Follow-up, food intake and tolerance
Of the 64 patients enrolled, 55 patients completed the entire protocol and were evaluated after 6 months of follow-up (i.e., 75.7% of patients in standard group versus 70.9% in the Arg–Ω-3 group).
Non-supplement and supplement food intake
Fig. 2 shows overall food intake including oral nutritional supplement. Initial energy and protein intake was 2959 ± 155 and 2802 ± 180 kcal/kg daily, and protein intake 103.2 ± 6.7 and 97.0 ± 5.7 g daily, in standard (n = 31) and Arg-Ω-3 (n = 29) groups, respectively. Daily energy intake was 45.0 ± 2.5 and 41.5 ± 2.5 kcal/kg body weight per day and protein intake was 1.6 ± 0.1 and 1.4 ± 0.1 g protein/kg body weight per day, in standard and Arg-Ω-3 groups, respectively.
Protein intake increased by about 20% with oral supplementation and remained above baseline throughout the entire trial period. The mean number of servings of oral nutritional supplements ingested was similar in both groups, and remained stable with a reported monthly intake of 42–52 supplements (Fig. 2). An overall increase in energy intake of 9–17% was observed during the first 2 months of the study. Later, total energy intake decreased to levels similar to initial values because of a progressive and spontaneous reduction of non-supplement food intake (data not shown).
Anorexia and gastrointestinal tolerance clearly improved over time in contrast to diarrhoea. There was no significant difference between groups. Although tolerance to oral nutritional supplements was acceptable in both groups, it was the reason for discontinuation of supplements for nine patients (five in the Arg–Ω-3 group and four in the standard group). No toxic events were observed in either group.
Anthropometrics and body composition change
Patients in both groups progressively gained weight, with a mean final gain of 1.9 ± 0.6 and 2.2 ± 0.6 kg in standard and Arg–Ω-3 groups, respectively (Fig. 1). Out of the 52 patients, six patients lost 0.3–5.0 kg, and four patients lost 0.5–4.4 kg in standard and Arg–Ω-3 groups, respectively, during the 6 months of supplementation. Body mass increased as a reflection of a combined gain of dry fat-free mass (from 14.1 to 14.7 kg and from 14.7 to 15.0 kg, in standard versus Arg–Ω-3 groups) and fat mass (Fig. 1). None of the differences were statistically significant.
Immune status, viraemia and clinical endpoints
The variations of lymphocytes, CD4 and CD8 cell counts were similar in both groups and no statistically significant differences were detected in the changes between the two groups over the 6-month trial period (Table 3). There was no statistically significant change in viraemia and plasma sTNF-R55 and sTNF-R75 concentrations over time within or between the two groups.
The comparison of the changes in lymphocytes, CD4 and CD8 cell counts for patients whose initial CD4 counts were above or below 400 × 106 cells/l and for patients whose CD8 counts were above or below 800 × 106 cells/l did not indicate any clinically nor statistically significant difference between the two types of oral supplements.
Influence of antiviral treatment
Antiviral treatment was similarly distributed in both groups at inclusion (Table 2). Zidovudine and didanosine treatments were initiated in three and two patients, respectively, in the standard group, and one patient each in the Arg–Ω-3 group during the study period.
Quality of life
At inclusion, all eight dimensions of health-related quality of life were below the normal values but within 1 SD (standard versus Arg–Ω-3): physical functioning (92 ± 14 versus 91 ± 13), physical role (83 ± 31 versus 84 ± 29), emotional role (65 ± 40 versus 78 ± 35), social functioning (69 ± 28 versus 74 ± 23), pain (82 ± 23 versus 86 ± 18), mental health (60 ± 20 versus 66 ± 18), vitality (53 ± 17 versus 56 ± 19), general health (61 ± 18 versus 62 ± 20). No significant change was observed during the study period (data not shown).
Comparison with non-supplemented patients of the SHCS
The SHCS group of 236 patients who met the study eligibility criteria were similar to the patients in this study with respect to weight, BMI, CD4 and CD8 lymphocyte counts. After 6 months of follow-up, however, only 23 of the SHCS non-supplemented patients (9.7%) had gained more that 5% of their initial body weight compared with 14 (26.4%) patients participating in the present trial. This difference was statistically significant, and supplemented patients were more than three times as likely to gain weight as non-supplemented SHCS participants (odds ratio, 3.32; 95% confidence interval, 1.4–7.46). The mean weight change between the two groups over the 6-month trial period was also statistically significant (P < 0.005). Trial participants gained almost 2 kg whereas non-supplemented patients lost an average of 0.5 kg (P ≤ 0.001). The changes in CD4 and CD8 lymphocyte counts was similar in both trial groups and the SHCS control group. Although seven (3%) opportunistic infections occurred in the non-supplemented group compared with none in the trial group, this difference was not statistically significant.
