title: Diarrhea and reduced levels of antiretroviral drugs: improvement with glutamine or alanyl-glutamine in a randomized controlled trial in northeast Brazil.
abstract: The effects of therapy with glutamine and alanyl-glutamine on diarrhea and antiretroviral drug levels in patients with acquired immune deficiency syndrome (AIDS) were examined in a randomized, double-blinded, placebo-controlled study in northeast Brazil. Patients with AIDS and with diarrhea and/or wasting were randomized into 4 groups to determine the efficacy of glutamine or high- or low-dose alanyl-glutamine given for 7 days, compared with isonitrogenous glycine given to control subjects. All patients in whom baseline antiretroviral drug levels were determined had low levels 2 h after dosing. Gastrointestinal symptom scores improved with receipt of high-dose alanyl-glutamine (P<.05) or glutamine (P<.01). Antiretroviral drug levels increased in patients given alanyl-glutamine (P=.02) or glutamine (P=.03) by 113% (P=.02) and 14% (P=.01), respectively. Antiretroviral drug resistance mutations were common in all groups. The dose-related efficacy of alanyl-glutamine and glutamine in treating diarrhea and in increasing antiretroviral drug levels shows that these supplements may help to improve therapy for patients with AIDS who have diarrhea and/or wasting in developing, tropical areas.
authors.affiliation: Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Oluma Y
authors.initials: OY
authors.lastname: Bushen
authors.forename: John A
authors.initials: JA
authors.lastname: Davenport
authors.forename: Afonso Bezerra
authors.initials: AB
authors.lastname: Lima
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Piscitelli
authors.forename: Arejas J
authors.initials: AJ
authors.lastname: Uzgiris
authors.forename: Terezinha M J
authors.initials: TM
authors.lastname: Silva
authors.forename: Roberio
authors.initials: R
authors.lastname: Leite
authors.forename: Margaret
authors.initials: M
authors.lastname: Kosek
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Dillingham
authors.forename: Arlete
authors.initials: A
authors.lastname: Girao
authors.forename: Aldo A M
authors.initials: AA
authors.lastname: Lima
authors.forename: Richard L
authors.initials: RL
authors.lastname: Guerrant
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy; D000328:Adult; D019380:Anti-HIV Agents / Q000097:blood* / Q000493:pharmacokinetics; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil; D003967:Diarrhea / Q000188:drug therapy / Q000209:etiology*; D004151:Dipeptides / Q000627:therapeutic use*; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D005973:Glutamine / Q000627:therapeutic use*; D006678:HIV / Q000235:genetics; D019247:HIV Wasting Syndrome / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
chemical_list: D019380:Anti-HIV Agents; D004151:Dipeptides; D005973:Glutamine; C054122:alanylglutamine