Micronutrients may be used alongside HAART or in settings with a high prevalence of HIV-1 infections, where individual status is often not known or not identified.
While HAART has been around for more than a decade, it hasn’t been widely implemented in the developing world (10). Previous WHO recommendations were to start ARVs when the CD4 cell count was 350 cells/mm3, but new 2013 recommendations have increased that number to 500 cells/mm3. The 2013 recommendations include having all pregnant women who are HIV-1 serum positive take a combination of ARVs, regardless of CD4 cell count. By controlling the viral load and its effect on CD4 cell count, you minimize the risk to the foetus and infant (figure 2) (2,8). Identified trials that used Nevarapine during delivery to reduce the rate of vertical transmission, were included in this paper as use of a single ARV has been shown to be less effective than a combination of ARVs or HAART (2,3,4,5).
Fig 2: The Relationship between viral...