Therapeutic food for MDR-TB and HIV patients

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.  

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