Nutritional interventions for reducing morbidity and mortality in people with HIV.

Systematic review of randomized trials in adults and children living with HIV/AIDS across diverse settings, including participants on and not on antiretroviral therapy. Some studies also included TB/HIV co-infection, while pregnant or lactating women were excluded.

This review evaluated orally administered macronutrient supplementation for people living with HIV, including protein and/or energy supplements, often fortified with micronutrients and usually given alongside nutrition counselling. Across trials, regimens varied widely in formulation, dose, and duration, so there was no single standardized intervention.

Overall, oral macronutrient supplementation did not show consistent clinical benefit for HIV-related outcomes. When macronutrient supplements fortified with micronutrients were added to nutrition counselling, energy and protein intakes increased compared with counselling alone, but there was no consistent evidence of improvement in mortality, morbidity, body weight, or immunologic outcomes. The evidence base was limited by small, heterogeneous trials with widely varying supplement types, formulations, durations, and participant characteristics.

The evidence came largely from small randomized trials with substantial heterogeneity in supplement type, dose, duration, and participant populations, which limited pooling and reduced certainty. Many studies were underpowered for clinical endpoints such as mortality and morbidity, and generalizability was limited by differences in HIV stage, ART status, and setting.