This study describes a group of 66 HIV-positive out-patients taking a balanced oral nutritional supplement (606 kcal per day, enriched with micronutrients) with or without arginine and Ω-3 fatty acids for 6 months. Comparison of before and after the trial suggests that both supplementation groups increased the nitrogen/energy intake ratio, body weight, dry fat-free mass and fat mass, and reduced the frequency of anorexia and gastrointestinal symptoms. Arginine and Ω-3 fatty-acid supplementation did not have an impact on the number of clinical endpoints and changes in CD4 and CD8 cell counts, viraemia and sTNF-R.
At inclusion, the comparison of actual body weight with ideal or usual body weight suggested that patients were slightly underweight but had exhibited no significant weight loss during the previous 12 months (Table 2). This suggests that they did not suffer from malnutrition, a fact further supported by body composition parameters (Fig. 1), which were not statistically different from those of healthy subjects with similar age and sex . This study should therefore be regarded as an analysis of the impact of food supplementation with arginine and Ω-3 fatty acids on body composition and immune status, and not on refeeding.
Patients' compliance was remarkable with over 70% patients (n = 55) completing the 6-month trial. This might be explained by the selection of patients who were willing to undertake proactively a prolonged action that they believed potentially able to improve the course of their HIV infection but also by the low degree of anorexia and gastrointestinal symptoms at inclusion. This study confirms that prolonged oral nutritional supplementation is feasible in HIV-infected patients [20–22].
Symptomatic patients in both groups reported progressive improvement of anorexia and gastrointestinal symptoms. As previously reported [34–37], this may be related to nutritional counselling as well as to their decision to undertake a nutritional therapy that helped to improve their food intake, rather than to a direct effect of the nutritional supplement.
Fifty to 100% of the energy content of the oral nutritional supplementation (606 kcal daily) was added to the non-supplemental food intake during the first 2 months of the study, after which time the energy intake returned to baseline level. Because the number of ingested oral supplements remained stable, this suggests that a compensatory mechanism reduced spontaneous food intake (Fig. 2) when patients had an energy intake in excess of their metabolic needs, which has been reported to be about 2750 ± 670 kcal daily in similar patients . This value is close to our patients' total food intake (Fig. 2). In addition, there was no difference between the two groups in the quality of the food intake or in the intake of vitamins, trace elements and other over-the-counter food supplements. On the other hand, the nitrogen/energy ratio was qualitatively improved by oral supplementation, as has previously been noted . This effect was in addition to an ingested protein level of 120–130% of the recommended range at inclusion . This suggests that nutritional supplements in clinically stable patients are selectively efficient to increase nitrogen intake and stimulate protein tissue deposition .
Body weight increases were associated with both fat-free mass and fat mass gains (Fig. 1), which demonstrated an expansion of body mass of mixed composition, but predominantly fat. Such an anabolism with fat deposition at different stages of the disease is associated with food intake in excess of metabolic needs in HIV-infected patients [3,39]. This observation is further supported by the comparison of our study patients with similar SHCS patients who received no oral nutritional supplementation and who did not gain body weight (P < 0.005).
The combined gain of about 0.5 kg of dry fat-free mass (non-fat tissue minus water) and 1 kg of fat mass in both groups of patients represented a theoretical metabolic excess of about 9 000–11 000 kcal. As protein and calorie intake during the 6 months of study were substantially above the recommended protein (1.2 g/kg body weight per day) and energy (35 kcal/kg body weight per day) requirements, it suggests that energy needs of HIV-infected patients were markedly higher than those of healthy subjects. This effect is thought to be related to malabsorption [40,41], reduced metabolic efficiency , and to some extent to modified energy expenditure due to HIV infection and possibly due to an increased diet-induced thermogenesis related to food intake in excess of metabolic needs [1,42]. It also suggests that protein intake in excess of basal needs with adequate energy intake can reduce lean tissue catabolism, which is all too frequently observed in infected patients, especially in those who are HIV-infected .
