Nutrition and HIV Progression

描述（由申请人提供）：全世界有4 000多万艾滋病毒感染者，其中大多数生活在资源有限的世界。在整个艾滋病毒流行过程中，很明显，宿主的营养状况在艾滋病毒相关结果中起着重要的独立作用，特别是艾滋病毒疾病的进展和死亡率。虽然维持或改善营养状况似乎可以改善艾滋病毒感染者的预后，但很少有数据可以证明维持正常营养状况的潜在益处。有数据表明，使用微量营养素可以减少CD4计数下降和延迟死亡，但微量营养素本身不能支持或维持营养状态。该应用的总体假设是，在HIV感染早期摄入营养密集蛋白补充剂（NDPS）将减缓疾病进展，并且从感染HIV到开始HAART的时间将延长。如果这一假设被证明是正确的，这种类型的干预将给个人带来好处，因为使用HAART的需求将被推迟。这也将有利于卫生系统，因为推迟启动HAART治疗将节省费用。具体来说，我们建议在肯尼亚招募740名感染艾滋病毒的妇女，她们的CD4细胞计数在350细胞/<L和500细胞/<L之间，没有症状、机会性感染或艾滋病定义疾病或营养不良（BMI <18.5 kg/m2），这些都需要开始HAART治疗。这些患有早期疾病的个体将被随机分配到一组，该组将提供营养密集蛋白补充剂（NDPS）或标准护理（SOC），并随访至需要开始HAART或总共2年。本研究的结果将包括启动HAART的需要、CD4细胞计数下降的速度、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。为了确定早期感染艾滋病毒的妇女的饮食摄入量和营养状况（BMI）是否在社区规范范围内，我们需要评估当地社区相似但未感染艾滋病毒的妇女的饮食摄入量和营养状况。我们建议在一次访问中收集200名经记录为艾滋病毒阴性的妇女的数据，该司还将为干预研究提供感染艾滋病毒的妇女。

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.