A comparative study: long and short term effect of a nutrition sensitive approach to delay the progression of HIV to AIDS among people living with HIV (PLWH) in Nigeria

Abstract

Background: Malnutrition has a negative impact on optimal immune function, thus increasing susceptibility to morbidity and mortality among HIV positive patients. Evidence indicates that the prevalence of macro and micronutrient deficiencies (particularly magnesium, selenium, zinc, and vitamin C) has a negative impact on optimal immune function, through the progressive depletion of CD4 T-lymphocyte cells, which thereby increases susceptibility to morbidity and mortality among PLWH. Objective: To assess the effectiveness of a nutrition sensitive intervention to delay the progression of human immune-deficiency virus (HIV) to AIDS among people living with HIV in Abuja, Nigeria.Methods: A randomised control trial was carried out on 400 PLWH (adult, male and female of different religious background) in Abuja, Nigeria between January and December, 2012. Out of these 400 participants, 100 were randomly selected for the six months pilot study (January to June, 2012). The participants in the pilot study overlapped to form part of the scale-up participants (n 400) monitored from June to December, 2012. The comparative effect of daily consumed 354.92 kcal/d optimised meal for six and twelve months was ascertained through the nutritional status and biochemical indices of the study participants (n 100 pilot and n 400 scale-up interventions) who were/were not taking the intervention meal. The meal consisted of: Glycine max 50g; Pennisetum americanum 20g; Moringa oleifera 15g; Daucus carota spp.sativa 15g.Results: At the end of six months of the scale-up intervention, mean CD4 cell count (cell/mm3) for Pre-ART and ART Test groups increased by 6.31% and 12.12% respectively. Mean mid upper arm circumference (MUAC) for Pre-ART and ART Test groups increased by 2.72% and 2.52% within the same period (n 400). Comparatively, participants who overlapped from pilot to scale-up intervention (Long term use, n 100) were assessed for 12 months. Mean CD4 cell count (cell/mm3) for Pre-ART and ART Test groups increased by 2.21% and 12.14%. Mean MUAC for Pre-ART and ART Test groups increased by 2.08% and 3.95% respectively. Moreover, Student’s t-test analysis suggests a strong association between the intervention meal, MUAC and CD4 count on long term use of optimised meal in the group of participants on antiretroviral therapy (ART) (P<0.05). Conclusion: Although the achieved results take the form of specific technology, it suggests that a prolong consumption of the intervention meal will be suitable to sustain the gained improvements in the anthropometric and biochemical indices of PLWHIV in Nigeria. Keywords: HIV; AIDS; Nutrition-sensitive approach; CD4 cell count; Macro and Micronutrients; ART; Tailored Functional Recipe - TFR.

The effects of nutritional supplementation on body mass index and CD4 count among adult people living with HIV AIDS on antiretroviral treatment in Conakry, Guinea

“…This finding echoes what multiple other studies in Africa and elsewhere have found. 3 , 8 , 19 , 21 , 23 This finding underscores the need for including nutritional assistance as part of a comprehensive strategy for promoting healthy outcomes among PLHIV on treatment. Another important finding from this study is that after controlling for intervention status and other variables associated with metabolic and immunological functions the lagged values of BMI and CD4 (at time of treatment initiation) are the strongest predictors of the current values.…”

“…Many of the studies that have contributed to this improved understanding come from African countries. 5 , 14 , 19 The World Health Organization has long acknowledged the importance of adequate nutrition for PLHIV and made specific recommendations about increased calorie intake as the disease progresses. 20 Nutrition-based interventions are becoming increasingly common in the care and support of PLHIV and have been found to be effective in Africa and other settings.…”

“…20 Nutrition-based interventions are becoming increasingly common in the care and support of PLHIV and have been found to be effective in Africa and other settings. 3 , 8 , 19 , 21 , 22 For example, in their study in Abuja, Amlogu, Tewfik found that provision of a nutritional functional meal made from locally available ingredients increase CD4 count by 40.8 cells/mm 3 compared to a decrease of 18.12 cells/mm 3 in the control group after a period of six months. Similarly in a double-blinded randomized control trial found an increase of 65 cells in the mean absolute CD4 count in the group that received micronutrient supplement compared to a decrease of 6 cells in the control group after 12 weeks of intervention.…”

Supplementation of Optimum Nutrient-Dense Formula to Modulate HIV Infection in Resource Limited Settings

“…Nutrition interventions for PLHIV which are based on formulating nutrient-dense meals are innovative, culturally relevant, reliable and requiring low-tech approaches in order to assure compliance, sustainability and cost-effectiveness [15,16]. It is possible to improve the nutritive value of local foods through simple but scientific combinations of food ingredients in form of tailored functional recipes [TFR].…”

Dietary diversity and impact of Moringa oleifera Lam. leaves supplemented – Diet on the nutritional status and CD4 cell counts of patients receiving antiretroviral therapy in Nigeria: A double - Blind randomized trial

“…Several studies reported on the importance of nutritional supplementation in PLHIV [ 12 , 13 , 14 ]. Evans et al.…”