June 16, 2014
Taking whey- or soy-based nutritional supplements during the first three to six months of starting treatment may improve weight, lean body mass and grip strength, according to results from a study conducted in three HIV clinics in Ethiopia. Additionally, taking whey-based supplements may improve CD8 and CD4 cell gains, while taking soy-based supplements does not appear to affect CD8 and CD4 counts.
The study followed 318 people starting antiretroviral therapy (ART). Participants were randomized to receive 200 g of whey- or soy-based supplements daily for three months, either immediately upon ART initiation or three months after starting HIV therapy, or a placebo.
At the start of the trial, study participants had a body mass index (BMI) of at least 16 kg/m2 (moderate thinness, according to the World Health Organization [WHO]), with a mean BMI of 19.5 kg/m2 (within normal range per WHO). Two thirds of those studied were women, and the average age of the entire cohort was 33. All participants received nutritional counseling per Ethiopia's national guidelines.
According to the researchers, prior studies have shown that a low BMI at the start of ART is associated with a higher risk of mortality, with some indication that people responded better to supplementation after their initial inflammation had been controlled. Additionally, whey is known to increase plasma glutathione, an antioxidant that is often deficient in those infected with HIV.
Adherence to supplementation was higher among those for whom supplements were delayed for three months compared to the groups that received supplements immediately.
The researchers found that those who took nutritional supplements gained more than three times as much weight as those without supplements, in addition to substantially increasing their lean body mass (LBM). At three months, study participants in the whey supplement group had gained 0.85 kg more in LBM than those in the control group, while participants in the soy supplement group had gained 0.93 kg more.
Weight gain was greater in the delayed supplementation groups (1.20 kg higher total body weight within six months compared to the early supplementation groups), which is only partly explained by better adherence in those groups (estimated weight gain, adjusted for adherence: 0.99 kg).
However, functional outcome, as determined by grip strength, was poorer in the delayed supplementation groups (-0.84 kg compared to 0.68 kg and 0.97 kg in the whey- and soy-based early supplementation groups, respectively).
Patients with an undetectable viral load after three months also gained more LBM than those who did not respond as well to ART. In addition, those in the whey supplement group gained on average 25 CD4 cells/µL and 112 CD8 cells/µL more than the control group.
After the trial ended, Ethiopia changed its national guidelines to recommend up to six months of nutritional supplements for all HIV-positive individuals with a BMI below 18.5 kg/m2. Those recommendations have, however, proven difficult to implement, with more than 70% of those eligible stopping supplementation early.
"It is now important to investigate how barriers to large scale supplementation can be overcome to achieve effectiveness of nutritional supplementation for patients with HIV," the researchers concluded.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.