Pilot randomized trial of nutritional supplementation in patients with tuberculosis and HIV–tuberculosis coinfection receiving directly observed short‐course chemotherapy for tuberculosis

Abstract

Summary OBJECTIVE To investigate the effects of nutritional supplementation on the outcome and nutritional status of south Indian patients with tuberculosis (TB) with and without human immunodeficiency virus (HIV) coinfection on anti-tuberculous therapy. METHOD Randomized controlled trial on the effect of a locally prepared cereal–lentil mixture providing 930 kcal and a multivitamin micronutrient supplement during anti-tuberculous therapy in 81 newly diagnosed TB alone and 22 TB–HIV-coinfected patients, among whom 51 received and 52 did not receive the supplement. The primary outcome evaluated at completion of TB therapy was outcome of TB treatment, as classified by the national programme. Secondary outcomes were body composition, compliance and condition on follow-up 1 year after cessation of TB therapy and supplementation. RESULTS There was no significant difference in TB outcomes at the end of treatment, but HIV–TB coinfected individuals had four times greater odds of poor outcome than those with TB alone. Among patients with TB, 1/35 (2.9%) supplemented and 5/42(12%) of those not supplemented had poor outcomes, while among TB–HIV-coinfected individuals, 4/13 (31%) supplemented and 3/7 (42.8%) non-supplemented patients had poor outcomes at the end of treatment, and the differences were more marked after 1 year of follow-up. Although there was some trend of benefit for both TB alone and TB–HIV coinfection, the results were not statistically significant at the end of TB treatment, possibly because of limited sample size. CONCLUSION Nutritional supplements in patients are a potentially feasible, low-cost intervention, which could impact patients with TB and TB–HIV. The public health importance of these diseases in resource-limited settings suggests the need for large, multi-centre randomized control trials on nutritional supplementation.

Effects of social protection on tuberculosis treatment outcomes in low or middle-income and in high-burden countries: systematic review and meta-analysis

“…The other studies (n = 8) occurred in countries out of this category, but referred to as low-income: Malawi 21 Quasi-experimental designs (n = 11) accounted for most of the reviewed studies, followed by RCTs (n = 9) and observational studies (n = 5). Seventeen studies (among then eight RCTs) presented evidences on effects of non-financial interventions for TB patients (lay community health workers or social workers 19,28,31,32,33,34,35 , food assistance 23,27,28,30,36,37 , counselling 22 , "TB clubs" 20 , training programs 26 , social franchising 38 , socio-educational approaches 21 ).…”

“…In this meta-analysis, financial and non-financial interventions also were effective in protecting against default, leading to treatment success. The scope of social protection includes economic support, food security and nutrition 23,27,28,30,36,37 , psychological support and health education approaches 22,26 , social mobilization 35 and training of volunteers to act as patient's supporters 19,28,31,32,33,34 .…”

Treatment of pulmonary tuberculosis

“…An Ethiopian trial [31] investigated whether arginine rich foods (peanuts, equivalent to 1 g of arginine per day) could improve cure rates compared with food with a low-arginine content (wheat crackers) among 180 participants and found no effect on cure rates or any other outcome. Similarly, a pilot trial in India [32] of a cereallentil mixture and a multivitamin supplement in 103 patients on antituberculosis treatment had no effect on completion of treatment.…”

Investigation of nutritional status and body composition in patients with tuberculosis

“…Индийское пилотное рандомизированное иссле дование влияния нутритивной поддержки на эффек тивность лечения и состав тела в смешанной группе больных туберкулезом с ВИЧ инфекцией и без нее (n = 103) показало значимое увеличение массы тела в ходе лечения преимущественно за счет безжиро вой, а не жировой массы [51]. Таким образом, отме чаемое в ряде работ увеличение веса у больных ту беркулезом в ходе лечения, в основном за счет жировой ткани, не является неизбежным.…”

“…В качест ве суррогатного маркера нарушений нутритивного статуса в отечественной фтизиатрии используется ИМТ [3] в сочетании с биохимическими, иммуноло гическими и другими показателями [16,17], а совре менная диагностика базируется на определении компонентного состава тела [7,25,26]. Результаты исследований свидетельствуют о существенных от клонениях параметров состава тела больных тубер кулезом от среднепопуляционных значений [19,43,45] и о связи состава тела с эффективностью лече ния [45,49,51]. Состояние истощения при туберку лезе ассоциировано с одновременным снижением тощей и жировой массы, причем уменьшение тощей массы может быть более выражено в конечностях, а жировой -в туловище [31].…”