Nutritional supplementation has only modest benefits for patients

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[Editors note: The findings of this study is significant. Macronutrient

supplementation did not result in significantly increased weight gain compared

with standard care (including nutritional counseling) among patients with

moderately advanced HIV disease].

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Nutritional Supplementation in HIV©\Infected Individuals in South India: A

Prospective Interventional Study

S. Swaminathan,1

C. Padmapriyadarsini,1

L. Yoojin,3

B. Sukumar,1

S. Iliayas,1

J. Karthipriya,1

R. Sakthivel,1

P. Gomathy,1

B. E. ,1

M. Mathew,2

C. A. Wanke,3 and

P. R. Narayanan1

1Tuberculosis Research Centre, Chennai, and 2World Food Program, New Delhi,

India; and 3Tufts University School of Medicine, Boston, Massachusetts. Clinical

Infectious Diseases 2010;51:51¨C57

Background.Malnutrition in human immunodeficiency virus (HIV)¨Cinfected

individuals is associated with faster disease progression, higher mortality

rates, and suboptimal response to antiretroviral therapy (ART).

Methods.We conducted a prospective interventional study to evaluate the effects

of an oral macronutrient supplement among HIV©\infected adults in South India.

Patients attending Tuberculosis Research Centre clinics from June 2005 through

December 2007 had baseline nutritional assessment and laboratory investigations

performed. Patients at 1 center received nutritional counseling and standard

care, whereas patients at 2 centers additionally received a macronutrient

providing 400 cal and 15 g of protein daily. Study outcomes were changes in

anthropometry, body composition, blood chemistry, and immune status at 6 months.

Results.In total, 636 ART©\naive patients were enrolled in the study; 361

completed 6 months of follow©\up (282 received supplements and 79 received

standard care). Mean age ¡À standard deviation (SD) was years, mean weight ¡À

SD was kg, and 42% were male. Significant increases in body weight, body mass

index, midarm circumference, fat©\free mass, and body cell mass were observed in

the supplement group but not in the control group at 6 months; gains were

greater in patients with CD4 cell counts <200 cells/¦ÌL. No changes were

observed in lipid levels, whereas the CD4 cell count decreased in the control

group. However, after adjusting for baseline differences, these changes were not

statistically significantly different between the groups.

Conclusions. Macronutrient supplementation did not result in significantly

increased weight gain compared with standard care (including nutritional

counseling) among patients with moderately advanced HIV disease. The effect of

supplementation on specific subsets of patients and on preserving immune

function needs further research.

Received 9 October 2009; accepted 12 March 2010; electronically published 28 May

2010.

Reprints or correspondence: Dr Soumya Swaminathan, Dept of Clinical Research,

Tuberculosis Research Centre (ICMR), Mayor V. R. Ramanathan Rd, Chetput, Chennai

600 031, India (doctorsoumya@...).