Levels of Β-Carotene, Iron and Zinc Among Hiv Positive Pregnant Women on Anti-Retroviral Therapy in Molo Sub-County, Kenya

Since Kenya recorded its first HIV case in 1984, AIDS epidemic has emerged to be one of the central impediments to national health. It has deepened poverty; slowed economic growth; reduced life expectancy; worsened other infectious diseases, with the harshest effects experienced by women. The HIV prevalence rate in Molo sub-county stands at 5.9%. However, there has been no documentation about antiretroviral therapy (ART) performance in relation to nutritional status of people living with HIV and AIDS. Micronutrient status of a pregnant woman is an important determinant of foetal growth and survival, and deficiencies of micronutrients can alter pregnancy outcome. The study was aimed at determining levels of β-carotene, iron and zinc among HIV positive pregnant women on ART in Molo sub-county in the context of pregnancy and HIV. A descriptive longitudinal study design was used. The sample size was 222 HIV positive expectant women. HIV – 1 RNA assay (bDNA) was done to determine viral load. The CD4 count was assessed by the use of four colour flow cytometer (BD FACS Caliber). Socio-economic and food preferences were determined using a questionnaire. Serum levels of Zinc were measured by flame atomic absorption spectrophotometry and Iron by photometric colorimetric test with lipid clearing factor (LCF). Sera concentrations of βcarotene was quantified by reversed-phased HPLC. The ARVs were given to all the women at appropriate time during their routine visits at the clinic. The overall mean CD4 counts at onset were 186 cell/μL, by midterm it was 301 cells/μL and increased to 349/μL at end term. The paired sample T-Test of CD4 count at end term and at onset was significant (p= 0.00). The mean viral load at the onset was 67374 copies/μL. This decreased to 8427 copies/μL at midterm and decreased further to 6062 copies/μL at end term with Wilcoxon signed-rank test statistic showing a statistically significant change (reduction) in viral load at end term as compared to onset (Z = -13.964, P = 0.000). Spearman's correlations were weak and non-significant between serum nutrient concentration and CD4 counts or viral. The CD4 counts and viral loads at onset and at end term were found to be inversely correlated (p<0.001; r = -0.5934), indicating that as CD4 count increased, viral load decreased. Either CD4 counts or viral loads were predictive of the benefits of ART. The mean level of serum β-carotene increased from 70.5283 μg/dL at onset to 95.849 μg/dL at end term. Mean Iron levels also increased from 36.887 μg/dL at onset to 42.167 μg/dL at end term. Mean Zinc levels on the other hand increased slightly from 54.133 μg/dL at onset to 55.632 μg/dL end term. The percentage concentrations for below recommended to recommended values increased from 20.7% to 38.3% in β-carotene and from 41.4% to 53.2% in but in Iron, those with below recommended levels increased from 56.8% at onset to 59.9% at end term. These findings stress the importance of the inclusion of functional periodic evaluation of serum nutrients in infected HIV expectant mothers, but confirms importance of ARVs in management of HIV in pregnant mothers. In addition, from this study, nutrition has a role in management of HIV and AIDS and probably supports the view that malnutrition is a major factor in HIV and AIDS progression. Therefore, expectant mothers living with HIV and AIDS should be supplemented or fed with foods rich in these micronutrients.