Early voluntary withdrawal of patients in this study due to intolerance of oral nutritional supplement was more frequent in the Arg–Ω-3-supplemented patients than in those on standard product (four versus one). This may be related to the lower palatability of synthetic Ω-3 fatty acids. Nevertheless, the difference in patients who did not complete the entire protocol probably did not influence our results because the number of patients who withdrew was small in both groups. Other trials with oral nutritional supplements without or with Ω-3 fatty-acid or arginine enrichment have reported similar good compliance [18,37,44,45].
Chlebowski et al.  and Süttmann et al.  demonstrated a 4 and 3 kg gain in body weight, respectively, in their HIV-infected patients on oral nutritional supplementation enriched with fish-oil and fish-oil-arginine for 6 and 4 months, respectively. Patients in the control groups on non-supplemented formula had no body weight gain in spite of the extra food intake, which suggests that either the excess nutrients were not metabolised or that the metabolic rate was higher in these patients. The authors explained this distinct increase in body weight as an effect of the so-called ‘immunostimulant compounds’, which may have downregulated the cytokine-related energy expenditure. However, our patients showed body weight gain in both groups. We have no rational explanation for this difference in findings compared with our study results.
Immune function is modulated by many compounds, including arginine and extra long-chain fatty acids (or Ω-3 fatty acids) [8,9,11–19]. Since we hypothesized that long-term oral nutritional supplementation enriched with arginine and Ω-3 fatty acids would contribute to preserve the immune status of HIV-infected patients, we measured the standard parameters used to follow HIV-infected patients' immune function such as CD4 lymphocyte count and sTNF-R as a reflection of cytokine activity [46,47]. sTNF-R55 and sTNF-R75 were elevated in HIV-infected patients and play the role of modulators of the antagonists or neutralizing agents of TNF secretion in response to HIV infection, and signalled an activation of the TNF-α system , although this finding is still debated . In our study, patients showed no change of sTNF-R55 and sTNFR75 plasma levels, which suggests that the rate of HIV activity or other associated infections remained stable, a fact supported by the stability of viraemia in both patient groups during the study.
The trial results do not support our hypothesis that either long-term oral nutritional supplementation contributes to preserve the immune status of HIV-infected patients, or that enrichment with arginine and Ω-3 fatty acids stimulates immune cell activity. In contrast to previous studies [22,44], our study did not support the clinical use of an enriched diet to stimulate the immune system of HIV-infected patients for the duration and the quantity used in this study. However, the fat and lean body weight gain noted in our study patients compared with weight loss observed in the SHCS patients argues in favour of routine nutritional supplementation and counselling to prevent weight loss, which is a contributing factor in HIV disease progression from an epidemiological point of view .
The doses of arginine and Ω-3 fatty acids in our study were based on animal or preliminary human studies in HIV-infected patients [13–17,19,44,49–57]. More recently, Süttmann et al.  have shown improvement in the immune function of HIV-infected patients, using combined supplementation of arginine and Ω-3 fatty acids (7.5 and 1.8 g daily, respectively). Larger doses could have been tested but might have decreased patients' compliance (due to taste problems) or tolerance (due to aftertaste and gastric reflux).
At the time the study protocol was prepared, it had been reported that supplementation with arginine or Ω-3 fatty acids stimulated immune function and thus avoided the reduction of CD4 cell count in a crossover study involving six HIV-positive non-AIDS patients during a 6-month period (unpublished data), as well as in various other clinical conditions [13–17,19,44,58].
More recent reports have suggested a decrease in renal transplant rejection and inflammatory response in ulcerative colitis, suggesting a decrease in immune function secondary to Ω-3 fatty-acid administration. On the other hand, arginine has been repeatedly associated with immune function enhancement. In our study, the consequences of a combination of arginine and Ω-3 fatty acids may have been to cancel each other out. Therefore, future research should evaluate the effects of single compounds of immune-enhancing nutrients as well as other nutrients.
After 6 months of oral nutritional supplementation, all patients were given the option of continuing for an additional 6 months. Only six and nine patients in standard and Arg–Ω-3 groups, respectively, completed this period. A post-hoc analysis did not reveal conclusions that were different from those drawn after the 6-month study period.
