title: Pilot randomized trial of nutritional supplementation in patients with tuberculosis and HIV-tuberculosis coinfection receiving directly observed short-course chemotherapy for tuberculosis.
abstract: OBJECTIVE
  To investigate the effects of nutritional supplementation on the outcome and nutritional status of south Indian patients with tuberculosis (TB) with and without human immunodeficiency virus (HIV) coinfection on anti-tuberculous therapy.
  
  
  METHODS
  Randomized controlled trial on the effect of a locally prepared cereal-lentil mixture providing 930 kcal and a multivitamin micronutrient supplement during anti-tuberculous therapy in 81 newly diagnosed TB alone and 22 TB-HIV-coinfected patients, among whom 51 received and 52 did not receive the supplement. The primary outcome evaluated at completion of TB therapy was outcome of TB treatment, as classified by the national programme. Secondary outcomes were body composition, compliance and condition on follow-up 1 year after cessation of TB therapy and supplementation.
  
  
  RESULTS
  There was no significant difference in TB outcomes at the end of treatment, but HIV-TB coinfected individuals had four times greater odds of poor outcome than those with TB alone. Among patients with TB, 1/35 (2.9%) supplemented and 5/42(12%) of those not supplemented had poor outcomes, while among TB-HIV-coinfected individuals, 4/13 (31%) supplemented and 3/7 (42.8%) non-supplemented patients had poor outcomes at the end of treatment, and the differences were more marked after 1 year of follow-up. Although there was some trend of benefit for both TB alone and TB-HIV coinfection, the results were not statistically significant at the end of TB treatment, possibly because of limited sample size.
  
  
  CONCLUSIONS
  Nutritional supplements in patients are a potentially feasible, low-cost intervention, which could impact patients with TB and TB-HIV. The public health importance of these diseases in resource-limited settings suggests the need for large, multi-centre randomized control trials on nutritional supplementation.
authors.affiliation: Department of Medicine, Christian Medical College, Vellore, India. thambu@cmcvellore.ac.in
authors.forename: T D
authors.initials: TD
authors.lastname: Sudarsanam
authors.forename: J
authors.initials: J
authors.lastname: John
authors.forename: G
authors.initials: G
authors.lastname: Kang
authors.forename: V
authors.initials: V
authors.lastname: Mahendri
authors.forename: J
authors.initials: J
authors.lastname: Gerrior
authors.forename: M
authors.initials: M
authors.lastname: Franciosa
authors.forename: S
authors.initials: S
authors.lastname: Gopal
authors.forename: K R
authors.initials: KR
authors.lastname: John
authors.forename: C A
authors.initials: CA
authors.lastname: Wanke
authors.forename: J
authors.initials: J
authors.lastname: Muliyil
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000178:diet therapy* / Q000188:drug therapy; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001823:Body Composition; D003131:Combined Modality Therapy / Q000379:methods; D019587:Dietary Supplements; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D008297:Male; D009753:Nutritive Value; D010865:Pilot Projects; D016896:Treatment Outcome; D014376:Tuberculosis / Q000178:diet therapy* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents