Nutritional interventions for reducing morbidity and mortality in people with HIV

Adequate nutrition promotes and maintains optimal immune function. Dietary support may, therefore, improve clinical outcomes in HIV-infected individuals by reducing the incidence of HIV-associated complications and attenuating progression of HIV disease, thereby improving quality of life and ultimately reducing disease-related mortality.

To evaluate the effectiveness of various macronutrient interventions, such as a balanced diet or high protein, high carbohydrate, or high fat diets given orally, in reducing morbidity and mortality in adults and children living with HIV infection.

We searched CENTRAL (up to March 2006), MEDLINE (1966 to March 2006), EMBASE (1988 to March 2006), LILACS (up to March 2006), and AIDSearch (up to March 2006). We also scanned reference lists of articles and contacted authors of relevant studies and other researchers.

Randomised controlled trials evaluating the effectiveness of macronutrient interventions compared with no nutritional supplements or placebo in the management of adults and children infected with HIV.

Three reviewers independently applied study selection criteria, assessed study quality, and extracted data. Effects were assessed using weighted mean difference and 95% confidence intervals. Meta-analysis employed a fixed-effect model, except when the chi-square test for heterogeneity was significant (p<0.1).

Eight trials (with a total of 486 participants), met the criteria for inclusion in our review. None of the studies reported on mortality, morbidity, or disease progression. Overall, macronutrient supplementation (with or without nutritional counselling) significantly improved energy intake (5 trials; n=254; WMD 367 kcal.day-1; 95% CI: 217 to 516) and protein intake (3 trials; n=128; WMD 17 g.day-1; 95% CI: 8 to 26) compared with no nutritional supplementation or placebo. There was no evidence of an effect on body weight (8 trials; n=423; WMD 0.24 kg; 95% CI: -0.6 to 1.1), fat mass (6 trials; n=305; WMD -0.73 kg; 95% CI: -1.83 to 0.37), fat-free mass (5 trials; n=311; WMD 0 kg; 95% CI: -2.3 to 2.4) or CD4 count (6 trials; n=271; WMD 0.23 cells.mm-3; 95% CI: -40.2 to 40.6).

Given the current evidence base, which is limited to a few small trials in high-income countries, no firm conclusions can be drawn about the effects of macronutrient supplementation on morbidity and mortality in people living with HIV.