Diarrhea and Reduced Levels of Antiretroviral Drugs: Improvement with Glutamine or Alanyl-Glutamine in a Randomized Controlled Trial in Northeast Brazil

Abstract

The effects of therapy with glutamine and alanyl-glutamine on diarrhea and antiretroviral drug levels in patients with acquired immune deficiency syndrome (AIDS) were examined in a randomized, double-blinded, placebo-controlled study in northeast Brazil. Patients with AIDS and with diarrhea and/or wasting were randomized into 4 groups to determine the efficacy of glutamine or high- or low-dose alanyl-glutamine given for 7 days, compared with isonitrogenous glycine given to control subjects. All patients in whom baseline antiretroviral drug levels were determined had low levels 2 h after dosing. Gastrointestinal symptom scores improved with receipt of high-dose alanyl-glutamine (P<.05) or glutamine (P<.01). Antiretroviral drug levels increased in patients given alanyl-glutamine (P=.02) or glutamine (P=.03) by 113% (P=.02) and 14% (P=.01), respectively. Antiretroviral drug resistance mutations were common in all groups. The dose-related efficacy of alanyl-glutamine and glutamine in treating diarrhea and in increasing antiretroviral drug levels shows that these supplements may help to improve therapy for patients with AIDS who have diarrhea and/or wasting in developing, tropical areas.

Risk Factors for Diarrhea in Children Under Five Years of Age Residing in Peri-urban Communities in Cochabamba, Bolivia

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]41 These risk factors were on water, sanitation, hygiene, and knowledge of the causes of childhood diarrheal disease and prevention. All of these variables were obtained from the baseline KPC survey administered to the primary caregiver in each household.…”

“…1 In Bolivia, diarrhea is the third leading cause of morbidity and mortality in children 5 years of age. 1 Diarrhea surveillance from national surveys for the country indicate an alarming rise in the diarrhea prevalence for this age group over time from 19.2% in 1998 to 31.3% in 2008. In Cochabamba, Bolivia, the site of this study, the most recent government survey from 2008 reported a diarrhea prevalence of 36.2% for children 5 years of age for the department.…”

“…In Cochabamba, Bolivia, the site of this study, the most recent government survey from 2008 reported a diarrhea prevalence of 36.2% for children 5 years of age for the department. 2 Previous studies have identified risk factors for diarrhea such as younger age, 3,4 male gender, 4,5 early weaning, 5-8 seasonal patterns, 5,7,9 low maternal education, 5,9,10 lack of piped water supply, 9,[11][12][13][14][15] poor water-storage practices, 9,14-18 younger maternal age, 11,12 lack of hand washing with soap by caregiver, 18,19 poor sanitation, 9,16,18,20,21 visible feces in the yard, 4 indiscriminate disposal of child feces, 17 unsatisfactory garbage disposal, 11 shorter boiling time, 13 using water from cistern trucks, 13 and not treating water in the home. 13 In a recent multisite study it was found that rotavirus was the most common cause of moderate to severe diarrhea in children 0-23 months of age, and shigellosis for the age group 24-59 months of age.…”

Drinking Water Quality, Feeding Practices, and Diarrhea among Children under 2 Years of HIV-Positive Mothers in Peri-Urban Zambia

“…Second, diarrheal disease may lead to intestinal malabsorption so that individuals on antiretroviral therapy (ART) are not acquiring essential nutrients and therapeutic dosages of medications. 5 Third, new mothers who are HIV-positive face a difficult choice to either breastfeed their infants and increase the risk of infecting them with the virus or provide formula or other replacement feeds with potentially unsafe water and increase the risk of diarrhea and other waterborne diseases. 6 Overall, up to16% of infants born to HIVpositive women acquire HIV from breastfeeding alone, accounting for up to 44% of all mother to child HIV transmission.…”

Bacterial and Parasitic Agents of Infectious Diarrhoea in the Era of HIV and AIDS - The Case of a Semi Rural Community in South Africa

“…The sensitivity of detection by PCR is greater than that by microscopy, making it of great use for detection of low numbers of parasites in stool samples (Bialek et al, 2002). PCR for the detection of Cryptosporidium species, for example, has a sensitivity of 93% and a specificity of 95%, compared with 67% and 99%, respectively, for the Direct immunofluorescence assay (DFA) assay and 68% and 58%, respectively, for Enzyme Immuno Assay (EIA) (Bushen et al, 2004;Kar et al, 2011). In addition to identifying protozoa, the use of real-time PCR restriction fragment length polymorphism (RFLP) analysis can detect as few as 5 Cryptosporidium oocysts and can differentiate between 5 genotypes and, more recently, subtypes (Limor et al, 2002).…”