Nutrition supplementation in patients with HIV infection

ABSTRACT

OBJECTIVE: To evaluate the use of high-energy, high protein, oral, liquid, nutrition supplementation and nutrition counselling on the weight status of patients infected with the human immuno-deficiency virus (HIV) with and without secondary infections. DESIGN: prospective, descriptive, intervention trial. Follow-up clinic visits were scheduled every 1 to 3 weeks for at least 6 weeks to monitor weight, gastrointestinal symptoms, number of supplements consumed, and incidence of secondary infections. SUBJECTS/SETTING: community-based, HIV-infected patients, with and without acquired immunodeficiency syndrome (AIDS) defining illness, who were receiving outpatient medical care at Deaconess Hospital, 17 patients were evaluated. INTERVENTION dietary counselling consisted of recommendations to consume a high protein diet (1.5 g/kg ideal body weight); select foods that minimize gastrointestinal complications; and at least one high-energy, high-protein, oral, liquid, nutrition supplement daily. MAIN OUTCOME MEASURES: Energy intake from the supplements and weight change over time in relation to whether a secondary infection occurred. STATISTICAL ANALYSIS: Means, standard deviations, and frequency. RESULTS: At the time of entry to the study, the patients with pre-existing weight loss (16 of 17) were 14 ñ 8 percent below their usual body weight. On average, patients consumed 11 ñ 4 supplements per week for 6 ñ 3 weeks. The majority (12 out of 17) were able to gain or maintain weight. Overall weight gain was 1.1 ñ 2.2 kg. Only 5 of 17 patients lost weight, 4 of whom developed a secondary infection during the study (i.e, after enrollment in the study). All of those who developed a secondary infection were classified as having AIDS and had lower mean CD4 counts at baseline than those who did not develop a secondary infection. Although those who developed a secondary infection had a higher incidence of weight loss, their consumption of oral supplements per week was greater than that of those without a secondary infection. APPLICATIONS/CONCLUSIONS: In patients with HIV infection and in the early stages of AIDS without a secondary infection, weight gain and/or maintenance was achieved with a high-energy, high-protein, oral, liquid, nutrition supplement in conjunction with nutrition counselling. The majority of patients who developed a secondary infection, however, lost weight despite the use of supplements and counselling (AU)