Die effek van 'n dieetsupplement op die lipiedprofiele van MIV-positiewe pasiënte in die Noordwes Provinsie

Abstract

The infection of humans with the immunodeficiency virus (HIV) and the developing of the acquired immunodeficiency syndrome (AIDS), have become a global pandemic. It seems that developing countries are most effected by the HIV/AIDS-pandemic, and there is no doubt about South Africa currently being confronted with a health crisis. Normal lipid homeostasis is essential for the optimal functioning of the immune system, and can therefore affect the disease progression from HIV to AIDS. Increased levels of triglyceride (TG) and decreased levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) are associated with HIV-infection. This abnormal lipidprofile is caused by an increased production of cytokines, and is part of the immune response to infection. Little is known about the impact of affordable nutrition interventions in the treatment of HIV/AIDS. No information exists about the effect of micronutrient supplementation on the lipidprofiles of HIV/AIDS-patients. The objective of this placebo-controlled, double blind, parallel intervention study, was to investigate the effect of a nutritional supplement, containing micronutrients and phytochemicals, on the lipidprofiles of HIV-infected patients. Fifty three HIV-infected patients from Fochville and Makwassie originally participated in the six month study. The patients were randomly assigned to a supplement group (n=26) and a placebo group (n=27). The supplement group received a nutritional supplement and a multivitamin supplement, while patients in the placebo group received a placebo and a multivitamin supplement. The supplements were given on a monthly basis to the patients. Blood samples for the analyses of the full blood parameters and biochemical variables were collected at the beginning and end of the study. Clinical evaluation, anthropometrical measurements, dietary intakes and dietary advice were done at the end of each period . Only 30 patients, 18 in the supplement group and 12 in the placebo group, completed the study.

The results showed that the nutritional supplement did not have any significant effect on TC, LDL-C or HDL-C concentrations. The TG concentrations decreased significantly in the supplement group from 0.98 mmol/L (0. 78; 1.26) to 0.79 mmol/L (0.66;0.98). The decrease could probably not be attributed to an independent effect of the supplement. The intake of the nutritional supplement did not cause any significant changes in most of the examined markers of nutritional status, namely vitamin A, albumin, pre-albumin and the anthropometrical measurements. The serum vitamin C concentration significantly increased in the supplement group from 15.14 µmol/L (10.23;22.39) to 24.55 µmol/L (17.78;33.88). The serum vitamin E concentration significantly decreased in the placebo group from 26.23 µmol/L (23.05;29.41) to 22.43 µmol/L (19.29;25.58). The nutritional supplement probably prevented a similar decrease in the supplement group. The malabsorption of fat could be one of the reasons why the fat soluble vitamins A and E did not significantly change in the supplement group. The nutritional supplement did not have any positive effect on the CD4 and CDs lymphocyte cells or the viral load. The fact that the nutritional supplement did not have any effect on the lipidprofile can probably be attributed to the nutritional status and immune response of the patients which did not show any change during the course of the study. It can be concluded that the nutritional supplement could not improve the lipidprofile, nutritional status or immune response of the HIV-infected patient. It must be added that the outcome of the results could have been influenced by the high prevalence of dropouts in the placebo group. It is recommended that further research be done to determine the effect of nutritional interventions on the lipidprofiles and immune response of HIV-positive patients. It is important to first determine the maximum absorption capacity and micronutrient dosages for HIV-patients, before such studies can be planned and implemented.