The study design had the limitation of not including a prospective, randomized group without nutritional supplementation. There are many reasons why prospective, double-blind, placebo-controlled trials of oral nutritional supplements are difficult to complete, and amongst them is the production of a placebo that cannot be distinguished from the oral nutritional supplement, and the extreme difficulty in recruiting placebo patients at a time when various campaigns were taking place to promote oral nutritional supplementation in Geneva. To circumvent this methodological problem and to add strength to our results, we compared our study patients with those included in the SHCS who were not on nutritional supplementation. Standard immune competence markers and viraemia remained unchanged and similar in both groups during the study period. Influence of existing antiviral treatment at inclusion or antiviral drug treatment alterations during the study period was not likely because the modifications were rare and equally distributed in both groups (Table 2). Finally, the absence of a statistically significant difference should not be interpreted as the demonstration that the two treatments were equivalent. It is possible that a small (and therefore not clinically relevant) difference existed, but was not detected because of the relatively small sample size.
In conclusion, oral nutritional supplements balanced for protein and energy supplying 606 kcal daily for a 6-month period were well tolerated and resulted in body weight gain in HIV-infected patients. Supplement enriched with nutrients potentially active in stimulating immune function, such as arginine and Ω-3 fatty acids, produced statistically similar results. No improvement in immune status, as reflected by CD4 lymphocyte counts, sTNF-R and viraemia, was observed. Quantities of arginine and Ω-3 fatty acids other than those used in this study may be found to have beneficial effects on immune function. Oral nutritional supplementation and diet counselling are likely to continue to be indicated in HIV-infected patients as supportive measures to antiretroviral treatments.
The authors are indebted to the physicians for their help in recruiting and following up patients; C. Willimann and M. Kruseman for their contribution to the data collection; H. Gallati for the measurements of TNF plasma; U. Kyle and H. Schneider for their helpful comments and editorial assistance; T. Perneger for his expertise in using and interpreting the SF-36 questionnaire.
1. Macallan DC, Noble C, Baldwin C, et al.
: Energy expenditure and wasting in human immunodeficiency virus infection
. N Engl J Med
2. Grunfeld C, Feingold KR: Body weight as essential data in the management of patients with human immunodeficiency virus infection and the acquired immunodeficiency syndrome
. Am J Clin Nutr
3. Macallan DC, McNurlan MA, Milne E, Calder AG, Garlick PJ: Whole-body protein turnover from leucine kinetics and the response to nutrition in human immunodeficiency virus infection
. Am J Clin Nutr
4. Ochitill H, Dilley J, Kohlwes J: Psychotropic drug prescribing for hospitalized patients with acquired immunodeficiency syndrome
. Am J Med
5. Mulligan K, Grunfeld C, Hellerstein MK, Neese RA, Schambelan M: Anabolic effects of recombinant human growth hormone in patients with wasting associated with human immunodeficiency virus infection
. J Clin Endocr Metab
6. Von Roenn JH, Armstrong D, Kotler DP, et al.
: Megestrol acetate in patients with AIDS-related cachexia
. Ann Intern Med
7. Palenicek JP, Graham NM, Hoover DA, Oishi JS, Kingsley L, Saah AJ: Weight loss prior to clinical AIDS as a predictor of survival
. J Acquir Immune Defic Syndr
8. Tang AM, Graham NMH, Kirby AJ, McCall LD, Willet WC, Saah AJ: Dietary micronutrient intake and risk of progression to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus type 1 (HIV-1)-infected homosexual men
. Am J Epidemiol
9. Baum M, Cassetti L, Bonvehi P, Shor-Posner G, Lu Y, Sauberlich H: Inadequate dietary intake and altered nutrition status in early HIV-1 infection
10. Schwenk A, Bürger B, Wessel D, et al.
: Clinical risk factors for malnutrition in HIV-1-infected patients
11. Coodley GO, Coodley MK, Nelson HD, Loveless MO: Micronutrient concentration in the HIV wasting syndrome
12. Chandra RK: 1990 McCollum Award Lecture. Nutrition and immunity: lessons from the past and new insights into the future
. Am J Clin Nutr
13. Kelley VE, Kirkman RL, Bastos LM, Barrett LV, Strom TB: Enhancement of immunosuppression by substitution of fish oil for olive oil as a vehicle for cyclosporine
14. Decsi T, Zaknun D, Zaknun J, Sperl W, Koletzko B: Long-chain polyunsaturated fatty acids in children with severe protein-energy malnutrition with and without human immunodeficiency virus-1 infection
