[pronut-hiv] Request for information on macro and micronutrient supplements for people living with HIV/AIDS

["subhasree sai raghavan" <subhasree_raghavan@yahoo.com>]

Dear All,

Greetings from Chennai. I am really glad to inform you that the state of
Tamilnadu will be implementing a comprehensive food distribution program
through WFP very soon. I am writing this e-mail to seek your guidance on
another critical issues.

We are in the process of procuring macro and micro-nutrient supplements for
4000 patients we will be serving through a ARV scale up program which will
include both adults and children. We will be providing ARV, care, support
and nutrition supplements for 1000 patients (Cd4 <200) and care, support and nutrition supplements for 3000 patients (CD4 >200). The funder and the
government are very keen on carefully documenting the impact of macro and
micronutrient supplementations on disease progress and death in those not
receiving ARVs. In other words we are hoping that supplementation may delay
need for ARVs by delaying disease progression, and we have secured funding
to carefully collect these data in this large cohort as an observational
study.

I have the following critical questions and will really appreciate if you
can share your experiences from rest of the world.

1. What are the current recommendations on micronutrient supplements you are using in rest of the world.

1. A. Can we go ahead with a supplement containing 100% Indian RDA of
vitamins and minerals .
1.b. However levels of vitamins which were shown to increase Cd4 cell counts and delay disease progression in wafie's study are much higher than our Indian RDA. Do you recommend that we ask the manufacturer to make a
supplement containing these high levels. The results are very compelling,
however we may run into resistance from the government to use such high
levels as current who guidlines instructs not to go over 200% rda.

2. With regard to minerals there are no studies that have documented the
impact of multi-mineral supplements. In absence of such data, is it safe for us to go ahead with a supplement containing 100% Indian RDA. if you have access to studies documenting the impact of minerals on disease progress, I will appreciate if you can share the same.

3. do we have any data on macronutrient supplementation and disease
progression and death from the developing world ? I will appreciate if you
can share the same if they are available.

4. Finally do you have access to operational nutrition manuals that can be
used by doctors, nurses and nutritionists ? If yes, I will be grateful if
you can direct me to the source.

best regards and thanks a lot for your assistance.

Dr. Sai Subhasree Raghavan
www.saathii.org