A review of nutrition in human immunodeficiency virus infection in the era of highly active antiretroviral therapy

Abstract

Background: Nutrition complications of HIV infection, including wasting syndrome, nutrient deficiencies, and metabolic complications, have been well documented over the last 25 years.

Methods: A systematic review of the literature was performed using the keywords HIV; nutrition; nutrition support; vitamins A, B, C, and E; selenium; zinc; and glutamine through MEDLINE using Medscape and PubMed.

Results: Although no accurate prediction equations exist for determining energy needs in patients with HIV/acquired immunodeficiency syndrome (AIDS), the Harris-Benedict equation with a 1.3 stress factor has been used for weight maintenance. Some experts recommend protein requirements of 1.0 to 1.4 g/kg for maintenance and 1.5 to 2.0 g/kg for anabolism. There is a general consensus that all individuals with HIV benefit from a daily multivitamin and mineral supplement at levels of 100% of the US recommended daily intake (RDI). Nutrition therapy for HIV wasting is similar to that for other chronic diseases and begins with nutrition counseling. For persistent weight loss, standard oral supplements may be useful. The benefit of specialized supplements has yet to be proven. Enteral and parenteral nutrition support has produced positive outcomes related to mortality and quality of life in patients with HIV.

Conclusions: Although the benefit of providing adequate amounts of calories, protein, and micronutrients for persons with HIV is well accepted, the exact amounts of nutrients and optimal feeding modalities are less clear. Long-term clinical trials are needed to provide more conclusive data on nutrition intervention in HIV infection, particularly related to supplementation of specific nutrients.