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Management of MAM in HIV adults

This question was posted the Prevention and treatment of moderate acute malnutrition forum area and has 4 replies. You can also reply via email – be sure to leave the subject unchanged.

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Ahmed

Normal user

20 Oct 2015, 05:24

What are the costs/benefits of using RUTF in MAM HIV positive clients? In a situation where there are no operational SFPs, should RUTF be recommended?

Paul

Frequent user

20 Oct 2015, 09:59

In Malawi the old CMAM guidelines recommended the admission of children with HIV for treatment in OTP (with RUTF) when WFH <80% (NCHS) or MUAC < 12.5cm (I.e. MAM).
This was related to HIV+ children having a higher rate of mortality. This guidance may have changed since the admission criteria for OTP have changed to MUAC <11.5cm and WHZ <-3 (WHO). In other countries HIV + children are treated according to the same criteria as HIV - children. If you have the resources then there is no contraindication to using RUTF in the absence of an SFP. I am sure that practitioners based in Malawi are likely to have data on child survival (or cost-benefit) that you are looking for.

Rosemary Atieno

Nutritionist- MOH

Normal user

22 Oct 2015, 07:26

Depending on your national guidelines if you have one. From my own experience nutrition therapy for MAM adults would require use of RUSF if you do not have FBFs(fortified blended flours). Many of this patients with proper adhearance to ARVs and nutritional support they do well in a very short time. I would not recommend RUTF for MAM since its like giving a wrong medication for a correct diagnosis. A MAM patient is not a very sick patient to require therapeutic feeds. Supplementation and normal diet just works as well

Mark Myatt

Consultant Epideomiologist

Frequent user

22 Oct 2015, 09:00

Just some random observations ...

RUTF / RUSF in the form of drinks in cartons is common in HIV treatment in the UK. These are similar to the peanut punch drinks popular in the Caribbean and USA. I think these were first produced by George Washington Carver in the early 20th century and were used as an RUTF in Belgian Congo (a sorry story of neglect in orphanages). Peanut punch is high in protein, fat, and sugar and is made from from peanut butter, milk (often evaporated / condensed) and sugars. If you fiddle with relative quantities in the recipe and add CMV you can make a drinkable RUTF.

One issue that has arisen with the use of commercial F100 RUTF is that it can be too sweet for adult palettes and this reduces compliance. This tends to be the case in places where the use of sour and fermented foods is common. At least one RUTF producer (VALID Nutrition) is investigating the use of less sweet RUTF formulations in adult HIV patients.

In the Caribbean and USA, peanut punch is marketed (mostly) to men as an "energy drink" or "sports drink" and tends to be flavoured with spices (mostly cinnamon and nutmeg) and "bitters" (e.g. Angostura bitters) which, presumably, make them more palatable to adults. It is quite a pleasant beverage and is widely available from a number of commercial sources.

Rosemary Atieno

Nutritionist- MOH

Normal user

22 Oct 2015, 11:50

I agree Mark we have been using RUTF+FBFs combination for HIV SAM patients and RUTF or RUSF for MAM patients this is an area with high prevalence of HIV of up to 18% and many patients improve quite quickly with cure rates of over 75%. Since its easy to take the RUTF with porridge its easier for the clients to take the stuff

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