. Am J Clin Nutr
15. Chang HR, Arsenijevic D, Pechère JC, et al.
: Dietary supplementation with fish oil enhances in vivosynthesis of tumor necrosis factor
. Immunol Lett
16. Manner T, Katz DP, Skeie B, Newsholme E, Kirvelä O, Askanazi J: Fish oils and the lung
. Clin Nutr
17. Daly JM, Lieberman MD, Goldfine J, et al.
: Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: immunologic, metabolic, and clinical outcome
18. Blackburn GL, Bell S: Eutrophia in patients with HIV infection and early AIDS with novel nutrient ‘cocktail’: is this the first food for special medical purpose? Nutrition
19. Kirk SJ, Hurson M, Regan MC, Holt DR, Wasserkrug HL, Barbul A: Arginine stimulates wound healing and immune function in elderly human beings
20. Chlebowski RT, Tai V, Novak D, et al.
: Adherence to an enteral supplement program in patients with HIV infection
. Clin Nutr
21. Bürger B, Ollenschläger G, Schrappe M, et al.
: Nutrition behavior of malnourished HIV-infected patients and intensified oral nutritional intervention
22. Süttmann U, Ockenga J, Schneider H, et al.
: Weight gain and increased concentrations of receptor proteins for tumor necrosis factor after patients with symptomatic HIV infection received fortified nutrition support
. J Am Diet Assoc
23. Ledergerber B, von Overbeck J, Egger M, Lüthy R: The Swiss HIV Cohort Study: rationale, organization and selected baseline characteristics
. Soz Präventivmed
24. Kushner RF, Kunigk A, Alspaugh M, Andronis PT, Leitch CA, Schoeller DA: Validation of bioelectrical-impedance analysis as a measurement of change in body composition in obesity
. Am J Clin Nutr
25. Ott M, Lembcke B, Fischer H, et al.
: Early changes of body composition in human immunodeficiency virus-infected patients: tetrapolar body impedance analysis indicates significant malnutrition
. Am J Clin Nutr
26. Wang J, Kotler DP, Russell M, et al.
: Body-fat measurement in patients with acquired immunodeficiency syndrome: which method should be used? Am J Clin Nutr
27. Pichard C, Kyle U, Hirschel B: SIDA et place de la bioimpedance électrique en routine clinique [abstract]
. Nutr Clin Métabol
28. Pichard C, Slosman D, Hirschel B, Kyle U: Bioimpedance analysis in AIDS patients: an improved method for nutritional follow-up [abstract]
. Clin Res
29. Pichard C, Kyle U, Slosman D, Kaiser L, Hirschel B, Loizeau L: Modifications de la composition corporelle et SIDA: place de l'analyse de la bioimpedance électrique [abstract]
. Schweiz Med Wochenschr
30. Centers for Disease Control: Revision of the CDC case definition for acquired immunodeficiency syndrome
31. Yerly S, Chamot E, Hirschel B, Perrin LH: Quantification of human immunodeficiency virus provirus and circulating virus: relationship with immunologic parameters
. J Infect Dis
32. Heilig B, Wermann M, Gallati H, et al.
: Elevated TNF receptor plasma concentrations in patients with rheumatoid arthritis
. Clin Invest
33. Perneger TV, Leplège A, Etter JF, Rougemont A: Validation of a French-language version of the MOS 36-item short form healthy survey (SF36) in young healthy adults
. J Clin Epidemiol
34. Schwenk A, Bürger B, Ollenschläger G, et al.
: Evaluation of nutritional counselling in HIV-associated malnutrition
. Clin Nutr
35. Sharkey SJ, Sharkey KA, Sutherland LR, Church DL, GI-HIV
Study Group: Nutritional status and food intake in human immunodeficiency virus infection
. J Acquir Immune Defic Syndr
36. Kormas J, Hynak-Hankinson MT: Acceptance of elemental formulas by people with HIV infections
. Topics Clin Nutr
37. Green CJ: Nutritional support in HIV infection and AIDS
. Clin Nutr
38. National Research Council: Recommended Dietary Allowances
. Washington, DC: National Academy Press; 1989.
39. Kotler DP, Tierney AR, Ferraro R, et al.
: Enteral alimentation and repletion of body cell mass in malnourished patients with AIDS
. Am J Clin Nutr
40. Kapembwa MS, Fleming SC, Griffin GE, Caun K, Pinching AJ, Harris JRW: Fat absorption and exocrine pancreatic function in HIV infection
41. Kotler DP (Ed): Gastrointestinal and Nutritional Manifestations of the Acquired Immunodeficiency Syndrome
. New York: Raven Press; 1991.
