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

Abstract

Access to antiretroviral therapy (ART) for HIV infection has expanded rapidly throughout sub-Saharan Africa, but malnutrition and food insecurity have emerged as major barriers to program success. Protein-calorie malnutrition (a common form 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 (BMI) at ART initiation as an independent predictor of early mortality, but the causes of low BMI are multi-factorial may represent normal anthropometric variation, chronic inadequate food intake, or wasting associated with HIV and other infections. While there is much experience 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; clinical trials in resource-adequate and resource-constrained settings; and highlight priority areas for future research.

Development of a cross-over randomized trial method to determine the acceptability and safety of novel ready-to-use therapeutic foods

“…They do not require any preparation or the addition of water before ingestion [1] and can be stored for long periods without refrigeration. They can be individually packaged and can therefore be used effectively in situations with non-optimal hygiene conditions [1].…”

“…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].…”

Preferences for food and nutritional supplements among adult people living with HIV in Malawi

“…Moreover, HIV infection results in increased resting energy expenditure (by 10-30 %), a faster rate of utilization of amino acids to fuel energy needs, altered fat accumulation and lack of preservation and restoration of lean tissue. Together, these metabolic changes can result in HIV-associated wasting syndrome (body weight loss ≥10 % or BMI <18·5 kg/m 2 ) (1)(2)(3)(4) .…”

“…While access to antiretroviral therapy (ART) has increased in African countries (4,5) and has contributed to improving immune system function and the overall health of people living with HIV (PLHIV) (6) , questions are emerging about how well drugs work in PLHIV if they are food insecure (7) . Studies show that malnutrition and food insecurity remain significant obstacles to treatment and improved outcomes for PLHIV (7)(8)(9) .…”

A qualitative investigation of adherence to nutritional therapy in malnourished adult AIDS patients in Kenya

“…Although the beneficial effects of ART on severe malnutrition in adults are well documented, Carr (5) reported severe toxicity associated with ART in well-nourished individuals, and it has been suggested that side effects may be worse in malnourished individuals (6) .…”