Nutritional Treatment for Acquired Immunodeficiency Virus-Associated Wasting Using β-Hydroxy β-Methylbutyrate, Glutamine, and Arginine: A Randomized, Double-Blind, Placebo-Controlled Study

Background: The current study was designed to examine whether a combination of three nutrients, consisting of β-hydroxy-β-methylbutyrate (HMB), a metabolite of leucine, L-glutamine (Gln) and L-arginine (Arg), each of which has been previously shown to slow muscle proteolysis, could synergistically alter the course of muscle wasting in patients with established acquired immunodeficiency syndrome (AIDS). Methods: Sixty-eight human immunodeficiency virus (HIV)-infected patients with a documented weight loss of at least 5% in the previous 3 months were recruited from the HIV clinic at Nassau County Medical Center. The subjects were randomly assigned in a double-blind fashion to receive either placebo containing maltodextrin or the nutrient mixture (HMB/Arg/Gln) containing 3 g HMB, 14 g L-glutamine, and 14 g L-arginine given in two divided doses daily for 8 weeks. Body weights (BW) were recorded weekly and lean body mass (LBM) and fat mass (FM) were measured by air displacement plethysmography and by a single computerized tomography (CT) slice through the thigh at 0, 4, and 8 weeks. Results: Forty-three subjects completed the 8-week protocol, (placebo, n = 21; HMB/Arg/Gln, n = 22). At 8 weeks, the subjects consuming the HMB/Arg/Gln mixture gained 3.0 ± 0.5 kg of BW while those supplemented with the placebo gained 0.37 ± 0.84 kg (p = .009). The BW gain in the HMB/Arg/Gln-treated subjects was predominantly LBM (2.55 ± 0.75 kg) compared with the placebo-supplemented subjects who lost lean mass (-0.70 ± 0.69 kg, p = .003). No significant change in FM gain was observed (0.43 ± 0.83 kg for the group receiving HMB/Arg/Gln and 1.07 ± 0.64 kg for the group receiving the placebo, p > .20). Similar percentage changes in muscle mass and fat mass were observed with CT scans. Immune status was also improved as evident by an increase in CD3 and CD8 cells and a decrease in the HIV viral load with HMB/Arg/Gln supplementation. Conclusions: The data indicate that the HMB/Arg/Gln mixture can markedly alter the course of lean tissue loss in patients with AIDS-associated wasting. (Journal of Parenteral and Enteral Nutrition 24:133-139, 2000)