Estudo duplo-cego, randomizado, controlado por placebo, utilizando doses isonitrogênicas de alanil-glutamina (24 g/dia) e de placebo (glicina, 25 g/dia) durante 10 dias. Antes e depois dessa suplementação nutricional a excreção urinária de lactulose e manitol foi determinada por cromatografia líquida de alta performance.

Resultados

Quarenta e seis pacientes com HIV/AIDS, sendo 36 do sexo masculino, com 37,28 ± 3 anos (média ± erro padrão) foram incluídos. Vinte e dois e 24 indivíduos foram tratados com alanil-glutamina e com glicina, respectivamente. Nos nove pacientes que relataram ter apresentado diarreia nos 14 dias anteriores ao início do estudo, a excreção urinária de manitol foi significativamente menor do que nos pacientes que não referiram essa queixa [mediana (intervalo): 10,51 (3,01-19,75) vs 15,37 (3,93-46,73), P = 0,0281] e a razão lactulose/manitol foi significativamente mais elevada [mediana (intervalo): 0,04 (0,00-2,89) vs 0,02 (0,00-0,19), P = 0,0317]. Constatou-se também aumento significativo na excreção urinária de manitol no grupo tratado com alanil-glutamina [mediana (intervalo): 14,38 (8,25-23,98), antes vs 21,24 (6,27-32,99) após o tratamento, n = 14, P = 0,0382].

Conclusão

Os resultados do presente estudo sugerem que a integridade e a absorção intestinais são mais intensamente afetadas em pacientes com HIV/AIDS que tiveram diarreia recentemente. Adicionalmente, a suplementação nutricional com alanil-glutamina associou-se à melhoria na absorção intestinal.

Absorção intestinal; Glutamina; HIV; Placebo

Parameters	All	Study groups		P
Parameters	n = 46	Placebo GLY ^a a GLY = glycine (placebo) – GLY (25 g/day) was given with orange juice for 10 days, beginning on the 1st day of the study protocol n = 24	AG ^b b AG = alanyl-glutamine - AG (24 g/day) was given with orange juice for 10 days, beginning on the 1st day of the study protocol n = 22	P
Age in years (Mean ± SE)	37.28 ± 3.00	40.13 ± 1.89	34.18 ± 1.66	0.024^* * P = 0.024 comparing the mean age between AG group and the GLY (placebo) group using the Student t test
Gender
Male, n (%)	36 (78.3)	17 (70.8)	19 (86.4)	NS
Female, n (%)	10 (21.7)	7 (29.2)	3 (13.6)	NS
Clinical classification ^c c CDC (1993)(7)
A, n (%)	15 (32.6)	7 (29.2)	8 (36.4)	NS
B, n (%)	3 (6.5)	1 (4.2)	2 (9.1)	NS
C, n (%)	28 (60.9)	16 (66.6)	12 (54.5)	NS
CD4/mm³, n (Mean ± SE)	44 (384.5 ± 16.47)	24 (409.5 ± 64.9)	20 (354.4 ± 46.0)	NS
<200, n (%)	12 (27.3)	7 (29.2)	5 (25.0))	NS
≥200, n (%)	32 (72.7)	17 (70.8)	15 (75.0)	NS
VL (log₁₀), n (Mean ± SE)	37 (4.08 ± 1.05)	22 (4.08 ± 1.11)	15 (4.05 ± 0.99)	NS
HAART
Yes, n (%)	38 (82.6)	22 (91.7)	16 (72.7)	NS
No, n (%)	8 (17.4)	2 (8.3)	6 (27.3)	NS
Weight, n (Median ± SE)	46 (60.9 ± 3.3)	24 (60.7 ± 2.4)	22 (62.2 ± 2.1)	NS
BMI , n (Median ± SE)	46 (22.9 ± 1.9)	24 (22.3 ± 0.7)	22 (22.4 ± 0.8)	NS
Diarrhea (last 14 days)
Yes, n (%)	9 (19.6)	6 (25.0)	3 (13.6)	NS
No, n (%)	37 (80.4)	18 (75.0)	19 (86.4)	NS

Intestinal permeability test parameters median (range)	Treatment group or clinical status		P
	Placebo GLY^a a GLY = Glycine (placebo) – GLY (25 g/day) was given with orange juice for 10 days, beginning on the 1st day of the study protocol (n = 24)	AG ^b b AG = alanyl-glutamine - AG (24 g/day) was given with orange juice for 10 days, beginning on the 1st day of the study protocol (n = 22)
% of lactulose excretion	0.32 (0.00–8.71)	0.30 (0.00–3.82)	NS
% of mannitol excretion	16.10 (3.01–46.70)	13.70 (5.30–31.60)	NS
Lactulose/mannitol ratio	0.02 (0.00–2.89)	0.02 (0.00–0.19)	NS
	Diarrhea reported in the last 14 days (n = 9)	No diarrhea reported in the last 14 days (n = 36)
% of lactulose excretion	0.86 (0.00–8.71)	0.29 (0.00–3.82)	0.0318^* * P = 0.0318 and P = 0.0261 comparing groups that reported and did not report diarrhea in the last 14 days at baseline, using the Student t test, for urinary excretion of lactulose (%) and for lactulose/mannitol ratio respectively
% of mannitol excretion	11.70 (3.01–22.20)	15.35 (3.90–46.70)	NS
lactulose/mannitol ratio	0.05 (0.00–2.89)	0.02 (0.00–0.19)	0.0261^* * P = 0.0318 and P = 0.0261 comparing groups that reported and did not report diarrhea in the last 14 days at baseline, using the Student t test, for urinary excretion of lactulose (%) and for lactulose/mannitol ratio respectively
	Without HAART (n = 8)	HAART use (n = 37)
% of lactulose excretion	0.33 (0.10–1.01)	0.29 (0.00–8.71)	NS
% of mannitol excretion	17.05 (5.30–43.60)	14.00 (3.01–46.70)	NS
Lactulose/mannitol ratio	0.03 (0.00–0.19)	0.02 (0.00–2.89)	NS
	CD4 <200/mm³ (n = 12)	CD4 ≥200/mm³ (n = 31)
% of lactulose excretion	0.32 (0.00–1.38)	0.32 (0.00–8.71)	NS
% of mannitol excretion	13.60 (6.40–46.70)	14.50 (3.01–43.60)	NS
Lactulose/mannitol ratio	0.02 (0.00–0.22)	0.02 (0.00–2.89)	NS
	BMI <18.5 (n = 4)	BMI ≥18.5 (n = 42)
% of lactulose excretion	0.67 (0.42–1.16)	0.29 (0.00–8.71)	NS
% of mannitol excretion	12.50 (5.40–31.60)	14.50 (3.01–46.70)	NS
lactulose/mannitol ratio	0.07 (0.01–0.13)	0.02 (0.00–2.89)	NS

