Roughly 25 million Africans live with HIV, many of who now have access to antiretroviral drugs (ARVs). Among their side effects, ARVs can cause patients to put on weight. Subsequently, attention paid to malnutrition among African HIV patients has waned. However, widespread malnutrition has been identified as a reason that up to a quarter of HIV patients in a number of African countries die just months after beginning medical treatment.
A collaborative project between the University of Copenhagen and Jimma University, Ethiopia has demonstrated that daily nutritional supplementation for the first three months of ARV treatment vastly improves the condition of HIV patients:
"Patients added three times as much weight as those who took ARVs without the nutritional supplement. And, in contrast to the medication-only group, the supplement takers didn't just add fat – a third of their increased weight came from added muscle mass. Furthermore, grip strength improved, and thereby the ability of patients to manage work and typical daily tasks," according to PhD Mette Frahm Olsen, one of the project researchers and together with Alemseged Abdissa, the main author of the BMJ article.
The results also reported effects upon the immune system:
"The immune system cell types typically supressed by HIV were restored more quickly in those patients who received a whey protein nutritional supplement. Therefore, the effects of the supplement were measurable, and very relevant for HIV patients living in countries where malnourishment is common," continues Mette Frahm Olsen.
For three months, patients received a daily supplement of 200 grams of peanut butter to which soy or whey protein, along with other vitamins and minerals, was added. The advantage of the supplement is that it is incredibly rich in energy and low in water content, allowing it to be better preserved in warm climates. The supplement was originally developed for severely malnourished children, but modified for the research project to satisfy the needs of adults living with HIV.
Medication induced weight gain has no benefit
Prior to ARV medication, HIV was characterised by massive weight loss that made the role of nutrition impossible to ignore. But today, the significance of a nutritious diet in conjunction with HIV treatment is often forgotten:
"We know that malnutrition fuels the AIDS epidemic, in part because poor nutrition facilitates the virus' attack on the human immune system. But today, the significance of nutrition is often ignored because patients gain weight while being treated with ARVs. As a result, a patient's doctor may believe, mistakenly, that the patient's nutritional state has been normalised. However, if the patient has not had a nutritious diet, the weight increase may be without benefit and consist mainly of fat," says PhD Mette Frahm Olsen.
The research project also demonstrated that it is possible to integrate a daily nutritional supplement into the lives of Ethiopian patients without disrupting cultural, social and religious practices regarding diet, as well as when and with whom eating takes place.