Menu ENN Search
Language: English Français

Therapeutic food for MDR-TB and HIV patients

This question was posted the Management of wasting/acute malnutrition forum area and has 5 replies.

» Post a reply

Mhiret Teshome

Nutrition Expert

Normal user

17 Dec 2020, 06:46

Through my experience meeting with different people in forums and workshops, I found that there are organizations and/or government agencies providing RUSF/Plumpy'Nut for Multi-Drug Resistance Tuberclossis and HIV/AIDS patients irrespective of the severity of infection and their physiological status (body condition). Do you think that this could be helpful and affordable? Is there existing protocol or guideline on doses and delivery mechanisms in your operation? If there is, would you please share? 

Thank you,

André Briend

Frequent user

17 Dec 2020, 10:25

RUTF does not cure HIV infection nor MDR TB. It can be given to these patients when they have associated severe malnutrition. In that case, they will benefit from nutritional treatment, provided their infection is under control. The effect of mortality and relapse however is not clear. See:

Schoonees A, Lombard MJ, Musekiwa A, Nel E, Volmink J. Ready-to-use therapeutic food (RUTF) for home-based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age. Cochrane Database Syst Rev. 2019 May 15;5(5):CD009000. doi: 10.1002/14651858.CD009000.pub3. PMID: 31090070

In non-malnourished patients, I doubt there is evidence that RUTF will really help.  

Carmen

Public Health

Normal user

17 Dec 2020, 11:22

Total ammount of calories should be calculated for each individual. There is a stress factor to consider on HIV and  MDR-TB patients. RUTF can help achieving the huge amount of calories needed. According to my experince not all RUTF is suitable, specialty for its  high content in fat, causing nausea, vomit. The sympthoms after ingestion were related to cultural context and intake habits.

Mhiret Teshome

Nutrition Expert

Normal user

18 Dec 2020, 07:36

Thank you André Briend and Carmen you got my point. Aboslutely true that RUTF doesn't treat MDRTB or HIV. As Carmen says RUTF can help achieving the huge amount of calories needed. Does anyone in the network has guidlines/protocols for such inetervention?

Jay Berkley

Professor

Frequent user

21 Dec 2020, 07:44

Dear Mhiret

There is some evidence from clinical trials, and results may depend on the balance of food insecurity/reduced food intake vs wasting caused by HIV due to intense inflammation, infections and malabsorption.

We also know that HIV is associated with abnormalities in lipid metabolism and insulin resistance, so benefits and risks may differ from those in people without HIV.

In advanced HIV (CD4 count <100 at ART initiation) the REALITY trial  tested blanket provision of RUSF to all patients vs treating only individuals who are malnourished (adults and older children). Giving RUSF to everyone resulted in temporary increased weight gain which reverted after stopping the supplement, and no benefits in terms of mortality, morbidity or immune recovery. Because this was advanced HIV, it's likely that wasting was more due to intense inflammation, infections and malabsorption than lack of food suggesting blanket supplementation would be expensive and without benefit compared to treating only malnourished indiivuals in that population. https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(18)30038-9/fulltext

Another trial (ARTFood) in Ethiopia included 282 adults initiating ART with BMI greater than 17 kg/m2  randomly assigned either early supplementation with immediate whey-based or soy-based RUSF (1100 kcal per day for 3 months), or delayed supplementation, 3 months after ART initiation. Early RUSF supplementation was associated with short term gains in weight and lean mass (BMI changes were not reported) and a small increase in grip strength. There were no differences in morbidity or CD4 count recovery between arms. After 12 months there was no difference in weight gain between groups. https://www.bmj.com/content/348/bmj.g3187

So overall, as André mentioned, the evidence suggests that benefits of RUSF or  RUTF for non-malnourished individuals with HIV are very liittle.

However, both HIV and TB treatment programs have problems of loss to follow up, and besides direct effects on health outcomes it is useful also to consider whether retention may be improved by feeding interventions - this was not able to be tested in the trials because they took extra measures to trace and retain people in the trial.

Best wishes

Jay

Anonymous 40504

INGO

Normal user

21 Dec 2020, 12:00

Dear colleagues,

Ready to use therapeutic food IS helpful in our poor setting mainly because disease and life conditions have a huge impact on normal people Health. Being malnourished and HIV positive despite of disease evolution, RUTF still strengthening or helping to avoid a worsened situation. For those without SAM but being HIV positive, RUTF IS helping to increase appetite (To be proved) and particularly increase the willing of patient to stay in touch with Health facility and workers where they could share without stigma their problems.As Health professionnal IAM in favor of RUTF for patient because i Saw thé Bad effects on HIV patient mood when IS lacking. Good job 

Best wishes,

If you have any problem posting a response, please contact the moderator at post@en-net.org.

Back to top

» Post a reply