HIV and the Church

Written by Jeannie Wraight and Mariel Selbovitz, MPH

Approximately 9.7 million people in low and middle-income countries are currently receiving ARVs in an attempt to treat HIV and prevent new infections. Access to ARVs has dramatically decreased the incidence of AIDS related deaths in many African countries. However, despite this advance, one in four people die during the first few months of treatment. Malnutrition plays a large part in these deaths.

A study conducted by The University of Copenhagen Denmark and Jimma University in Ethiopia published in the journal BMJ has shown that a simple nutritional supplement can reverse this statistic.

Researchers studied 318 individuals at three different clinical sites in Ethopia, with body mass indexes greater than 16 who were initiating ARV therapy. Participants were randomized to receive 200 grams of a peanut butter lipid-based supplement with either whey or soy with ARVs or ARVs alone.

Researchers measured body mass index, weight, CD3 cells, grip strength and physical activity (with the use of heart monitors and accelerometer).

Of the study participants 66% were women, the mean age was 33 years and mean BMI was 19.5. After 3 months, those receiving the supplements containing whey or soy saw an increase in lean body mass by 1.87 pounds and 2.3 pounds respectively over the group who did not receive the supplement. Total weight gain for the supplement groups was approximately 4.5 pounds. Those in the whey protein group also saw an increase of CD3 cells of 150 cell/ul. The increase in immune function in the soy group was not significant. More lean body mass was seen in those who had an undetectable viral load at 3 months. An increase in grip strength of 150 pounds in the whey supplement group and 205 pounds in the soy group was seen. No difference was seen in physical activity.

The duration of this study was very short. Longer studies such as this one need to be performed to ascertain whether survival can be increased for people with HIV utilizing nutritional supplements during the initiation of ARVS and before the use of ARVs. In addition, some ARVs should be taken with high fat diets to help absorption and for many ARVs, high fat diet or supplements may prove a cost-effective means for decreasing nausea which could allow for better adherence to new drug regimens.

This is not the first study to show a nutritional supplement could have significant benefit on HIV patients in resource-limited settings.  Laboratory experiments have shown selenium to have an inhibitory effect on HIV in vitro through antioxidant effects of glutathione peroxidase and other selenoproteins. Numerous studies have reported low selenium status in HIV-infected individuals, and serum selenium concentration declines with disease progression. Some cohort studies have shown an association between selenium deficiency and progression to AIDS or mortality. In several randomized controlled trials, selenium supplementation has reduced hospitalizations and diarrheal morbidity, and improved CD4 cell counts.

A study published in 2013 in the Journal of Clinical Investigation suggests that supplementation with pre and probiotics may be beneficial for HIV patients on ARVs after research in an animal model showed promising results.  Led by Jason Brenchley from NIAID, the researchers noted that HIV infection results from GI tract damage, microbial translocation and immune activation, which are not completely addressed by antiretroviral therapy.  “Our data suggest PP treatment may be a useful approach to supplementing ARV therapy in HIV-infected individuals to mitigate residual GI inflammation and damage, thereby potentially having a beneficial impact on morbidity and mortality,” they said.  Other studies have found that probiotic supplementation in HIV patients both on and off therapy has resulted in an increase in CD4 counts, including a study conducted by the AIDS Healthcare Foundation.

Nutritional supplementation represents a cost-effective intervention for addressing HIV infection in both resource-rich and resource-limited settings for patients both receiving and not receiving ART and should be investigated further by publicly sponsored research networks such as the ACTG

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