HIGH-ENERGY, HIGH-PROTEIN, ORAL, LIQUID, NUTRITION SUPPLEMENTATION INPATIENTS WITH HIV-INFECTION - EFFECT ON WEIGHT STATUS IN RELATION TO INCIDENCE OR SECONDARY INFECTION

Objective To evaluate the use of high-energy, high-protein, oral, liqu id, nutrition supplementation and nutrition counsel ing on the weight status of patients infected with the human immunodeficiency virus (HIV ) with and without secondary infections. Design Prospective, descripti ve, intervention trial. Follow-up clinic visits were scheduled every 1 to 3 weeks for at least 6 weeks to monitor weight, gastrointestinal s ymptoms, number of supplements consumed, and incidence of secondary in fections. Subjects/setting Community-based, HIV-infected patients, wit h and without an acquired immunodeficiency syndrome (AIDS) defining il lness, who were receiving outpatient medical care at Deaconess Hospita l. Twenty-two patients enrolled; however, 4 dropped out and 1 died, so 17 were eligible for evaluation. Intervention Dietary counseling cons isted of recommendations to consume a high-protein diet (1.5 g/kg idea l body weight); select foods that minimize gastrointestinal complicati ons; and take at least one high-energy, high-protein, oral, liquid, nu trition supplement daily. Main outcome measures Energy intake from the supplements and weight change over time in relation to whether a seco ndary infection occurred. Statistical analysis Means, standard deviati ons, and frequency. Results At the time of entry to the study, the pat ients with preexisting weight loss (16 of 17) were 14+/-8% below their usual body weight. On average, patients consumed 11+/-4 supplements p er week for 6+/-3 weeks. The majority (12 of 17) were able to gain or maintain weight. Overall weight change was 1.1+/-2.2 kg. Only 5 of 17 patients lost weight, 4 of whom developed a secondary infection during the study (ie, after enrollment in the study). All of those who devel oped a secondary infection were classified as having AIDS and had lowe r mean CD4 counts at baseline than those who did not develop a seconda ry infection. Although those who developed a secondary infection had a higher incidence of weight loss, their consumption of oral supplement s per week was greater than that of those without a secondary infectio n. Applications/conclusions In patients with HIV infection and in the early stages of AIDS without a secondary infection, weight gain and/or maintenance was achievable with a high energy, high-protein, oral, li quid, nutrition supplement in conjunction with nutrition counseling. T he majority of the patients who developed a secondary infection, howev er, lost weight despite the use of supplements and counseling. Use of a high-energy, high-protein oral, liquid, nutrition supplement, with i ntact nutrients, should be the first-line nutrition treatment for maln ourished, HIV-infected patients without secondary infections.