Impact of an enzyme-modified enriched maize supplement on the growth, immune and health status of HIV+ children

[摘要] English: The aim of the study was to describe changes in growth, immune status, micronutrients linked to immune status and health status in food secure HIV-infected children, after nutrition intervention with an enzyme modified maize supplement. Sub-objectives included the determination of baseline data with regard to growth, immune and health status and to determine correlations between these indicators.One hundred and fifty five food-secure HIV-affected children in care centres in Mangaung were screened to determine HIV status. A randomised, double blind, clinically controlled, prospective trial was subsequently undertaken on 37 clinically stable, antiretroviral naïve, HIV-infected children. All the children received co-trimoxazole prophylaxis and were dewormed prior to the intervention.Baseline data showed a median age of 5.35 years within the group. Fifteen children (46%) were underweight, 30 children (77%) were stunted and one child was wasted. The median viral load of the group was 117 000 copies/ml, with the median CD4+ cell count and percentage, 477 cells/mm3 and 22.5% respectively. Multiple micronutrient deficiencies were found amongst the children in relation to glutathione in 91%, albumin in 78%, vitamin A in 63%, vitamin D in 44%, zinc in 38% and vitamin E in 13%. Sixty percent of the children were anaemic and 30% were iron deficient. The most commonly occurring clinical features were lymphadenopathy in 84%, skin rashes in 51% and hepatomegaly in 32%. Nutrition related disorders presented in less than 20% of the sample.Significant but weak positive correlations were demonstrated between the height-for-age z-score (HAZ) and the CD4%, serum cholesterol and -albumin. Apart from a significant but weak positive correlation between the weight-for-height z-score (WHZ) and glutathione, no other correlations could be demonstrated between micronutrient levels and growth. Viral load was significantly but weakly to moderately negatively correlated with the CD4:CD8, CD4%, CD4+ cell count, haemoglobin, serum albumin, -cholesterol, -vitamin A, -vitamin D and -zinc. Significantly weak to moderate positive correlations were reported between CD4 concentrations and serum albumin, -hemoglobin, -cholesterol, -vitamin A, -vitamin D, -zinc and -glutathione. High viral loads and decreased CD4 concentrations in food secure children in care centres are linked to decreased serum levels of micronutrients, albumin and haemoglobin.Nutrition supplementation with two maize soy blends (experimental and placebo) with exactly the same content, apart from the enzyme mixture in the experimental product, resulted in the following: Non-significant decreases in median viral loads of 30 145 copies/ml for the experimental group (E) and 350 copies/ml for the placebo group (P). The median (quartiles) CD4+ cell count increases were 38.5 (-17; 180) cells/mm3 for E (p=0.07) and 167 (-160; 575) cells/mm3 for P (p=0.76). No significant differences relating to growth and changes in micronutrient levels could be demonstrated between the two groups. Children in P experienced a significant (p=0.003) decrease in serum albumin levels, while the E group maintained their levels, resulting in a significant difference.Nutrition supplementation in both groups led to non-significant improvements in median viral loads and CD4+ cell counts. Improvements could, however, not reproduce decreases in viral loads expected from children on ARVs. There was a significant difference between the two groups in relation to changes in serum albumin levels. As serum albumin levels are linked to higher CD4+ cell counts in most studies, this outcome need to be further investigated. None of the groups benefited in terms of growth, health status or micronutrient status, despite micronutrient intakes in excess of 100% RDA. The high prevalence of underweight and stunting found at baseline indicate that inclusion of HIV-infected AIDS orphans in care centres, do not necessarily protect them from becoming malnourished. Known HIV-infected children in care centers should receive optimal care by including ARVs and more aggressive nutrition support into treatment regimens.

[发布机构] University of the Free State