42. Melchior J-C, Raguin G, Boulier A, et al.
: Resting energy expenditure in human immunodeficiency virus-infected patients: comparison between patients with and without secondary infections
. Am J Clin Nutr
43. Risser JMH, Rabeneck L, Foote LW, Klish WJ: A comparison of fat-free mass estimates in men infected with the human immunodeficiency virus
. J Parent Enteral Nutr
44. Chlebowski RT, Beall G, Grosvenor M, et al.
: Long-term effects of early nutritional support with new enterotropic peptide-based formula vs. standard enteral formula in HIV-infected patients: randomized prospective trial
45. Yeatman TJ, Risley GL, Brunson ME: Depletion of dietary arginine inhibits growth of metastatic tumor
. Arch Surg
46. Grunfeld C, Schambelan M: The wasting syndrome: pathophysiology and treatment
. In The Wasting Syndrome: Pathophysiology and Treatment
. Edited by Broder S, Merigan T, Bolognesi D. Baltimore: Williams and Wilkins; 1994:637–649.
47. Kalinkovich A, Engelmann H, Harpaz N, et al.
: Elevated serum levels of soluble tumour necrosis factor receptors (sTNF-R) in patients with HIV infection
. Clin Exp Immunol
48. Nahlen BL, Chu SY, Nwanyanwu OC, Berkelman RL, Martinez SA, Rullan JV: HIV wasting syndrome in the United States
49. Alexander JW: The importance of lipid type in the diet after burn
. Ann Surg
50. Kinsella JE, Lokesh B: Dietary lipids, eicosanoids, and the immune system
. Crit Care Med
51. Homann HH, Kemen M, Senkal M, Birkenbeil AK, Neumann H, Zumtobel V: Influence of arginine, RNA and omega-3-fatty acid supplemented enteral nutrition on postoperative humoral immunity in cancer patients undergoing major upper gastrointestinal surgery [abstract]
. Clin Nutr
52. Kemen M, Senkal M, Homann HH, Mumme A, Baier J, Zumtobel V: Influence of arginine, RNA and omega-3 fatty acid supplemented enteral nutrition on postoperative humoral immunity in cancer patients undergoing major upper gastrointestinal surgery
. Clin Nutr
53. Kirk SJ, Barbul A: Role of arginine in trauma, sepsis, and immunity
. J Parent Enteral Nutr
54. Kramer TR, Schoene N, Douglass LW, et al.
: Increased vitamin E intake restores fish-oil-induced suppressed blastogenesis of mitogen-stimulated T lymphocytes
. Am J Clin Nutr
55. Loo LS, Tang JP, Kohl S: Inhibition of cellular cytotoxicity of leukocytes for herpes simplex virus-infected cells in vitro and in vivo by Intralipid
. J Infect Dis
56. McClave SA, Lowen CC, Snyder HL: Immunonutrition and enteral hyperalimentation of critically ill patients
. Dig Dis Sci
57. Van Buren CT, Rudolph RB, Kulkarni A, Pizzini R, Fanslow WC, Kumar S: Reversal of immunosuppression induced by a protein-free diet: comparison of nucleotides, fish oil, and arginine
. Crit Care Med
58. Süttmann U, Selberg O, Galatti H, Ockenga J, Deicher H, Müler MJ: TNF-Rezeptorserumkonzentrationen bei HIV-1-Infizierten: Bedeutung für die Ausprägung der Fehlernährung? Clin Invest
Members of the Swiss HIV Cohort Study
M. Battegay, Ph. Bürgisser, L. Jeannerod, M. Egger, P. Erb (President of the Laboratory Group), W. Fierz, M. Flepp (President of the Clinical Group), P. Francioli (President of the SHCS, University Hospital, Lausanne, Switzerland), P. Grob, U. Grüninger (Observers of the Federal Office of Public Health), B. Hirschel (President of the Scientific Board), B. Ledergerber, R. Lüthy, R. Malinverni, L. Matter, M. Opravil, F. Paccaud, L. Perrin, W. Pichler, M. Rickenbach (Manager of the Data Coordination Centre), O. Rutschmann, P. Vernazza, J. von Overbeck.
Keywords:© Lippincott-Raven Publishers.
HIV; immunity; viraemia; nutritional status; tumour necrosis factor soluble receptors; body composition; electrical bioimpedance; food supplement; arginine; Ω-3 fatty acid