Impact of nutritional supplementation on immune response, body mass index and bioelectrical impedance in HIV-positive patients starting antiretroviral therapy

Abstract

BackgroundChallenges to HIV care in resource limited settings (RLS) include malnutrition. Limited evidence supports the benefit of nutritional supplementation when starting antiretroviral therapy (ART) in RLS.MethodsRandomized controlled pilot study. HIV-positive ART-naive adults with self-reported weight loss were randomized to receive ART plus FutureLife porridge® nutritional supplement (NS) (388 kcal/day) or ART alone (Controls) for 6 months. Patients returned for monthly assessments and blood was drawn at enrolment and 6 months on ART. Differences in body composition, biochemical and laboratory parameters were estimated at 6 months on treatment.ResultsOf the 36 randomized patients, 26 completed the 6 month follow-up (11 NS vs 15 Controls). At enrolment, groups were similar in terms of age, gender, body mass index (BMI) and bioelectrical impedance. NS patients had a lower median CD4 count (60 cells/mm3 [IQR 12–105 vs 107 cells/mm3 [IQR 63–165]; p = 0.149) and hemoglobin (10.3 g/dL [IQR 9.0-11.3] vs 13.1 g/dL [IQR 11.1-14.7]; p = 0.001).At 6 months, NS patients increased their median CD4 count by 151 cells/mm3 [IQR 120–174) vs 77 cells/mm3 [IQR 33–145] in the Controls. NS patients had higher mean percentage change in body weight (12.7% vs 4.9%; p = 0.047), BMI (7.8% vs 5.5%; p = 0.007), absolute CD4 count (83.0% vs 46.4%, p = 0.002) and hemoglobin (9.5% vs 1.0%; p = 0.026). Patients in the NS arm had a higher mean percentage fat-free mass (16.7% vs −3.5%, p = 0.036), total body water (13.0% vs −1.9%, p = 0.026), intracellular water (16.1% vs −4.1%, p = 0.010) and basal metabolic rate (5.3% vs −0.2%, p = 0.014) compared to Controls. Patients in the NS arm also showed an improvement in physical activity at 6 months post-ART initiation compared to Controls (p = 0.037).ConclusionPreliminary results are encouraging and suggest that NS taken concurrently with ART can promote weight gain, improve immune response and improve physical activity in HIV-positive patients that present at ART initiation with weight loss.

Daily consumption of ready-to-use peanut-based therapeutic food increased fat free mass, improved anemic status but has no impact on the zinc status of people living with HIV/AIDS: a randomized controlled trial

“…In a previous study from our laboratory (unpublished data), we showed that Senegalese outpatients PLWH with anemia were not iron deficient according to their plasma ferritin concentration or serum transferrin receptor. In the present study, the prevalence of anemia was and remained high after 9 weeks follow-up in both groups, and these results are similar to those reported by others [14, 16, 35]. The failure of erythropoiesis is generally considered as the primary physiopathological mechanism of anemia in HIV-associated opportunistic infections, micronutrient deficiencies, direct effect of HIV on erythropoiesis and tuberculosis mediated-anemia [36–38].…”

“…Ndekha et al in Malawi showed a significant improvement on body mass index (BMI) and fat free mass in adult PLWH supplemented with 245 g RUTF/d providing 1362 kcal, 35.5 g protein, 78 μg of selenium, and 8 mg of zinc [15]. Recently, in South Africa, Evans et al [16] in a randomized study showed a positive effect of supplementation with a high-protein high-energy meal (100 g equivalent to 388 kcal/d). Others authors have found similar results on body composition using different supplements [14, 17, 18].…”

A Self-Management Framework to Assess the Need for Nutritional Supplementation in People Living with HIV/AIDS

“…Evans et al [73] randomized 38 adults with HIV who were low weight into a group given HAART plus nutritional supplementation and to a HAART-only group. These scholars found that between baseline and the 6-month follow-up, the group that received HAART plus nutritional supplementation demonstrated a greater increase in weight, CD4 T-cell count, and red and white blood cell counts compared with the HAARTonly group.…”

Evaluación nutricional de personas con VIH/SIDA

“…El valor promedio del Índice de masa corporal en las personas con VIH reportado por algunos autores (15) Según las tablas de los percentiles de circunferencia braquial en adultos sanos del sexo masculino, los valores encontrados en este estudio pertenecen a percentiles entre el 10 y el 90, considerado normal (9), lo que puede deberse a que aun con la enfermedad, mantienen un buen estado nutricional y la mayoría tiene una evolución igual o menor a cinco años. Se ha demostrado que los tratamientos actuales permiten elevar la calidad de vida de las personas con sida, lo que pudiera explicar estos resultados (19).…”