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
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
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.
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