title: Macronutrient supplementation for malnourished HIV-infected adults: a review of the evidence in resource-adequate and resource-constrained settings.
abstract: Access to antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has expanded rapidly throughout sub-Saharan Africa, but malnutrition and food insecurity have emerged as major barriers to the success of ART programs. Protein-calorie malnutrition (a common form of malnutrition in the region) hastens HIV disease progression, and food insecurity is a barrier to medication adherence. Analyses of patient outcomes have identified a low body mass index after the start of ART as an independent predictor of early mortality, but the causes of a low body mass index are multifactorial (eg, normal anthropometric variation, chronic inadequate food intake, and/or wasting associated with HIV infection and other infectious diseases). Although there is much information on population-level humanitarian food assistance, few data exist to measure the effectiveness of macronutrient supplementation or to identify individuals most likely to benefit. In this report, we review the current evidence supporting macronutrient supplementation for HIV-infected adults, we report on clinical trials in resource-adequate and resource-constrained settings, and we highlight priority areas for future research.
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. john.r.koethe@vanderbilt.edu
authors.forename: John R
authors.initials: JR
authors.lastname: Koethe
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.forename: Karen M
authors.initials: KM
authors.lastname: Megazzini
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Heimburger
authors.forename: Jeffrey S A
authors.initials: JS
authors.lastname: Stringer
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic; D019049:Developed Countries; D003906:Developing Countries; D019587:Dietary Supplements; D018450:Disease Progression; D005523:Food Supply; D005526:Food, Formulated; D015658:HIV Infections / Q000453:epidemiology; D019247:HIV Wasting Syndrome / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control*; D006295:Health Resources; D006801:Humans; D011204:Poverty Areas; D011502:Protein-Energy Malnutrition / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control*