High-energy, high-protein, oral, liquid, nutrition supplementation in patients with HIV infection: effect on weight status in relation to incidence of secondary infection.
OBJECTIVE
to evaluate the use of high-energy, high-protein, oral, liquid, nutrition supplementation and nutrition counseling on the weight status of patients infected with the human immunodeficiency virus (HIV) with and without secondary infections.


METHODS
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.


METHODS
Community-based, HIV-infected patients, with and without an acquired immunodeficiency syndrome (AIDS) defining illness, who were receiving outpatient medical care at Deaconess Hospital. Twenty-two patients enrolled; however, 4 dropped out and 1 died, so 17 were eligible for evaluation.


METHODS
Dietary counseling consisted of recommendations to consume a high-protein diet (1.5 g/kg ideal body weight); select foods that minimize gastrointestinal complications; and take at least one high-energy, high-protein, oral, liquid, nutrition supplement daily.


METHODS
Energy intake from the supplements and weight change over time in relation to whether a secondary infection occurred.


METHODS
Means, standard deviations, and frequency.


RESULTS
At the time of entry to the study, the patients with preexisting weight loss (16 of 17) were 14+/-8% below their usual body weight. On average, patients consumed 11+/-4 supplements per week for 6+/-3 weeks. The majority (12 of 17) were able to gain or maintain weight. Overall weight change was 1.1+/-2.2 kg. Only 5 of 17 patients lost weight, 4 of whom developed a secondary infection during the study (ie, 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.


CONCLUSIONS
In patients with HIV infection and in the early stages of AIDS without a secondary infection, weight gain and/or maintenance was achievable with a high-energy, high-protein, oral, liquid, nutrition supplement in conjunction with nutrition counseling. The majority of the patients who developed a secondary infection, however, lost weight despite the use of supplements and counseling. Use of a high-energy, high-protein, oral, liquid, nutrition supplement, with intact nutrients, should be the first-line nutrition treatment for malnourished, HIV-infected patients without secondary infections.
Stack
J A
JA
Surgical Metabolism Laboratory, Deaconess Hospital, Cancer Research Institute, Boston, MA,02215, USA.
Bell
S J
SJ
Burke
P A
PA
Forse
R A
RA
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D001835:Body Weight; D004044:Dietary Proteins / Q000008:administration & dosage; D004045:Dietary Services; D002149:Energy Intake; D005500:Follow-Up Studies; D005527:Food, Fortified; D015658:HIV Infections / Q000150:complications / Q000178:diet therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies
D004044:Dietary Proteins