Impact of nutritional supplementation on immune response, body mass index and bioimpedance in HIV-positive patients starting antiretroviral therapy (NuStART)

By  Dr. Denise Evans  Lynne McNamara  Dr Mhairi Maskew  Desiree van Amsterdam   Nicola Baines  Tracey Webster  Professor Ian Sanne  |  | 

Abstract

Background: Challenges to HIV care in resource limited settings (RLS) include malnutrition. Limited evidence supports the benefit of nutritional supplementation when starting antiretroviral therapy (ART) in RLS. Methods: Randomized controlled pilot study. HIV-positive ART-naive adults with self-reported weight loss were randomized to receive ART plus nutritional supplement (NS) (388 kCal/day) or ART alone (controls) for 6 months. Patients returned for monthly assessments and blood was drawn at enrolment and 6 months on ART. Differences in anthropometric, biochemical and laboratory parameters were estimated at 6 months on treatment. Results: Of the 36 randomized patients, 26 completed the 6-month follow-up (11 NS vs 15 controls). At enrolment, groups were similar in terms of age, gender, body mass index (BMI) and bioimpedence indexes. NS patients had a lower median CD4 count (60cells/mm3 [IQR 12-105 vs 107cells/mm3 [IQR 63-165]) and hemoglobin (10.3g/dL [IQR 9.0-11.3] vs 13.1g/dL [IQR 11.1-14.7]). At 6-months, NS patients increased their median CD4 count by 151cells/mm3 [IQR 120-174) vs 77cells/mm3 [IQR 33-145] in the controls. NS patients had higher mean percentage change in body weight (12.7% vs 4.9%; p=0.047), BMI (7.8% vs 5.5%; p=0.007), absolute CD4 count (83.0% vs 46.4%, p=0.002) and hemoglobin (9.5% vs 1.0%; p=0.026). Bioelectrical impedance analysis demonstrated a change in nutritional status in NS patients with a higher mean percentage fat-free mass (16.7% vs -3.5%, p=0.036), total body water (13.0% vs -1.9%, p=0.026), intracellular water (16.1% vs -4.1%, p=0.010) and basal metabolic rate (5.3% vs -0.2%, p=0.014) compared to controls. Conclusion: Preliminary results are encouraging and suggest that NS taken concurrently with ART can promote weight gain, improve immune response and reverse malnutrition.

Conference: SA AIDS 2013, Durban, SA

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