Effects of daily supplementation with spirulina fortified cereals on the body composition of people living with HIV/AIDS in Chad

Abstract

Background: Nutritional status of people living with HIV/AIDS (PLHA) in low- and middle-income countries remains a major determinant of mortality, poor response to antiretroviral therapy (ART), and higher dropout rates. Protein supplementation is a promising strategy for restoring fat-free mass (FFM) and reducing weight loss in PLHIV. Our objective was to assess, among PLHA receiving ART, the effectiveness of supplementation with spirulina-fortified or unfortified millet flour on the change in weight, and in FFM and fat mass (FM). Method. In an interventional randomized controlled trial, 345 adults living with HIV/AIDS, who attended the Hôpital du jour, N’Djamena and just started ART were enrolled. Participants were assigned randomly to receive one of the nutritional treatments for a period of six months: 1) standard care only, ART and nutritional counseling (Control); 2) daily 500 g of unfortified millet flour and standard care (Millet); and 3) daily 500 g of spirulina-fortified millet flour and standard care (Spirulina). At baseline and endline, weight and height were measured. Body composition was assessed using the deuterium dilution method. Analysis of co-variance was used to compare the difference between groups. Differences were considered significant at p<0.05. Results : 345 adults (33.2 ± 7.7 years of age) were enrolled and 295 completed the study. At baseline, 16.5% of participants were underweight (body weight index, BMI <18.5 kg/m2) and 79.4% had low to severely-low CD4. Weight increased in all groups (mean ± SD; 3.41 ± 4.17 kg). Weight gain was significantly higher in spirulina (4.74 ± 0.41 kg) than in millet (3.63 ± 0.44 kg) and control (1.91 ± 0.36 kg) groups (p<0.0001). Change in FFM was significantly greater in spirulina (6.02 ± 0.69 kg) compared to millet (3.06 ± 0.52 kg) and control (1.07 ± 0.84 kg). Proportion of FM (%FM) was lowest in the spirulina group (25.1% vs. 27.6% and 28.0% in control and millet groups respectively, p=0.003). Conclusion: In food insecure settings, spirulina-fortified cereal flour increased weight with a body composition favoring FFM and a lower %FM. Further analyses will assess the effects on the immune response to ART.