Oral supplements as adjunctive treatment to nutritional counseling in malnourished HIV-infected patients: randomized controlled trial

Abstract

Aims: To compare nutritional counseling with and without oral supplements in HIV-infected patients with recent weight loss.

Design: Randomized non-blinded controlled trial, stratified for change in antiretroviral treatment at baseline.

Patients: HIV-infected patients with recent weight loss (> 5% of total, and >3% in the last month).

Intervention: Nutritional counseling to increase dietary intake by 600 kcal/day over 8 weeks; in group A (n=24) by normal food, and in group B (n=26) by a range of fortified drink supplements with a calorific value of 0.6 to 1.5 kcal/ml.

Methods: Body composition by bioelectrical impedance analysis, dietary intake by 24 h recall.

Results: Fat free mass increased from baseline to week 8 (P<0.05) with no difference between groups A and B (P=0.97). Body cell mass and weight gain were not significant and equal between groups. Assessed at weeks 2 and 4, group B patients consumed 11 +/- 6 kcal/kg as supplements, and their total energy intake was 6 kcal/kg higher than in group A (P<0.01). Total energy intake was not different between groups at weeks 6 and 8.

Discussion: Nutritional counseling and oral supplements are both feasible methods to restore food energy intake in malnourished HIV-infected patients. Although normal food intake is partially replaced, oral supplements may improve the adherence to a weight gain regimen.