Macronutrient Supplementation for Malnourished HIV-Infected Adults: A Review of the Evidence in Resource-Adequate and Resource-Constrained Settings

Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
Clinical Infectious Diseases (Impact Factor: 9.42). 10/2009; 49(5):787-98. DOI: 10.1086/605285
Source: PubMed

ABSTRACT Access to antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has expanded rapidly throughout sub-Saharan Africa, but malnutrition and food insecurity have emerged as major barriers to the success of ART programs. Protein-calorie malnutrition (a common form of malnutrition in the region) hastens HIV disease progression, and food insecurity is a barrier to medication adherence. Analyses of patient outcomes have identified a low body mass index after the start of ART as an independent predictor of early mortality, but the causes of a low body mass index are multifactorial (eg, normal anthropometric variation, chronic inadequate food intake, and/or wasting associated with HIV infection and other infectious diseases). Although there is much information on population-level humanitarian food assistance, few data exist to measure the effectiveness of macronutrient supplementation or to identify individuals most likely to benefit. In this report, we review the current evidence supporting macronutrient supplementation for HIV-infected adults, we report on clinical trials in resource-adequate and resource-constrained settings, and we highlight priority areas for future research.

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Available from: Douglas C Heimburger, Jul 29, 2015
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    • "Over the last 10 years, the World Health Organization (WHO) and other international organizations have issued recommendations that nutritional assessment, counseling, and support be a standard part of comprehensive care for HIV (FANTA, 2004; World Bank, 2007; World Health Organization, 2008). While research generally finds a positive effect of supplemental feeding on the nutritional status and HIV outcomes of underweight PLHIV (Koethe, Chi, Megazzini, Heimburger, & Stringer, 2009; Tirivayi & Groot, 2011), providing food support to overweight or obese PLHIV may result in further weight gain even if food security improves (Larson & Story, 2011; Leroy, Gadsden, de Cossío, & Gertler, 2013), putting PLHIV at risk for chronic comorbidities such as diabetes and cardiovascular disease. With data from a pilot intervention study in Honduras, we investigated how food support combined with nutrition education influences food security and body weight, compared to nutrition education alone, in a population with high food insecurity and diverse nutritional statuses. "
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    ABSTRACT: Optimal strategies to improve food security and nutrition for people living with HIV (PLHIV) may differ in settings where overweight and obesity are prevalent and cardiovascular disease risk is a concern. However, no studies among PLHIV have investigated the impact of food support on nutritional outcomes in these settings. We therefore assessed the effect of food support on food insecurity and body weight in a population of PLHIV with high prevalence of overweight and obesity. We implemented a pilot intervention trial in four government-run HIV clinics in Honduras. The trial tested the effect of a monthly household food ration plus nutrition education (n = 203), compared to nutrition education alone (n = 197), over 12 months. Participants were clinic patients receiving antiretroviral therapy (ART). Assessments were obtained at baseline, 6 and 12 months. Primary outcomes for this analysis were food security, using the validated Latin American and Caribbean Food Security Scale and body weight (kg). Thirty-one percent of participants were overweight (22%) or obese (8%) at baseline. At 6 months, the probability of severe food insecurity decreased by 48.3% (p < 0.01) in the food support group, compared to 11.6% in the education-only group (p < 0.01). Among overweight or obese participants, food support led to average weight gain of 1.13 kg (p < 0.01), while nutrition education alone was associated with average weight loss of 0.72 kg (p < 0.10). Nutrition education alone was associated with weight gain among underweight and normal weight participants. Household food support may improve food security but not necessarily nutritional status of ART recipients above and beyond nutrition education. Improving nutritional tailoring of food support and testing the impact of nutrition education should be prioritized for PLHIV in Latin America and similar settings.
    AIDS Care 11/2014; 27(4):1-7. DOI:10.1080/09540121.2014.983041 · 1.60 Impact Factor
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    • "They can be individually packaged and can therefore be used effectively in situations with non-optimal hygiene conditions [1]. RUTFs are popular in feeding programs [2], including human immunodeficiency virus/tuberculosis (HIV/TB) interventions [1] [3], because their use has been associated with an increase in successful treatment rates for severe acute malnutrition (SAM) when compared to other conventional treatments [4]. However, at present, the high price of RUTFs and their low regional availability hampers widespread use [5]. "
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    ABSTRACT: OBJECTIVE: To develop a method for determining the acceptability and safety of ready-to-use therapeutic foods (RUTF) before clinical trialing. Acceptability was defined using a combination of three consumption, nine safety, and six preference criteria. These were used to compare a soy/maize/sorghum RUTF (SMS-RUTFh), designed for the rehabilitation of human immunodeficiency virus/tuberculosis (HIV/TB) wasted adults, with a peanut-butter/milk-powder paste (P-RUTF; brand: Plumpy'nut) designed for pediatric treatment. METHODS: A cross-over, randomized, controlled trial was conducted in Kenya. Ten days of repeated measures of product intake by 41 HIV/TB patients, >18 y old, body mass index (BMI) 18-24 kg·m(-2), 250 g were offered daily under direct observation as a replacement lunch meal. Consumption, comorbidity, and preferences were recorded. RESULTS: The study arms had similar age, sex, marital status, initial BMI, and middle upper-arm circumference. No carryover effect or serious adverse events were found. SMS-RUTFh energy intake was not statistically different from the control, when adjusted for BMI on day 1, and the presence of throat sores. General preference, taste, and sweetness scores were higher for SMS-RUTFh compared to the control (P < 0.05). Most consumption, safety, and preference criteria for SMS-RUTFh were satisfied except for the average number of days of nausea (0.16 versus 0.09 d) and vomiting (0.04 versus 0.02 d), which occurred with a higher frequency (P < 0.05). CONCLUSION: SMS-RUTFh appears to be acceptable and can be safely clinically trialed, if close monitoring of vomiting and nausea is included. The method reported here is a useful and feasible approach for testing the acceptability of ready-to-use foods in low income countries.
    Nutrition 09/2012; 29(1). DOI:10.1016/j.nut.2012.04.016 · 3.05 Impact Factor
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