Nahaskida Alain, Somé Jérome W, Gutema Befikadu Tariku, Pauwels Nele S, De Henauw Stefaan, Abbeddou Souheila
Département de la Nutrition, Direction de la Nutrition et des Technologies Alimentaires, Ndjamena, Chad.
Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
PLoS One. 2025 Jun 3;20(6):e0319843. doi: 10.1371/journal.pone.0319843. eCollection 2025.
HIV/AIDS may cause malnutrition, both directly and indirectly, through common infections. This systematic review and meta-analysis aim to evaluate the effects of nutritional interventions on nutritional status, immunological status, adherence to antiretroviral treatment (ART), and food security among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs).
Five databases-MEDLINE, Embase, Scopus, Web of Science, and CENTRAL-were searched for articles on August 17, 2021, with an updated search conducted on September 30, 2023 to identify new records. Studies were considered eligible if they included adults living with HIV/AIDS who recently initiated ART, if they were controlled trials that provided nutritional interventions, and if they assessed the relevant nutritional, immunological and adherence outcomes. The effects of nutritional interventions were analyzed using a random-effects model.
The systematic review comprised 22 articles from 12 LMICs, while the meta-analysis included 19 articles. The interventions provided lipid-based nutrient supplements, corn-soy blends, food baskets, conditional cash, prepared meals, micronutrient supplementation, and functional foods to PLWHA. Compared to controls, nutritional interventions for PLWHA significantly improved their body mass index (standardized mean difference, 95% confidence interval) (SMD 0.42; 95% CI: 0.03, 0.81; p = 0.03), fat mass (SMD 0.21; 95% CI: 0.07, 0.34; p = 0.002), fat-free mass (SMD 0.33; 95% CI: 0.19, 0.46; p < 0.0001), and CD4 (SMD 0.54; 95% CI: 0.01, 1.07; p = 0.05), but had no effect on their weight, viral load, or adherence to ART. The baseline nutritional and immunological characteristics of PLWHA, as well as the intervention characteristics, further modified these effects.
Nutritional interventions improved some nutritional and immunological indicators but not ART adherence among PLWHA. Additionally, their effects were modified by some baseline characteristics and the type and duration of interventions which require consideration before its scaling up.
艾滋病毒/艾滋病可能直接或通过常见感染间接导致营养不良。本系统评价和荟萃分析旨在评估营养干预对低收入和中等收入国家（LMICs）艾滋病毒/艾滋病感染者（PLWHA）营养状况、免疫状况、抗逆转录病毒治疗（ART）依从性和粮食安全的影响。
于2021年8月17日在五个数据库——MEDLINE、Embase、Scopus、科学引文索引和Cochrane系统评价数据库中检索文章，并于2023年9月30日进行更新检索以识别新记录。如果研究纳入了最近开始接受抗逆转录病毒治疗的艾滋病毒/艾滋病成年感染者，是提供营养干预的对照试验，并评估了相关的营养、免疫和依从性结果，则被认为符合纳入标准。使用随机效应模型分析营养干预的效果。
系统评价纳入了来自12个低收入和中等收入国家的22篇文章，荟萃分析纳入了19篇文章。干预措施为艾滋病毒/艾滋病感染者提供了基于脂质的营养补充剂、玉米大豆混合食品、食品篮、有条件现金、预制餐、微量营养素补充剂和功能性食品。与对照组相比，对艾滋病毒/艾滋病感染者的营养干预显著改善了他们的体重指数（标准化均值差，95%置信区间）（SMD 0.42；95%CI：0.03，0.81；p = 0.03）、脂肪量（SMD 0.21；95%CI：0.07，0.34；p = 0.002）、去脂体重（SMD 0.33；95%CI：0.19，0.46；p < 0.0001）和CD4细胞计数（SMD 0.54；95%CI：0.01，1.07；p = 0.05），但对他们的体重、病毒载量或抗逆转录病毒治疗依从性没有影响。艾滋病毒/艾滋病感染者的基线营养和免疫特征以及干预特征进一步改变了这些效果。
营养干预改善了艾滋病毒/艾滋病感染者的一些营养和免疫指标，但没有提高其抗逆转录病毒治疗依从性。此外，其效果因一些基线特征以及干预的类型和持续时间而有所不同，在扩大干预规模之前需要加以考虑。