Parameters	Treatment group
Parameters	Placebo glycyne ^a a GLY = Glycine (placebo) – GLY (25 g/day) was given with orange juice for 10 days, beginning on the 1st day of the study protocol		Alanyl-glutamine ^b b AG = alanyl-glutamine - AG (24 g/day) was given with orange juice for 10 days, beginning on the 1st day of the study protocol
Weight (kg)	n = 20	P	n = 17	P
Before (mean ± SE)	60.64 ± 2.59	NS	63.08 ± 2.04	NS
After (mean ± SE)	62.66 ± 2.82		63.82 ± 1.98
BMI	n = 20		n = 17
Before (mean ± SE)	23.75 ± 0.82	NS	22.62 ± 0.87	NS
After (mean ± SE)	23.73 ± 0.99		22.87 ± 0.86
CD4 (/mm³)	n = 19		n = 17
Before (mean ± SE)	421.26 ± 75.84	NS	384.88 ± 48.48	NS
After (mean ± SE)	278.45 ± 63.88		412.00 ± 54.97
HIV viral load (log₁₀)	n = 19		n = 9
Before (mean ± SE)	4.04 ± 0.56	NS	4.07 ± 0.99	NS
After (mean ± SE)	3.86 ± 0.63		3.71 ± 0.72
% of lactulose excretion	n = 19		n = 14
Before, median (range)	0.28 (0.00–1.15)	NS	0.21 (0.00–3.82)	NS
After, median (range)	0.29 (0.00–3.95)		0.26 (0.00–1.17)
% of mannitol excretion	n = 19		n = 14
Before, median (range)	16.79 (3.93–46.73)	NS	14.38 (8.25–23.98)	0.0382^* * P = 0.0382 comparing the percentage of mannitol urinary excretion before and after treatment in AG group, using paired Student t test
After, median (range)	17.47 (0.00–47.51)		21.24 (6.27–32.99)
Lactulose/mannitol ratio	n = 19		n = 14
Before, median (range)	0.02 (0.00–0.12)	NS	0.02 (0.00–0.19)	NS
After, median (range)	0.02 (0.00–0.24)		0.01 (0.00–0.41)

Parameters	Treatment groups
	Placebo glycine ^a a GLY = Glycine (placebo) – GLY (25 g/day) was given with orange juice for 10 days, beginning on the 1st day of the study protocol (n = 24)		Alanyl-glutamine ^b b AG = alanyl-glutamine - AG (24 g/day) was given with orange juice for 10 days, beginning on the 1st day of the study protocol (n = 22)		Total (n = 46)
	n	%	n	%	n	%
Adverse event ^c c,d P > 0.05 comparing treatment with versus GLY (Chi-square or Fisher's exact test)
Dizziness	4	14.81	4	16.00	8	15.38
Nausea	4	14.81	4	16.00	8	15.38
Asthenia	2	7.40	2	8.00	4	7.69
Vomit	2	7.40	2	8.00	3	5.76
Facial paresthesia	2	7.40	0	0.00	2	3.84
Sweating	1	3.70	1	4.00	2	3.84
Cold extremities	1	3.70	1	4.00	2	3.84
Blurred vision	1	3.70	0	0.00	1	1.92
Headache	1	3.70	0	0.00	1	1.92
Constipation	1	3.70	0	0.00	1	1.92
Colic	1	3.70	0	0.00	1	1.92
Burning in thorax	1	3.70	0	0.00	1	1.92
Diarrhea	0	0.00	1	4.00	1	1.92
Fever	0	0.00	1	4.00	1	1.92
Paresthesia of members	0	0.00	1	4.00	1	1.92
Dyspnea	0	0.00	1	4.00	1	192
Serious adverse event ^d c,d P > 0.05 comparing treatment with versus GLY (Chi-square or Fisher's exact test)
Death ^e e Clinical feature of disseminated histoplasmosis	1	3.70	0	0.00	1	1.92
Head injury ^f f Motorcycle accident	0	0.00	1	4.00	1	1.92

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E-mail: secretariaarqgastr@hospitaligesp.com.br

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[1] § In Memoriam