Project Title:  The role of whey in nutritional support of HIV infected patients on antiretroviral treatment: A randomized trial in Jimma, Ethiopia

Project Period: 2008-2011

Project Budget: Total 571.680 USD (US Dairy Export Council, USDEC)

Main Collaborating Institutions: Jimma University, Ethiopia

Principal Project Coordinators:  Professor Kim Fleischer Michaelsen, Dept Human Nutrition, KU-LIFE, Denmark, Assistant Professor Tsinuel Girma, Dept of Paediatrics, Jimma University, Ethiopia

Project Description:

Background: Existing evidence on which to base nutritional recommendations for people with HIV infection is limited. After initiation of antiretroviral treatment (ART) HIV patients often gain weight which is generally regarded as a sign of recovery. Nevertheless, it is likely that the HIV induced weight losses to a large extent is due to loss of lean body mass, while weight gain during recovery from opportunistic infections after initiation of ART mainly consists of fat. Gain in lean body mass is more likely to positively influence general health, survival and quality of life than is accumulation of fat. Construction of lean body mass requires high quality protein and adequate micronutrients. Therefore, in food insecure populations it may be cost-effective to provide energy-nutrient dense food supplements to HIV patients starting ART. There is some evidence that milk proteins, in particular whey, as part of such food supplements may support the accumulation of lean body mass and also delay disease progression.

Aim: The aim is to assess the effect of a whey-containing nutritional supplement, and the timing of such a supplement, on lean body mass, grip strength, physical activity and progression of HIV.

Methodology: A micronutrient fortified peanut based food supplement containing either whey or soy protein will be given daily for three months to 350 HIV patients starting ART. Terminally ill patients and patients with severe acute malnutrition (BMI £16 or MUAC < 170 mm) are excluded. The supplement is a ready to use supplementary food (RUSF) covering around half of the patients daily energy need. A third group will receive the food supplement after a delay of three months. This group serves both as a control group for the first three months as well as to investigate whether the optimal timing for such a supplement is at start of ART or when the acute phase reaction to opportunistic infections have declined. Changes in lean body mass after three and six months will be evaluated using the gold standard deuterium dilution, as well as bioelectrical impedance analysis, and simple anthropometry.

Scope of study: This study will provide knowledge about the effect of targeted energy and nutrient dense dietary supplementation to HIV patients starting ART.

Contact person:

Henrik Friis, MD, PhD
Professor of International Nutrition and Health

Dept Human Nutrition, University of Copenhagen
Rolighedsvej 30, DK-1958 Frederiksberg, Denmark
Tel: +45 3533 3860 / Fax: +45 3533 2483

Email: hfr @ life.ku.dk