title: A randomized trial of ready-to-use supplementary food versus corn-soy blend plus as food rations for HIV-infected adults on antiretroviral therapy in rural Haiti.
abstract: BACKGROUND
  The epidemics of food insecurity, malnutrition, and human immunodeficiency virus (HIV) frequently overlap. HIV treatment programs increasingly provide nutrient-dense ready-to-use supplementary foods (RUSFs) to patients living with HIV and food insecurity, but in the absence of wasting, it is not known if RUSF confers benefit above less costly food commodities.
  
  
  METHODS
  We performed a randomized trial in rural Haiti comparing an RUSF with less costly corn-soy blend plus (CSB+) as a monthly supplement to patients with HIV infection who were on antiretroviral therapy (ART) <24 months prior to study start. We compared 6- and 12-month outcomes by ration type in terms of immunologic response, body mass index (BMI), adherence to ART, general health quality of life, household food insecurity, and household wealth.
  
  
  RESULTS
  A cohort of 524 patients with HIV receiving ART was randomized and followed over time. Median CD4 cell count at baseline was 339 cells/µL (interquartile range [IQR], 197-475 cells/µL) for the CSB+ group, and 341 cells/µL (IQR, 213-464/µL) for the RUSF group. Measured outcomes improved from baseline over time, but there were no statistically significant differences in change for BMI, household wealth index, hunger, general health perception score, or adherence to ART by ration type at 6 or 12 months. The RUSF group had higher CD4 count at 12 months, but this was also not statistically significant.
  
  
  CONCLUSIONS
  In 12 months of follow-up, there was no statistically significant difference in outcomes between those receiving RUSF-based compared with CSB+-based rations in a cohort of HIV-infected adults on ART in rural Haiti.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Ivers
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Teng
authors.forename: J Gregory
authors.initials: JG
authors.lastname: Jerome
authors.forename: Matthew
authors.initials: M
authors.lastname: Bonds
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: Molly F
authors.initials: MF
authors.lastname: Franke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D015331:Cohort Studies; D004032:Diet / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D006205:Haiti; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000628:therapy*; D055118:Medication Adherence; D008875:Middle Aged; D011788:Quality of Life; D012424:Rural Population; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; food insecurity; food security; macronutrient supplement; nutrition