Abstract:
The relationship between nutrition and HIV infection/AIDS is well recognised. HIV
infection compromises the nutritional status of infected persons and in turn, poor nutritional
status affects the progression of HIV infection.
Nutritional supplementation has been shown to be associated with a significant slowing of
disease progression, assists in maintaining and· optimising the nutritional status and the
immune function of HIV-infected persons. The value of nutritional supplementation on the
immune function of HIV-positive/AIDS patients from low socio-economic communities in
the Free State is not yet known. Hence, the main purpose of this study was to determine
the influence of a nutritional supplement (Africa's Solution) on the immune status of HIVpositive/
AIDS patients from the low socio-economic communities of Bloemfontein in the
Free State Province.
The study entailed a clinical trial that consisted of one screening visit and three monthly
visits. A total of 35 respondents were selected according to specific inclusion criteria.
Food frequency questionnaires were completed during the screening visit. Haematological
parameters, CD4+T-cell counts and CD8+T-cell counts were determined at the screening
visit, monthly visits and by the end of nutrient supplementation (final visit).
The patients studied, demonstrated energy and dietary intake of major macronutrients,
higher than the RDNAI and higher (P<O.05) in the male than in the female subjects. It
was also observed that the mineral and trace element intakes exceeded the RDNAI,
except for iodine and selenium. A majority of the patients reported adequate intake of
most vitamins with the exception of folate and vitamin D. It is envisaged that the high
dietary intake of major macronutrients and micronutrients would help in maintaining the
nutritional status and in curtailing wasting in the patients.
The anthropometric profiles and the viral load were determined at baseline (n= 35) and at
the end of study (n=28). There was no significant difference (P>O.05) in the fat percentage
and body weight before and after nutrient supplementation; however, fat percentage
differed significantly (P<O.05) between genders. The body mass index (BMI) and the lean
body mass (LBM) produced a trend towards an improvement. There was a positive correlation between BMI and fat percentage. The CD4+T-cell count showed no correlation
with the anthropometric profiles, while the viral load showed a negative correlation with the
LBM, the fat percentage and the BMI.
Results of the influence of the supplement on the immune status, haematological and
clinical conditions showed that the viral load decreased significantly (P<0.002) with time
following supplementation. The mean cell volume (MCV) and the mean cell haemoglobin
concentration (MCHC) increased significantly (P<0.002, P<0.0002 respectively), reflecting
the positive effect of the supplement on a few of the haematological parameters. The
supplement demonstrated no effect on the CD4+T-cell count and the CD4+T-cell count
decreased significantly (P<0.05) with HIV disease progression. The non-positive effect of
the supplement on the CD4+T-cell count may be related to the already low CD4+T-cell
counts before supplementation (lower than 200 cells/mm3 in the majority of patients); short
duration; inter-assay variation; changes due to inter-current illness; impaired production of
CD4+T -cells; red istribution within the intravascular spaces and drug-nutrient interactions.
The supplement showed observable positive effects on the general well-being (clinical
conditions) of the patients.
Although, the nutritional supplement did not indicate a positive effect on the CD4+T-cell
counts, the reduction in the viral load is very important, since median survival time is
known to increase with reduction in HIV viral load. Because of certain limitations (small
sample size, short duration, late stage of the infection and inter-assay variation), further
study is needed to confirm the efficacy of the supplement.