HIV and weight loss

HIV is a grave problem in sub-Saharan and the basic treatment is antiretroviral therapy. Mortality is high during the first few months of treatment, significantly associated with weight loss i.e. reduced BMI. How can the BMI be increased?
The most commonly used supplement in food aid programmes is corn-soy blended flour, a cheap fortified cereal-legume combination that requires cooking.
The results are disappointing.
A controlled trial using an energy dense ready to use fortified pre-cooked lipid paste made from peanuts that resists bacterial contamination is reported in the BMJ of May 30th 2009. And works, increases BMI and lean body mass but does not change mortality.
Which challenges the underlying concepts and ideas. Is weight loss the entire cause of death? There was no increase in micronutrient content of the supplement above normal recommendations. More is not necessarily better.
The editorial quotes Kleiber’s law, that in the face of competitive functional demands, how specific nutrients are used eg energy and pattern of protein deposition will be determined by the relative availability of all other nutrients. A wise thought.
In the resuscitation of inmates of freed concentration camp inmates in 1944 much had to be learnt about the way in which food was reintroduced.
MacDonald et al 2009 Supplementary feeding with either ready o use fortified spread or corn soy blend in wasted adults starting antiretroviral therapy in Malawi: randomised , investigator blinded controlled trail BMJ vol 338 pp 1309-1312
Rollins in Editorial Food supplements and HIVBMJ vol 338 pages 1282-3

Martin Eastwood
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