A randomized controlled trial evaluating nutrition counseling with or without oral supplementation in malnourished HIV-infected patients.

OBJECTIVE

To evaluate the effects of nutrition counseling with or without oral supplementation in malnourished patients infected with the human immunodeficiency virus (HIV).

DESIGN

Randomized controlled trial.

SUBJECTS

HIV-infected men (n=118) who were less than 90% of usual weight for height or who had lost more than 10% of body weight.

INTERVENTION

Nutrition counseling alone (control group) vs nutrition counseling plus enteral supplementation (supplement group) for 6 weeks. All patients were instructed to consume a diet that exceeded estimated total energy expenditure by 960 kcal/day.

MAIN OUTCOME MEASURES

Weight, skinfold thickness, fat-free mass, grip strength, quality of life, and cognitive function (Buschke test).

STATISTICAL ANALYSES

Differences in baseline variables and outcomes were evaluated using analysis of variance or the Wilcoxon rank sum test.

RESULTS

Ninety-nine men completed at least 4 weeks of treatment, 49 in the supplement group and 50 in the control group. Half the patients in each treatment group achieved at least 80% of their energy target. No differences in weight, skinfold thickness measurements, or quality of life were observed. Compared with the control group, the supplement group had larger increases in fat-free mass and grip strength, although the differences did not reach statistical significance.

APPLICATIONS

In the short term, nutrition counseling with or without oral supplementation can achieve a substantial increase in energy intake in about 50% of malnourished HIV-infected patients. Although further study is needed to evaluate long-term effects, these findings suggest that nutrition counseling has an important role in the management of malnourished HIV-infected patients.