Probiotics, soluble fiber, and L-Glutamine (GLN) reduce nelfinavir (NFV)- or lopinavir/ritonavir (LPV/r)-related diarrhea.
OBJECTIVE
Highly active antiretroviral therapy (HAART) can be associated with diarrhea and other gastrointestinal (GI) side effects. Reducing these side effects may improve treatment durability and quality of life (QOL). This study assessed the impact of nutritional co-therapies known to reduce diarrhea in HIV-positive men treated with nelfinavir (NFV)- or lopinavir/ritonavir (LPV/r)-containing regimens.


METHODS
Thirty-five HIV-positive men treated with NFV (n = 27) or LPV/r (n = 8) with diarrhea (> or = two liquid stools/day [d]) participated in a 12-week prospective study. Twenty-eight subjects were randomly assigned supplements (S), seven received standard of care (C). Group S received probiotics (1.2g/d) and soluble fiber (11g/d). If diarrhea persisted at week 4, 30g/d L-Glutamine (GLN) was added. Diarrhea incidence, as well as supplement and antidiarrheal use, was assessed monthly.


RESULTS
Weight, CD4 count, and HIV RNA were unchanged in both groups. Diarrhea completely resolved in 10 of 28 (36 percent) S subjects. The mean (+/-SD) number of stools/d declined [3.40+/-1.25 to 2.54+/-1.34 (p < 0.01)]. Diarrhea (loose, watery stools/d) lessened in S from 2.84+/-1.42 to 0.74+/-1.03 (p < 0.0001). Fifteen S subjects did not obtain full relief with probiotics and fiber, but stools/d decreased from 4.08+/-1.35 to 3.06+/-1.68 (p < 0.05) after starting GLN. In C, stools/d, 4.14+/-4.86 to 3.44+/-1.68(p = 0.678) and incidence of diarrhea/d, 3.00+/-4.82 to 1.36+/-1.29 (p= 0.361) was unchanged. In S, loperamide use decreased from 1.69+/-2.34 to 0.31+/-0.69 mg/d (p < 0.01); 18 versus eight subjects used loperamide at 0 and 12 weeks, respectively.


CONCLUSIONS
Probiotics, soluble fiber, and GLN significantly reduced diarrhea for subjects receiving NFV or LPV/r. Nutritional co-therapies show clinical benefit in HIV-positive men with diarrhea.
Heiser
Carla R
CR
Center for Functional Nutrition, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.
Ernst
Judith A
JA
Barrett
James Tom
JT
French
Neel
N
Schutz
Malte
M
Dube
Michael P
MP
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D003967:Diarrhea / Q000139:chemically induced / Q000145:classification / Q000517:prevention & control*; D004043:Dietary Fiber / Q000627:therapeutic use*; D005973:Glutamine / Q000627:therapeutic use*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D061466:Lopinavir; D008297:Male; D019888:Nelfinavir / Q000008:administration & dosage / Q000009:adverse effects*; D019936:Probiotics / Q000008:administration & dosage / Q000627:therapeutic use*; D011744:Pyrimidinones / Q000008:administration & dosage / Q000009:adverse effects*; D011788:Quality of Life; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D004043:Dietary Fiber; D017320:HIV Protease Inhibitors; D011744:Pyrimidinones; D005973:Glutamine; D061466:Lopinavir; D019888:Nelfinavir; D019438:Ritonavir