This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Heiser, C. R. Articles by Dube, M. P. Search for Related Content PubMed PubMed Citation Articles by Heiser, C. R. Articles by Dube, M. P. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information AIDS AIDS Medicines Diarrhea Dietary Fiber Social Bookmarking                   What's this?

Probiotics, Soluble Fiber, and L-Glutamine (GLN) Reduce Nelfinavir (NFV)or Lopinavir/Ritonavir (LPV/r)-related Diarrhea

Center for Functional Nutrition, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA

Judith A. Ernst, DMSc, RD

Indiana University, Indianapolis, Indiana, USA

James Tom Barrett, MD

Howard Brown Health Center, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA

Neel French, MD

Malte Schutz, MD

Howard Brown Health Center, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA

Michael P. Dube, MD

Indiana University, Indianapolis, Indiana, USA

Purpose: Highly active antiretroviral therapy (HAART) can be associated with diarrhea and other gastrointestinal (GI) side effects. Reducing these side effects may improve treatment durability and quality of life (QOL). This study assessed the impact of nutritional co-therapies known to reduce diarrhea in HIV-positive men treated with nelfinavir (NFV)- or lopinavir/ritonavir (LPV/r)-containing regimens. Methods: Thirty-five HIV-positive men treated with NFV (n = 27) or LPV/r (n = 8) with diarrhea (± two liquid stools/day [d]) participated in a 12-week prospective study. Twenty-eight subjects were randomly assigned supplements (S), seven received standard of care (C). Group S received probiotics (1.2g/d) and soluble fiber (11g/d). If diarrhea persisted at week 4, 30g/d L-Glutamine (GLN) was added. Diarrhea incidence, as well as supplement and antidiarrheal use, was assessed monthly. Results: Weight, CD4 count, and HIV RNA were unchanged in both groups. Diarrhea completely resolved in 10 of 28 (36 percent) S subjects. The mean (± SD) number of stools/d declined [3.40 ± 1.25 to 2.54 ± 1.34 (p < 0.01)]. Diarrhea (loose, watery stools/d) lessened in S from 2.84 ± 1.42 to 0.74 ± 1.03 (p < 0.0001). Fifteen S subjects did not obtain full relief with probiotics and fiber, but stools/d decreased from 4.08 ± 1.35 to 3.06 ± 1.68 (p < 0.05) after starting GLN. In C, stools/d, 4.14 ± 4.86 to 3.44 ± 1.68(p = 0.678) and incidence of diarrhea/d, 3.00 ± 4.82 to 1.36 ± 1.29 (p= 0.361) was unchanged. In S, loperamide use decreased from 1.69 ± 2.34 to 0.31 ± 0.69 mg/d (p < 0.01); 18 versus eight subjects used loperamide at 0 and 12 weeks, respectively. Conclusion: Probiotics, soluble fiber, and GLN significantly reduced diarrhea for subjects receiving NFV or LPV/r. Nutritional co-therapies show clinical benefit in HIV-positive men with diarrhea.

Key Words: HIV • nelfinavir • lopinavir/ritonavir • diarrhea • protease inhibitors

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 3, No. 4, 121-129 (2004)
DOI: 10.1177/154510970400300403


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?