Aetiology and management of malnutrition in HIV-positive children

Abstract

Worldwide, more than 3 million children are infected with HIV and, without treatment, mortality among these children is extremely high. Both acute and chronic malnutrition are major problems for HIV-positive children living in resource-limited settings. Malnutrition on a background of HIV represents a separate clinical entity, with unique medical and social aetiological factors. Children with HIV have a higher daily calorie requirement than HIV-negative peers and also a higher requirement for micronutrients; furthermore, coinfection and chronic diarrhoea due to HIV enteropathy play a major role in HIV-associated malnutrition. Contributory factors include late presentation to medical services, unavailability of antiretroviral therapy, other issues surrounding healthcare provision and food insecurity in HIV-positive households. Treatment protocols for malnutrition have been greatly improved, yet there remains a discrepancy in mortality between HIV-positive and HIV-negative children. In this review, the aetiology, prevention and treatment of malnutrition in HIV-positive children are examined, with particular focus on resource-limited settings where this problem is most prevalent.

Outcomes of antiretroviral therapy among younger versus older adolescents and adults in an urban clinic, Zimbabwe

“…Other factors include late presentation for medical services and food insecurity in households with HIV-positive members, especially in limited-resource settings. 24 Policy guidelines should provide adequate nutritional care and support for younger adolescents in HIV care. More older adolescents presented with normal BMI at initiation; this could be because, in this setting, older adolescents had their own income and were not relying on parental support.…”

Antiretroviral Therapy in Severely Malnourished, HIV-infected Children in Asia

“…Expert opinion suggests that SM should be stabilized and ART initiated as soon as possible following stabilization. 3, 5 Yet information on the effectiveness and safety of antiretroviral drugs in this setting is lacking, 3, 6, 7 and HIV-infected children with SM have a high risk of early mortality after starting ART. 3, 8-11 …”

Leaf concentrate compared with skimmed milk as nutritional supplementation for HIV-infected children: a randomized controlled trial in Burundi

“…However, in 2013 there were an estimated 240 000 new infections, and 3·2 million children under the age of 15 years were living with HIV, 91 % of whom were in sub-Saharan Africa. Given that these children are more likely to live in foodinsecure households (1) , that HIV infection is associated with faltering growth to at least 10 years of age (22) and that micronutrient sufficiency might be an important adjunct to ART (23) , effective and sustainable approaches to maintaining adequate nutrition for HIV-infected children in resource-poor settings should be a priority area for research.…”

“…Maintaining good nutritional status among HIV-infected children is clearly of paramount importance (1) . WHO guidelines for incorporating nutritional support into care programmes for HIV-infected children are available for local adaptation (2) and nutritional support services appear to be generally available at HIV care and treatment sites in sub-Saharan Africa (3) .…”