Dept of Clinical Research, Tuberculosis Research Centre, Chennai, India.
Clin Infect Dis. 2010 Jul 1;51(1):51-7. doi: 10.1086/653111.
Malnutrition in human immunodeficiency virus (HIV)-infected individuals is associated with faster disease progression, higher mortality rates, and suboptimal response to antiretroviral therapy (ART).
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.
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 +/- standard deviation (SD) was 31 +/- 7 years, mean weight +/- SD was 50 +/- 10 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/microL. 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.
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.
人类免疫缺陷病毒（HIV）感染者的营养不良与疾病进展更快、死亡率更高以及抗逆转录病毒治疗（ART）反应不佳有关。
我们进行了一项前瞻性干预研究，以评估印度南部 HIV 感染成人中口服宏量营养素补充剂的效果。2005 年 6 月至 2007 年 12 月期间，患者在结核病研究中心就诊，进行了基线营养评估和实验室检查。1 个中心的患者接受营养咨询和标准护理，而另外 2 个中心的患者则额外接受每日提供 400 卡路里和 15 克蛋白质的宏量营养素补充剂。研究结果是 6 个月时人体测量学、身体成分、血液化学和免疫状况的变化。
共有 636 名未接受 ART 的患者参加了该研究；361 名完成了 6 个月的随访（282 名接受了补充剂，79 名接受了标准护理）。平均年龄（+/-标准差）为 31（+/-7）岁，平均体重（+/-标准差）为 50（+/-10）公斤，42%为男性。在 6 个月时，补充组的体重、体重指数、上臂中部周长、无脂肪量和身体细胞量均显著增加，但对照组没有增加；CD4 细胞计数<200 个/微升的患者增加幅度更大。脂质水平没有变化，而对照组的 CD4 细胞计数下降。然而，在调整了基线差异后，两组之间的这些变化没有统计学意义。
与标准护理（包括营养咨询）相比，宏量营养素补充剂并未导致中度晚期 HIV 疾病患者体重显著增加。补充剂对特定亚组患者和维持免疫功能的效果需要进一步研究。
