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

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Abstract
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)