Effects of protein-calorie supplementation on HIV disease in breastfeeding women

补充蛋白质热量对母乳喂养妇女艾滋病毒疾病的影响

• 批准号: 8209271
• 负责人: Charles Fordham von Reyn
• 金额: $ 31.76万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-15 至 2013-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8209271
• 关键词: Address; Affect; Africa South of the Sahara; African; Allied Health Sciences; Anti-Retroviral Agents; Biological Response Modifiers; Breast Feeding; Caring; Child; Clinical; Clinical Trials; Collaborations; Country; Data; Developing Countries; Diet; Disease; Disease Outcome; Enrollment; Focus Groups; HIV; HIV Infections; Health; Human Milk; Immune; Immune response; Immunity; In Vitro; Infant; Intervention; Interview; Joints; Lead; Malnutrition; Measurement; Micronutrients; Mothers; Nutrition Assessment; Nutritional Study; Outcome; Patients; Plasma; Play; Policies; Positioning Attribute; Production; Proteins; Public Health; Randomized Clinical Trials; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Recommendation; Research; Research Infrastructure; Resources; Risk; Role; Severities; Severity of illness; Supplementation; Surrogate Markers; T cell response; T-Lymphocyte; Tanzania; Time; Tuberculosis; Universities; Vertical Disease Transmission; Viral Load result; Vulnerable Populations; Woman; cytokine; experience; high risk; immune function; improved; medical schools; nutrition; prevent; programs; standard of care; transmission process

DESCRIPTION (provided by applicant): In resource poor regions of the world where HIV is endemic, especially countries in sub-Saharan Africa, nutrition plays a critical role in HIV disease. Nutrition affects the health of HIV-infected women and children, and may influence the risk of mother to infant transmission of HIV through breast milk. Nutrition influences the risk of tuberculosis (TB) and TB disease severity. Existing research has focused on the role of micronutrients in HIV disease outcomes but has not addressed the role of protein calorie supplementation (PCS) in subpopulations of patients with HIV disease at high risk, specifically; HIV-infected women who are either breast feeding or have active TB. Our hypotheses are that administration of a culturally acceptable PCS is a practical, sustainable and effective strategy to: 1) decrease HIV viral load in plasma and breast milk of breast feeding women, enhance passively transferred immune mediators in breast milk, and improve HIV outcomes in women and their breast-fed infants and, 2) decrease HIV viral load, enhance TB-specific T cell immunity, and improve outcomes in women with HIV and active TB. Our two specific aims are to show that these strategies are effective in randomized clinical trials. Drawing on the 8 year DarDar collaboration between Dartmouth and Muhimbili University of Health and Allied Sciences in Tanzania we will conduct 3 nutritional studies among HIV-infected women in Dar es Salaam. Study A will enroll 160 HIV+ and HIV- women who are either breast feeding (BF) or have active TB to conduct dietary interviews and focus groups to quantitate existing nutritional deficiencies and to define a culturally acceptable PCS. Studies B (118 HIV+ and 60 HIV- women who are breastfeeding) and C (118 HIV+ and 60 HIV- women with active TB) are randomized controlled trials which will compare the effects of 6 months of PCS + micronutrient supplement (MNS) vs. MNS alone on overall disease outcomes as well as specific surrogate markers of HIV disease, specific immune factors in breast milk and specific T cell responses against TB. Findings from these studies are expected to have a major impact on policies for nutritionally vulnerable HIV subpopulations.

描述（由申请人提供）：在世界上艾滋病毒是地方性的世界贫困地区，尤其是撒哈拉以南非洲的国家，营养在艾滋病毒疾病中起着至关重要的作用。营养会影响感染HIV的妇女和儿童的健康，并可能影响母亲通过母乳传播艾滋病毒的风险。营养影响结核病（TB）和结核病疾病严重程度的风险。现有的研究集中在微量营养素在HIV疾病结局中的作用，但尚未解决蛋白质辅助补充（PC）在高风险高风险的HIV疾病患者的亚群中的作用。艾滋病毒感染的妇女是母乳喂养或具有活性结核病。 Our hypotheses are that administration of a culturally acceptable PCS is a practical, sustainable and effective strategy to: 1) decrease HIV viral load in plasma and breast milk of breast feeding women, enhance passively transferred immune mediators in breast milk, and improve HIV outcomes in women and their breast-fed infants and, 2) decrease HIV viral load, enhance TB-specific T cell immunity, and improve outcomes in women with HIV and活性结核我们的两个具体目的是表明这些策略在随机临床试验中有效。利用达特茅斯和坦桑尼亚穆希比利卫生大学和盟军科学之间的8年Dardar合作，我们将在达累斯萨拉姆的HIV感染妇女中进行3项营养研究。研究A将招募160名HIV+和HIV-妇女，他们要么是母乳喂养（BF），要么具有活跃的结核病来进行饮食访谈和焦点小组，以量化现有的营养缺乏症并定义文化上可接受的PC。 Studies B (118 HIV+ and 60 HIV- women who are breastfeeding) and C (118 HIV+ and 60 HIV- women with active TB) are randomized controlled trials which will compare the effects of 6 months of PCS + micronutrient supplement (MNS) vs. MNS alone on overall disease outcomes as well as specific surrogate markers of HIV disease, specific immune factors in breast milk and specific T cell responses against TB.这些研究的发现预计将对营养脆弱的HIV亚群的政策产生重大影响。