Diarrhea and Reduced Levels of Antiretroviral Drugs: Improvement with Glutamine or Alanyl-Glutamine in a Randomized Controlled Trial in Northeast Brazil

• Published in: Clinical infectious diseases 2004-06, Vol.38 (12), p.1764-1770
• Main Authors: Bushen, Oluma Y., Davenport, John A., Lima, Afonso Bezerra, Piscitelli, Stephen C., Uzgiris, Arejas J., Silva, Terezinha M. J., Leite, Roberio, Kosek, Margaret, Dillingham, Rebecca A., Girao, Arlete, Lima, Aldo A. M., Guerrant, Richard L.
• Format: Article
• Language: English
• Subjects: Acquired Immunodeficiency Syndrome - blood; Acquired Immunodeficiency Syndrome - complications; Acquired Immunodeficiency Syndrome - drug therapy; Adult; AIDS; Anti-HIV Agents - blood; Anti-HIV Agents - pharmacokinetics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active; Antiretrovirals; Antiviral agents; Antivirals; Biological and medical sciences; Brazil; Control groups; Diarrhea; Diarrhea - drug therapy; Diarrhea - etiology; Dipeptides - therapeutic use; Dosage; Drug Resistance, Viral - genetics; Excretion; Female; Gin; Glutamine - therapeutic use; HIV; HIV - genetics; HIV Wasting Syndrome - blood; HIV Wasting Syndrome - drug therapy; HIV/AIDS; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pilot Projects; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viruses
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/421394

The effects of therapy with glutamine and alanyl-glutamine on diarrhea and antiretroviral drug levels in patients with acquired immune deficiency syndrome (AIDS) were examined in a randomized, double-blinded, placebo-controlled study in northeast Brazil. Patients with AIDS and with diarrhea and/or wasting were randomized into 4 groups to determine the efficacy of glutamine or high- or low-dose alanyl-glutamine given for 7 days, compared with isonitrogenous glycine given to control subjects. All patients in whom baseline antiretroviral drug levels were determined had low levels 2 h after dosing. Gastrointestinal symptom scores improved with receipt of high-dose alanyl-glutamine (P < .05) or glutamine (P < .01). Antiretroviral drug levels increased in patients given alanyl-glutamine (P = .02) or glutamine (P = .03) by 113% (P = .02) and 14% (P = .01), respectively. Antiretroviral drug resistance mutations were common in all groups. The dose-related efficacy of alanyl-glutamine and glutamine in treating diarrhea and in increasing antiretroviral drug levels shows that these supplements may help to improve therapy for patients with AIDS who have diarrhea and/or wasting in developing, tropical areas.