Nutrition and disease progression pre-highly active antiretroviral therapy (HAART) and post-HAART: can good nutrition delay time to HAART and affect response to HAART?
Nutrition and disease progression pre-highly active antiretroviral therapy (HAART) and post-HAART: can good nutrition delay time to HAART and affect response to HAART?
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DOI：
10.3945/ajcn.111.019018
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发表时间：
2011-12-01
影响因子：
7.1
通讯作者：
Gupta, Amita
中科院分区：
文献类型：
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作者：
Chandrasekhar, Aditya;Gupta, Amita
几项研究调查了成人艾滋病毒感染者的各种营养补充干预措施。在这篇叙述性综述中，我们总结了 31 项临床试验的证据，这些试验探讨了补充大量营养素和微量营养素对该人群的临床益处，同时试图回答良好的营养是否可以延迟高效抗逆转录病毒治疗 (HAART) 启动和反应的时间的问题。我们重点关注 1990 年至 2010 年间以英文发表的试验，这些试验报告了 CD4 计数、病毒载量以及疾病进展或生存情况。在 9 项常量营养素和 22 项微量营养素试验中，我们发现通过营养补充改善 CD4 计数和 HIV 病毒载量的证据有限；仅 11.1% 和 36.8% 的常量营养素和微量营养素补充试验报告 CD4 计数有所改善；常量营养素和微量营养素试验中分别有 33.3% 和 12.5% 报告病毒载量下降。鉴于营养干预措施可作为 HIV 疾病进展的替代标志物，这表明营养干预措施对延迟 HAART 启动或改善 HAART 反应有影响的证据有限。然而，评估营养补充对临床疾病的影响存在挑战，因为研究设计、患者群体、营养剂量和组合、缺乏基线水平和研究终点的异质性（包括定义和报告 HAART 状态缺乏明确性）的异质性，比较很困难。未来的研究需要采用更严格的标准设计，具有足够的力度和随访，并需要就待测试的营养干预措施的成分和剂量达成共识，以更具体地回答营养干预措施对HIV疾病进展和HAART反应的影响问题。 Am J Clin Nutr 2011；94（增刊）：1703S-15S。
Several studies have investigated a variety of nutritional supplementation interventions in adults with HIV. In this narrative review, we summarize the evidence from 31 clinical trials that explore clinical benefits of macronutrient and micronutrient supplementation in this population while attempting to answer the question of whether good nutrition can delay the time to highly active antiretroviral therapy (HAART) initiation and response. We focused on trials published in English between 1990 and 2010 that reported on CD4 count, viral load, and disease progression or survival. Among 9 macronutrient and 22 micronutrient trials, we found that evidence for improved CD4 count and HIV viral load with nutritional supplementation was limited; only 11.1% and 36.8% of macronutrient and micronutrient supplementation trials, respectively, reported improved CD4 count; and 33.3% and 12.5% of macronutrient and micronutrient trials, respectively, reported decreased viral load. Given their utility as surrogate markers of HIV disease progression, this suggests limited evidence for nutritional interventions having an impact on delaying HAART initiation or on improving HAART response. However, there are challenges in evaluating the effects of nutritional supplementation on clinical disease in that comparisons are difficult due to heterogeneity in study design, patient population, nutrient doses and combinations, baseline levels of deficiency, and study endpoints, including lack of clarity in defining and reporting HAART status. Future studies need to adopt a more rigorous standard design with adequate power and follow-up and require a consensus on composition and dose of nutrient interventions to be tested to more specifically answer the question on the impact of nutritional interventions on HIV disease progression and HAART response. Am J Clin Nutr 2011;94(suppl):1703S-15S.