The study by National Institute for Research in Tuberculosis had about 282 patients getting macronutrient supplement at Tuberculosis Research Centre clinics in Chennai and Madurai for six months. It showed not just significant improvement in nutritional parameters, but also that the CD4 cell count of these patients remained stable, indicating their immunity was being maintained. The patients who took part in the study were were not on antiretroviral therapy (ART).
CD4 cells are a type of white blood cells that protect the body from infection. Once infected with HIV, the cells are attacked and destroyed by the virus. However, at the time of the study, the guideline recommended initiation of ART before CD4 cell counts decrease below 250 cells while the recent guidelines suggest 350 cells.
Malnutrition in HIV-positive adults is an issue that requires special attention as it leads to faster disease progression, high mortality rate and suboptimal response to anti-retroviral therapy. And if they are the bread winners, it could affect the whole family.
The nutritional parameters that were observed to have significantly increased among the group that received macronutrient supplement are body weight, body mass index, mid-arm circumference, fat-free mass, and body cell mass. The observation was compared with that of a control group of 79 patients who received only standard care. This group did not show any improvement, and their CD4 count dropped.
While the standard care involved treatment to prevent other diseases and treating common infections, by providing multivitamin tablets, nutritional counselling and psychosocial support. The supplement group, meanwhile, also got a mixture of whole wheat and soya bean flour fortified with vitamins and folic acid, providing a high-calorie, high-protein diet.
NIRT director Dr Soumya Swaminathan said that though an increase in nutrition levels were observed, they may not be statistically significant. That was partly due to the study design and other biological and behaviourial factors.
Scientist C Padmapriyadarsini says that the patients in the 'beneficiary' group were also given interesting recipes to try out new ways to cook and eat. "M Being a catabolic illness, HIV requires high-protein content to build muscle mass," she said. The study also recalled a macronutrient supplementation programme in TN for all HIV-positive patients initiating ART at government centres, which showed weight gain in treated patients. The programme was discontinued after the funding was stopped.
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