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Nutrition assessment, counseling, and support interventions to improve health-related outcomes in people living with HIV/AIDS: a systematic review of the literature.

Abstract

BACKGROUND

Although numerous studies have shown that severe to moderate wasting at the time of antiretroviral therapy initiation is strongly predictive of mortality, it remains unclear whether nutritional interventions at or before antiretroviral therapy initiation will improve outcomes. This review examines data on nutrition assessment, counseling, and support interventions in resource-limited settings.

METHODS

We identified articles published between 2005 and 2014 on the effectiveness of nutrition assessment, counseling, and support interventions, particularly its impact on 5 outcomes: mortality, morbidity, retention in care, quality of life, and/or prevention of ongoing HIV transmission. We rated the overall quality of individual articles and summarized the body of evidence and expected impact for each outcome.

RESULTS

Twenty-one articles met all inclusion criteria. The overall quality of evidence was weak, predominantly because of few studies being designed to directly address the question of interest. Only 2 studies were randomized trials with no food support control groups. The remainder were randomized studies of one type of food support versus another, cohort (nonrandomized) studies, or single-arm studies. Ratings of individual study quality ranged from "medium" to "weak," and the quality of the overall body of evidence ranged from "fair" to "poor." We rated the expected impact on all outcomes as "uncertain."

CONCLUSIONS

Rigorous better designed studies in resource-limited settings are urgently needed to understand the effectiveness of nutrition assessment and counseling alone, as well as studies to understand better modalities of food support (targeting, timing, composition, form, and duration) to improve both short- and long-term patient retention in care and treatment, and clinical outcomes.

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  • Authors+Show Affiliations

    ,

    *Nutrition/Infection Unit, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA; and †USAID Office of HIV/AIDS, Washington, DC.

    , ,

    Source

    MeSH

    Adolescent
    Adult
    CD4 Lymphocyte Count
    Cost-Benefit Analysis
    Counseling
    Developing Countries
    Dietary Supplements
    HIV Infections
    Health Impact Assessment
    Health Resources
    Humans
    Morbidity
    Nutrition Assessment
    Outcome Assessment (Health Care)
    Quality of Life

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    25768873

    Citation

    Tang, Alice M., et al. "Nutrition Assessment, Counseling, and Support Interventions to Improve Health-related Outcomes in People Living With HIV/AIDS: a Systematic Review of the Literature." Journal of Acquired Immune Deficiency Syndromes (1999), vol. 68 Suppl 3, 2015, pp. S340-9.
    Tang AM, Quick T, Chung M, et al. Nutrition assessment, counseling, and support interventions to improve health-related outcomes in people living with HIV/AIDS: a systematic review of the literature. J Acquir Immune Defic Syndr. 2015;68 Suppl 3:S340-9.
    Tang, A. M., Quick, T., Chung, M., & Wanke, C. A. (2015). Nutrition assessment, counseling, and support interventions to improve health-related outcomes in people living with HIV/AIDS: a systematic review of the literature. Journal of Acquired Immune Deficiency Syndromes (1999), 68 Suppl 3, pp. S340-9. doi:10.1097/QAI.0000000000000521.
    Tang AM, et al. Nutrition Assessment, Counseling, and Support Interventions to Improve Health-related Outcomes in People Living With HIV/AIDS: a Systematic Review of the Literature. J Acquir Immune Defic Syndr. 2015 Apr 15;68 Suppl 3:S340-9. PubMed PMID: 25768873.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Nutrition assessment, counseling, and support interventions to improve health-related outcomes in people living with HIV/AIDS: a systematic review of the literature. AU - Tang,Alice M, AU - Quick,Timothy, AU - Chung,Mei, AU - Wanke,Christine A, PY - 2015/3/14/entrez PY - 2015/3/15/pubmed PY - 2015/5/20/medline SP - S340 EP - 9 JF - Journal of acquired immune deficiency syndromes (1999) JO - J. Acquir. Immune Defic. Syndr. VL - 68 Suppl 3 N2 - BACKGROUND: Although numerous studies have shown that severe to moderate wasting at the time of antiretroviral therapy initiation is strongly predictive of mortality, it remains unclear whether nutritional interventions at or before antiretroviral therapy initiation will improve outcomes. This review examines data on nutrition assessment, counseling, and support interventions in resource-limited settings. METHODS: We identified articles published between 2005 and 2014 on the effectiveness of nutrition assessment, counseling, and support interventions, particularly its impact on 5 outcomes: mortality, morbidity, retention in care, quality of life, and/or prevention of ongoing HIV transmission. We rated the overall quality of individual articles and summarized the body of evidence and expected impact for each outcome. RESULTS: Twenty-one articles met all inclusion criteria. The overall quality of evidence was weak, predominantly because of few studies being designed to directly address the question of interest. Only 2 studies were randomized trials with no food support control groups. The remainder were randomized studies of one type of food support versus another, cohort (nonrandomized) studies, or single-arm studies. Ratings of individual study quality ranged from "medium" to "weak," and the quality of the overall body of evidence ranged from "fair" to "poor." We rated the expected impact on all outcomes as "uncertain." CONCLUSIONS: Rigorous better designed studies in resource-limited settings are urgently needed to understand the effectiveness of nutrition assessment and counseling alone, as well as studies to understand better modalities of food support (targeting, timing, composition, form, and duration) to improve both short- and long-term patient retention in care and treatment, and clinical outcomes. SN - 1944-7884 UR - https://www.unboundmedicine.com/medline/citation/25768873/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=25768873 DB - PRIME DP - Unbound Medicine ER -