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

Nutrition Journal

Ian Sanne¹  Tracey Webster³  Nicola Baines³  Desiree van Amsterdam³  Katerina Selibas³  Mhairi Maskew²  Lynne McNamara³  Denise Evans² 

[1] Right to Care, Johannesburg, South Africa;Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa;Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

关键词: Treatment outcomes;    Human immunodeficiency virus;    Antiretroviral therapy;    Nutritional supplement;   

Others  :  806001
DOI  :  10.1186/1475-2891-12-111

 received in 2013-04-30, accepted in 2013-07-26,  发布年份 2013

【 摘 要 】

Background

Challenges 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.

Methods

Randomized 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.

Results

Of 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).

Conclusion

Preliminary 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.

【 授权许可】

   
2013 Evans et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Semba RD, Darnton-Hill I, de Pee S: Addressing tuberculosis in the context of malnutrition and HIV coinfection. Food Nutr Bull 2010, 31:S345-S364.
• [2]Friis H: Micronutrient interventions and HIV infection: a review of current evidence. Trop Med & Int Health 2006, 11(12):1849-1857.
• [3]Swaminathan S, Padmapriyadarsini C, Sukumar B, Iliayas S, Kumar SR, Triveni C, Gomathy P, Thomas B, Mathew M, Narayanan PR: Nutritional status of persons with HIV infection, persons with HIV infection and tuberculosis and HIV-negative individuals from southern India. Clin Inf Dis 2008, 46:946-949.
• [4]Kalofonos IP: “All I Eat is ARVs”: The paradox of AIDS treatment in central Mozambique. Med Anthropol Q 2010, 24(3):363-380.
• [5]Oketch JA, Paterson M, Maunder EW, Rollins NC: Too little, too late: Comparison of nutritional status and quality of life of nutrition care and support recipient and non-recipients among HIV-positive adults in KwaZulu-Natal. South Africa. Health Policy 2011, 99:267-276.
• [6]Waterlow JC, Tomkins A, Grantham-McGregor SM: Protein energy malnutrition. London: Edward Arnold; 1992.
• [7]Koethe JR, Jenkins CA, Shepherd BE, Stinnette SE, Sterling TR: An optimal body mass index range associated with improved immune reconstitution among HIV-infected adults initiating antiretroviral therapy. Clin Infect Dis 2011, 53:952-960.
• [8]Wheeler DA, Gilbert CL, Launer CA, et al.: Weight loss as a predictor of survival and disease progression in HIV infection. JAIDS 1998, 18:80-85.
• [9]Koethe JR, Chi BH, Megazzini KM, Heimburger DC, Stringer JSA: Macronutrient supplementation for malnourished HIV-infected adults: a review of the evidence in resource-adequate and resource-constrained settings. Clin Infect Dis 2009, 49:787-798.
• [10]Koethe JR, Heimburger DC: Nutritional aspects of HIV-associated wasting in sub-Saharan Africa. Am J Clin Nutr 2010, 91:1138S-1142S.
• [11]World Health Organisation: Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Geneva: WHO; 1995.
• [12]Lawn S, Harries A, Anglaret X, Myer L, Wood R: Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. AIDS 2008, 22:1897-1908.
• [13]Boulle A, Bock P, Osler M, et al.: Antiretroviral therapy and early mortality in South Africa. Bull World Health Organ 2008, 86:678-687.
• [14]Evans D, Takuva S, Rassool M, Firnhaber C, Maskew M: Prevalence of peripheral neuropathy in antiretroviral therapy naïve HIV-positive patients and the impact on treatment outcomes -a retrospective study from a large urban cohort in Johannesburg. South Africa. J Neurovirol 2012, 18(3):162-171.
• [15]de Pee S, Semba RD: Role of nutrition in HIV infection: review of evidence for more effective programming in resource-limited settings. Food Nutr Bull 2010, 31:S313-S344.
• [16]Meynell J, Barroso J: Bioimpedance analysis and HIV-related fatigue. J Assoc Nurses in AIDS Care 2005, 16(2):13-22.
• [17]Argemi X, Dara S, You S, Mattei JF, Courpotin C, Simon B, Hansmann Y, Christmann D, Lefebvre N: Impact of malnutrition and social determinants on survival of HIV-infected adults starting antiretroviral therapy in resource-limited settings. AIDS 2012, 26:1161-1166.
• [18]Onyango AC, Khakoni M, Mbagaya G, Kakai R: Anthropometric and dietary profile of HIV-sero-positive patients in Chulaimbo sub-district hospital, Kenya. J Pharm Biomed Sci 2011, 1:34-44.
• [19]HIV/AIDS: a guide for nutritional care and support. Fanta Project website. Available at http://www.fantaproject.org/downloads/pdfs/HIVAIDS_Guide02.pdf webcite. Assessed on 08 August 2013
• [20]Tang AM, Forrester J, Spiegelman D, Knox TA, Tchetgen E, Gorbach S: Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2002, 31:230-236.
• [21]Ott M, Fischer H, Polat H, et al.: Bioelectrical impedance analysis predicts as a predictor of survival in patients with human immunodeficiency virus infection. J Acquir Immune Defic Syndr Hum Retrovirol 1995, 9:20-25.
• [22]Schwenk A, Beisenherz A, Römer K, Kramer G, Salzberger B, Elia M: Phase angle from biolectical impedance analysis remains an independent predictive marker in HIV-infected patients in the era of highly active antiretroviral treatment. Am J Clin Nut 2000, 72:496-501.
