Macronutrient Supplementation for Malnourished HIV-Infected Adults

Macronutrient Supplementation for Malnourished HIV-Infected Adults: A Review of the Evidence in Resource-Adequate and Resource-Constrained Settings.

Access to antiretroviral therapy for human immunodeficiency virus infection has expanded rapidly throughout sub-Saharan Africa, but malnutrition and food insecurity have emerged as major barriers to the success of antiretroviral therapy programs. Protein-calorie malnutrition (a common form of malnutrition in the region) hastens HIV disease progression, and food insecurity is a barrier to medication adherence. Analyses of patient outcomes have identified a low body mass index after the start of antiretroviral therapy as an independent predictor of early mortality, but the causes of a low body mass index are multifactorial (eg, normal anthropometric variation, chronic inadequate food intake, and/or wasting associated with HIV infection and other infectious diseases). Although there is much information on population-level humanitarian food assistance, few data exist to measure the effectiveness of macronutrient supplementation or to identify individuals most likely to benefit. In this report, Koethe and colleagues review the current evidence supporting macronutrient supplementation for HIV-infected adults and report on clinical trials in resource-adequate and resource-constrained settings, and highlight priority areas for future research.

This excellent review is a must-read for anyone wanting to learn in a nutshell what is known about the effects of malnutrition on HIV disease progression, the causes of increased mortality in malnourished people on antiretroviral treatment, and the advantages and disadvantages of the macronutrient supplements that are readily available now in low- and middle-income countries. The target intake should be 2100 kcal/day for adults increased by a additional 30% of patients with advanced HIV infection. Among the questions for future trials to address are the proportion of daily calories to supply, choice of supplement, duration of supplementation, acceptability and behaviour, logistics, and programme exit criteria.