The influence of a nutritional supplement on lung function and immune status of hiv-positive patients in the Mangaung metropolitan

Abstract

The HIV pandemic in South-Africa has created a new form of vulnerability for households with regards to food security and nutritional status which are vital components in the general care of HIV-infected individuals. The risk of nutritional deficiencies and malnutrition are predictors of disease progression and treatment in resource limited settings. Furthermore, HIV affects nutritional status by increasing the energy requirements, reducing food intake, affecting nutrient absorption and metabolism inadequacies due to cytokine activity and diarrhea. Several vitamins and minerals are important in fighting HIV infection because they are required by the immune system and major organs to attack infectious pathogens. Many of these micronutrients have been found to be deficient in HIVinfected persons and several studies were launched worldwide to investigate the feasibility of food assistance and nutrient supplementation. Nutritional supplementation has been advocated in HIV-infected persons especially in lowincome countries such as South Africa. Therefore, a study to evaluate the role of nutritional supplementation in HIV-positive patients becomes necessary, especially in a developing country such as South Africa. It is against this background that the present research was initiated to examine the influence of a nutritional supplement on the immune status and health status of HIVpositive/ AIDS adult individuals. The aim of the investigation was to determine if supplementation with a mixture comprised from specific minerals, vitamins and herbs over a period of one year, affected the haematological status, immune status, viral load and pulmonary function in forty (40) HIV-infected individuals living in the Mangaung Metropolitan, RSA. viii A quantitative, open-labeled, before-after clinical trial was conducted at the Central University of Technology, in Bloemfontein, Free State Province in the RSA. Socio-demographic and dietary intake questionnaires were completed. All data pertaining to anthropometric measurements, haematological status, immune status, viral load and pulmonary function were obtained my means of using standard procedures and technological equipment. The data were subjected to parametric and non-parametric statistical analysis. The results of the present investigation show that the eating pattern of this urbanized group of individuals reflects high energy (KJ) and macronutrient intakes coinciding with sub-optimal intake of Vitamin D and iodine. Of all the haematological variables the only statistical significant changes observed were increases in the median erythrocyte sedimentation rate (ESR) (p=0.0219) and mean cell haemoglobin concentration (MCHC) (p=0.0245) after six months of nutritional supplementation. At 12 months a statistical significant decrease in the median CD/CD8 ratio (p<0.0048), median Hematocrit concentration (p<0.0312), median mean cell volume (MCV) (p<0.0359), and median RDW (p<0.0273) accompanied a statistically significant increase in the MCHC (p<0.0003) at 12 months after supplementation. At 6 months 89% (CI95%: 73%; 96%) of the individuals showed a decline in viral load counts with a median percentage decline of 34% (CI95%: 73%; 96%). At 12 months 85% [CI95%: 68%; 94%] of the individuals show a decrease in viral load counts with a median percentage decline of 62.9% (CI95%: 50%; 78.6%) following the intake of the supplement. The main findings of the present investigation reveal that 68% (50%-81%) of the individuals show a statistical median increase (p=0.0302) of 16.9% (11.5%; ix 36.1%) in the Peak Expiratory Flow (PEF) at six months. A significant decrease (p=0.0484) in the median FEF75 of 28.1% (14%; 35.3%) is observed in 70% (53%-83%) of the individuals after 12 months of exposure to the supplement. No statistical significant changes are observed for FVC, FEV1, FEV1/FVC and FEF50 over the entire trial period. The present results suggest that a significant measurable decrease in viral load in HIV-infected individuals can be obtained by means of subjecting individuals to a nutritional fortification supplement strategy for 6 months or more.