A Randomized Trial of Ready-to-Use Supplementary Food Versus Corn-Soy Blend Plus as Food Rations for HIV-Infected Adults on Antiretroviral Therapy in Rural Haiti

Autor: Jessica E. Teng, Molly F. Franke, Matthew H. Bonds, Kenneth A. Freedberg, Louise C. Ivers, J. Gregory Jerome
Rok vydání: 2014
Předmět:
Zdroj: Clinical Infectious Diseases. 58:1176-1184
ISSN: 1537-6591
1058-4838
DOI: 10.1093/cid/ciu028
Popis: Food insecurity, undernutrition, and human immunodeficiency virus (HIV) infection are structurally linked and often geographically overlapping problems that have negative impacts on individuals as well as on their households [1, 2]. As HIV infection progresses, it causes a catabolic state and increased susceptibility to other infections, which are both compounded by lack of caloric and other nutrient intake, leading to progressive worsening of malnutrition [3]. In persons with HIV infection, low body mass index (BMI) is associated with increased early mortality [4], and food insecurity is associated with reduced adherence to antiretroviral therapy (ART) and incomplete viral RNA suppression [5, 6]. To address the problems of undernutrition and food insecurity, HIV programs increasingly provide food assistance to patients in the form of food rations [7]. In addition to the most obvious benefit of reducing hunger, food assistance has been associated with improved adherence to ART, improved attendance at routine clinical appointments, and increases in BMI compared with no food assistance [8, 9]. However, the commodities used for supplementary food assistance vary greatly, and although the role of micronutrients in improving HIV-related outcomes has been studied extensively [10, 11], few studies examine the relationship between macronutrient supplements and morbidity or mortality. As a result, there is little evidence to guide providers on the most appropriate type, quantity, or duration of food assistance or on the most appropriate eligibility criteria for those receiving food supplements to achieve maximum benefit. Corn-soy blends (CSBs) are fortified blended foods that have been used extensively as food aid for decades [12]. Concerns about low nutrient content and ration sharing have resulted in the creation of newer CSB varieties with added micronutrients such as corn-soy blend plus (CSB+) [13]. Increasing attention is also being focused on the use of ready-to-use spreads known as ready-to-use therapeutic foods (RUTFs) or ready-to use supplementary foods (RUSFs). RUTFs/RUSFs have been used as treatment and supplements for malnourished children with great success and are increasingly being studied for use in adults with HIV wasting [14, 15]. They are energy-dense, lipid-based spreads that resist bacterial contamination and require no cooking [16]. These characteristics may contribute to increased consumption by adults with HIV infection, who often have poor appetite and/or mouth lesions. They are often individually packaged, which could dissuade sharing by the targeted individual. Despite potential advantages, the cost of RUSF may be up to 3 times greater than CSB [14]. Although local production is increasing, RUSF must often be imported, thus adding to logistics costs and potentially diverting resources for food assistance away from local economies [17, 18]. RUSFs are regularly distributed to and marketed for adults living with HIV [19]. In Haiti, food insecurity is very common [20], and the prevalence of HIV infection among 15- to 49-year-olds is 2.2% [21]. This paper describes a prospective randomized trial in rural Haiti in which adults with HIV infection on ART were randomized to receive either an RUSF- or CSB+-based food ration. We hypothesized that RUSF might lead to better nutritional and nonnutritional outcomes for adults with HIV infection, compared to CSB+.
Databáze: OpenAIRE
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