A study conducted in the southern Indian state of Tamil Nadu shows that good nutrition dramatically increases the CD4 count and reduces opportunistic infections in HIV/AIDS patients
A study jointly undertaken by the Tamil Nadu State AIDS Control Society (TNSACS) and Duke University has found that nutritional supplements greatly improved the health and quality of life of people living with HIV/AIDS.
The 18-month study on more than 10,500 people with HIV/AIDS in Tamil Nadu may be the biggest of its kind ever conducted in India. It started in September 2005 in three centres that provide antiretroviral therapy (ART), in 10 districts.
The study involved the supply of both micro and macronutrients to people, both adults and children, who were on ART, as well as those who did not require it.
Macronutrient supplements (calories, protein, carbohydrate, fat and fibre) were provided to 10,780 people, and micronutrient supplements (Vitamin A, B, C, folic acid, etc) in the form of tablets, to 11,109.
The most dramatic improvement was seen in the CD4 count of those on treatment. A person infected with HIV is provided ART only when his/her CD4 count drops below 200. Those on ART in the study had a CD4 count of 113. This shot up to 309, six months into the programme and reached 402 at the end of the 18-month study period.
The improvement was marginal in the case of those not on ART -- from 494 at the start to 515 at the end of the study duration.
“The study confirms that good nutrition helps in delaying the progression of the disease,” said Supriya Sahu, project director, TNSACS. The advantage is that with good nutrition a person will take longer to reach a stage where he/she needs ART, and those already on ART will live healthier lives.
The study also found that good nutrition helped people gain weight -- 5 kg in the case of men and 4 kg in the case of women on ART. It was 4 kg in men and 2 kg in the case of women who did not need treatment.
The study found that as the health of people improved, the rate of tuberculosis, one of the most common opportunistic infections among people with HIV/AIDS, dropped. Again, most significantly in those on ART -- from 25% co-infected with TB at the start of the study to 5% at the end of the study period. In the case of those who did not need treatment, TB rates dropped from 10% to 3% after 18 months.
Other major opportunistic infections affecting people with AIDS also showed a drastic drop from 46% to 10% at the end of the study period. The drop was 20% to 10% in the case of those who did not require ART.
TNSACS has found the results of the study so encouraging that it has introduced the supplementation programme in all 26 ART centres in the state, even though it is not part of the national programme. The ART programme was started in Tamil Nadu in March-April 2007 and covers 21,000 people.
With improved health the study found people were working again and children’s attendance improved too. For those on ART, the percentage of employment more than doubled from 30 at the start of the study to 62 after 18 months. In the case of those not on ART, the percentage increase was from 48 to 64.
The cost of the nutritional treatment is Rs 900 per person per year. This is very reasonable when one considers the savings that result from delaying ART and cutting down on medicines for TB and other opportunistic infections.
Source: The Hindu, July 31, 2008
AIDS-INDIA, July 31, 2008