TABLE 1.
Summary of trials on the role of macronutrients and HIV progression in adults1
| Effect on |
|||||||
| First author (reference),country (year) | Study population(no. or % receiving HAART)2 | Nutritional intervention | Control group | CD4 count | Viral load | Survival | Other outcomes |
| Low-income settings | |||||||
| Swaminathan (12), India (2010) | 636 HIV+ patients (∼40%) | 100 mg/d of a mixture of whole-wheat and soybean flour fortified with vitamins A, B-1 (thiamine), B-2 (riboflavin), B-12 and C; niacin; and folate plus standard care3 for 6 mo (nonrandomized) | Standard care alone3 | No significant effect | Not reported | Not reported | No significant changes in weight, BMI, body fat, body cell mass, mid-arm circumference, or concentrations of hemoglobin, albumin, or lipids between the 2 groups. |
| Ndekha (13), Malawi (2009) | 491 HIV+ patients with BMI (in kg/m2) <18.5 (491) | 245 g peanut-based RUFs/d for 3.5 mo | 374 g corn-soy blend/d | No significant effect | No significant effect | No significant effect | Intervention group had significant gains in BMI and MUAC. No significant effect on quality of life, weight gain, or fat-free body mass. |
| Cantrell (14), Zambia (2008) | 636 HIV+ patients (636) | Home-based adherencefollow-up with food supplementation (nonrandomized) | No intervention | No significant effect | Not reported | Not reported | Significantly improved adherence with food supplementation. No significant effect on weight gain. |
| High-income settings | |||||||
| Sattler (15), United States (2008) | 59 HIV+ patients with HIV RNA <5000 copies/mL (56) | High-calorie protein supplement twice daily for 12 wk | Isocaloric control supplement without added protein | Significantly increased | Not reported | Not reported | Significantly increased fasting triacylglycerol in intervention group. No significant difference in total energy intake, weight change, lean body mass, waist-to-hip ratio, waist-to-thigh ratio, or thigh-to-waist-to-hip ratio. |
| Karsegard (16), Switzerland (2004) | 46 HIV+ patients (8) | 10 g monohydrated OKG/d for 12 wk | Isonitrogenous placebo containing milk proteins + nutritional counseling | No significant effect | No significant effect | Not reported | Significantly greater frequency of gastrointestinal symptoms in intervention group. No significant difference in muscle area, fat-free mass, or bodyfat mass. |
| Keithley (17), United States (2002) | 90 HIV+ patients with CD4 counts between 275 and 550 cells/mm3 (unknown) | Group 1: immune-enhancing oral formula group (Advera) for 12 mo + basic nutritional counseling | Basic nutritional counseling alone | No significant effect | Not reported | Not reported | No significant differences in body weight, body cell mass, fat mass, daily caloric intake, or serum albumin. |
| Group 2: standard oral formula (Ensure plus) + basic nutritional counseling | |||||||
| Berneis (19), Switzerland (2000) | 18 HIV+ patients with ≥5% weight loss in past 6 mo or BMI <21 or CD4 count <500 cells/mm3 (unknown) | Oral nutritional supplements + dietary counseling | No nutritional therapy | No significant effect | Not reported | Not reported | Significantly reduced leucine oxidation rate in intervention group. No significant differences in total body weight, lean mass, or fat mass between the 2 groups. |
| Clark (18), United States (2000) | 68 HIV+ patients with >5% weight loss in past 3 mo (68) | Nutrient mixture (HMB/Arg/Gln) for 8 wk | Placebo (maltodextrin) | No significant effect | Significantly decreased | Not reported | Significant increase in body weight, lean body mass, CD3 cells, and CD8 cells, but no difference in fat mass. |
| Rabeneck (20), United States (1998) | 118 HIV+ men who were <90% of usual weight for height or had lost >10% body weight (unknown) | Enteral supplementation with a specialized medium-chain triglyceride formula + nutritional counseling for 6 wk | Nutritional counseling alone | No significant effect | Not reported | Not reported | No significant differences in weight, skinfold thickness, quality of life, fat-free mass, or grip strength. Intervention group had some significantly better cognitive outcomes (short-term recall and long-term storage) but no difference in sum of recall or long-term retrieval. |
1
Results compared the intervention groups with control group; changes within groups over time are not reported. HAART, highly active antiretroviral therapy; HMB, β-hydroxy β-methylbutyrate; MUAC, mid–upper arm circumference; OKG, l-ornithine α-ketoglutarate; RUFs, ready-to-use foods.
2
Single-drug and 2-drug combinations were included in the definition of HAART; status was reported as unknown if sufficient details of regimens were not provided to confirm definition of HAART.
3
Standard care included cotrimoxazole, multivitamins, nutritional counseling, and psychosocial support.