• [23]Mahlungulu S, Grobler LA, Visser ME, Volmink J: Nutritional interventions for reducing morbidity and mortality in people with HIV. Cochrane Database Syst Rev 2007., 18CD004536
• [24]Cobb and Bland: Nutritional supplementation: the additional costs of managing children infected with HIV in resource-constrained settings. Trop Med Int Health 2013, 18:45-52.
• [25]Fox M, Maskew M, MacPhail A, Long L, Brennan A, Westreich D, MacLeod W, Majuba P, Sanne I: Cohort profile: The Themba Lethu Clinical Cohort, Johannesburg, South Africa. Int J Epidemiol 2013, 42:430-439.
• [26]National Department of Health, Republic of South Africa: Clinical Guidelines for the Management of HIV & AIDS in Adults and Adolescents. Pretoria: South African Department of Health; 2010.
• [27]Swaminathan S, Padmapriyadarsini C, Yoojin L, Sukumar B, Iliayas S, Karthipriya J, Sakthivel R, Gomathy P, Thomas BE, Mathew M, Wanke CA, Narayanan PR: Nutritional supplementation in HIV-infected individuals in South India: A prospective interventional study. Clin Inf Dis 2010, 51:51-57.
• [28]Rudolph M, Kroll F, Beery M, Marinda E, Sobiecki JF, Douglas G, Orr G: A pilot study assessing the impact of a fortified supplementary food on the health and well-being of Crèche children and adult TB patients in South Africa. PLoS 2013, 8:e55544.
• [29]Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O'brien WL, Bassett DR, Schmitz KH, Emplaincourt PO, Jacobs DR, Leon AS: Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc 2000, 32:S498-S516.
• [30]Ogden CL, Flegal KM, Carroll MD, Johnson CL: Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA 2002, 288(14):1728-1732.
• [31]Sattler FR, Rajicic N, Mulligan K, Yarasheski KE, Koletar SL, Zolopa A, Alston Smith B, Zackin R, Bistrian B, ACTG 392 Study Team: Evaluation of high-protein supplementation in weight-stable HIV-positive subjects with a history of weight loss: a randomized, double-blind, multicenter trial. Am J Clin Nutr 2008, 88:1313-1321.
• [32]Fawzi WW, Msamaga GI, Spiegelman D, et al.: A randomized trial of multivitamin supplements and HIV disease progression and mortality. N Engl J Med 2004, 351:23-32.
• [33]de Luis Román DA, Bachiller P, Izaola O, Romero E, Martin J, Arranz M, Eiros Bouza JM, Aller R: Nutritional treatment for acquired immunodeficiency virus infection using an enterotropic peptide-based formula enriched with n-3 fatty acids: a randomized prospective trial. Eur J Clin Nutr 2001, 55:1048-1052.
• [34]van Oosterhout JJ, Ndekha M, Moore E, Kumwenda JJ, Zijlstra EE, Manary M: The benefit of supplementary feeding for wasted Malawian adults initiating ART. AIDS Care 2010, 22:737-742.
• [35]Scarcella P, Buonomo E, Zimba I, Doro Altan AM, Germano P, Palombi L, Marazzi MC: The impact of integrating food supplementation, nutritional education and HAART (Highly Active Antiretroviral Therapy) on the nutritional status of patients living with HIV/AIDS in Mozambique: results from the DREAM Programme. Ig Sanita Pubbl 2011, 67:41-52.
• [36]Salomé MA, Grotto HZ: Human immunodeficiency virus-related anemia of chronic disease: relationship to hematologic, immune, and iron metabolism parameters, and lack of association with serum interferon-gamma levels. AIDS Patient Care STDS 2002, 16:361-365.
• [37]Dunn-Lewis C, Kraemer WJ, Kupchak BR, Kelly NA, Creighton BA, Luk HY, Ballard KD, Comstock BA, Szivak TK, Hooper DR, Denegar CR, Volek JS: A multi-nutrient supplement reduced markers of inflammation and improved physical performance in active individuals of middle to older age: a randomized, double-blind, placebo-controlled study. BMC Nutrition Journal 2011, 10:90. BioMed Central Full Text
• [38]Isolauri E, Sűtas Y, Kankaanpā A, Arvilommi H, Salminen S: Probiotics: effects on immunity. Am J Clin Nutr 2001, 73:444S-450S.
• [39]Schwenk A, Steuck H, Kremer G: Oral supplements as adjunctive treatment to nutritional counseling in malnourished HIV-infected patients: randomized controlled trial. Clin Nutr 1999, 18:371-374.
• [40]Niyabongo T, Bouchard O, Henzel D, Melchior JC, Samb B, Daza MC, et al.: Nutritional status of HIV-1 sero-positive subjects in an AIDS clinic in Paris. Eur J Clin Nutr 1997, 51:637-640.
• [41]Cantrell RA, Sinkala M, Megazinni K, Lawson-Marriott S, Washington S, Chi BH, Tambatamba-Chapula B, Levy J, Stringer EM, Mulenga L, Stringer JS: A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. J Acquir Immune Defic Syndr 2008, 49:190-195.
• [42]Tirivayi N, Koethe JR, Groot W: Clinic-Based Food Assistance is Associated with Increased Medication Adherence among HIV-Infected Adults on Long-Term Antiretroviral Therapy in Zambia. J AIDS Clin Res 2012, 3(7):171.
• [43]Dietary Guidelines Advisory Committee: Part D. Science Bases, Section 3. Discretionary Calories. Nutrition and your health: Dietary Guidelines for Americans. Washington, DC: U.S. Department of Agriculture, Agricultural Research Service; 2010.
• [44]Anema A, Zhang W, Wu Y, Elul B, Weiser SD, Hogg RS, Montaner JS, El Sadr W, Nash D: Availability of nutritional support services in HIV care and treatment sites in sub-Saharan African countries. Public Health Nutr 2012, 15:938-947.