Nutrition and HIV Progression

描述(申请人提供)：全世界有4000多万艾滋病毒感染者，其中大多数人生活在资源有限的世界里。在整个艾滋病毒流行过程中，很明显，宿主的营养状况对艾滋病毒相关后果，特别是艾滋病毒疾病的进展和死亡率起着重要的、独立的作用。尽管维持或改善营养状况会改善艾滋病毒感染者的结局似乎是直观的，但几乎没有数据可以证明将营养状况保持在正常水平的潜在好处。有数据表明，使用微量营养素可以减少CD4计数的下降并延缓死亡，但仅使用微量营养素不能支持或维持营养状态。这一应用的总体假设是，在艾滋病毒感染早期服用营养密集蛋白补充剂(NDP)将减缓疾病进展，并且从感染艾滋病毒到开始HAART的时间将延长。如果这一假设被证明是正确的，这种类型的干预将使个人受益，因为使用HAART的需要将被推迟。这也将使卫生系统受益，因为推迟启动HAART将节省成本。具体地说，我们建议在肯尼亚招募740名感染艾滋病毒的妇女，CD_4细胞数在350个/&lt；L到500个/&lt；之间，没有任何症状、机会性感染或艾滋病定义了需要启动HAART的疾病或营养不良(BMI&lt；18.5 kg/m2)。这些早期疾病患者将被随机分成一组，给予营养密集蛋白补充剂(NDPS)或标准护理(SOC)，并进行跟踪，直到需要开始HAART或总共2年。这项研究的结果将包括启动HAART的必要性、CD4细胞计数的下降速度、以BMI和瘦体重衡量的总体营养状况以及生活质量。我们将确定这一干预策略的成本效益。为了确定患有早期疾病的艾滋病毒感染妇女的膳食摄入量和营养状况是否在社区正常范围内，我们需要评估当地社区类似但未感染艾滋病毒的妇女的膳食摄入量和营养状况。我们建议从VOI司收集记录为艾滋病毒阴性的200名妇女的数据，该司也将为干预研究提供艾滋病毒感染妇女。

DESCRIPTION (provided by applicant): There are more than 40 million individuals infected with HIV living throughout the world, the majority of these live within the resource-limited world. It has been clear throughout the HIV epidemic that the nutritional status of the host plays an important, independent role in HIV-associated outcomes particularly progression of HIV disease and mortality. Although it would appear to be intuitive that maintenance of or improvement in nutritional status would lead to improved outcomes in HIV infected individuals, few data are available to demonstrate the potential benefits of maintaining nutrition status at normal. There are data that suggest that the use of micronutrients could reduce CD4 count decline and delay death, however micronutrients alone will not support or maintain nutritional status. The overall hypothesis of this application is that the consumption of a nutrient dense protein supplement (NDPS) early in HIV infection will slow disease progression, and that the time from infection with HIV to the initiation of HAART will be prolonged. If this hypothesis is proven to be correct, this type of intervention will result in benefit to the individual, as the need for the use of HAART would be delayed. It would also benefit the health systems, as cost savings would result from a delay in the initiation of HAART. Specifically we propose to enroll 740 HIV infected women in Kenya, with CD4 counts between 350 cells/<L and 500 cells/<Land no symptoms, opportunistic infections or AIDS defining illnesses or malnutrition (BMI <18.5 kg/m2) that would require the initiation of HAART. These individuals with early disease will be randomized to a group that will be provided with the nutrient dense protein supplement (NDPS) or standard of care (SOC) and followed until the initiation of HAART is necessary or a total of 2 years. Outcomes in this study will include the need for the initiation of HAART, the rate of decline of CD4 cell count, overall nutritional status as measured by BMI and lean body mass, and quality of life. We will determine the cost effectiveness of this intervention strategy. In order determine if the dietary intake and the nutritional status (BMI) of the HIV-infected women with early disease is within the community norm, we need to evaluate the dietary intake and nutritional status of similar but non HIV-infected women in the local community. We propose to collect data on 200 women who are documented to be HIV-negative from Voi Division at a single visit, the Division that will also provide the HIV -infected women for the intervention study.