CD4 Counts Decline Despite Nutritional Recovery in HIV-Infected Zambian Children With Severe Malnutrition

Hughes, Stephen; Amadi, Beatrice; Mwiya, Mwiya; Nkamba, Hope; Mulundu, Georgina; Tomkins, Andrew; Green, David

doi:10.1542/peds.2008-1316

Cited by 32 publications

(34 citation statements)

References 24 publications

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“…The majority (54%) of children with HIV in this study presented with oedema, consistent with reports of oedema in 67% and 71% from Malawi (6,18) and 50% in Zambia (17), though rates were lower in Burkina Faso and Uganda at 37-43% (13,21,34).…”

Section: Anthropometrysupporting

confidence: 89%

See 1 more Smart Citation

Features associated with underlying HIV infection in severe acute childhood malnutrition: a cross sectional study

Bunn¹,

Thindwa²,

Kerac³

2009

Mal. Med. J

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Section: Anthropometrysupporting

confidence: 89%

“…Nutritional features which may help identify underling HIV in a child with SAM include wasting (marasmus), reported to be 4-6 times more common in HIV infection (3,13,(15)(16)(17)(18)(19)(20), and a weight <60% of the expected median for age (18).…”

Section: Introductionmentioning

confidence: 99%

Features associated with underlying HIV infection in severe acute childhood malnutrition: a cross sectional study

Bunn¹,

Thindwa²,

Kerac³

2009

Mal. Med. J

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“…This is contrary to our study participants who were at an early stage of infection It is known that HIV has a close relationship with nutritional status. However, it's impact on BMI is independent of the CD4 count [26,34]. This assumption was confirmed in our study by the absence of correlation between BMI after 6 months and baseline CD4.…”

Section: Discussionsupporting

confidence: 84%

“…Other investigators have made similar observations with HIV patients having rates of overweight/obesity as high as that of the general population [23,25]. Previously overweight/obesity in HIV/AIDS was associated with HAARTS intake [8,26]. Recent evidence exists that HAARTS represents just a modest contribution to weight gain in HIV patients and that many HIV patients are already overweight/ obese before HAARTS initiation [11].…”

Section: Discussionmentioning

confidence: 70%

Effects of nutritional education and lifestyle modification on the nutritional status of HIV positive patients: results of a cluster randomized intervention over a period of six months

Nkengfack¹,

Torimiro²,

Ngogang³

et al. 2013

Glob Epidemi Obes

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Background: Effective strategies to improve nutritional status exist, though short-termed and less sustainable for HIV patients in resource limited settings. The aim of this study was to describe the BMI of treatment naïve HIV patients in Yaoundé, Cameroon, and investigate the effects of nutritional education and lifestyle modification on the nutritional status of these patients. Method: A cluster randomized trial was conducted between 2010 and 2012, and included 5 health facilities, randomized either to the intervention (HIV-Care-Program) or control group (usual care). The HIV-Care-Program consisted of counselling lessons for 6 months on: nutrition, hygiene and coping with stigma and discrimination, complemented by practical activities. Primary outcome variable were change in BMI and serum albumin after 6 months, using analysis of covariance. BMI was calculated from weight (kg) and height (m

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“…However, in our experience, HIV-infected ART-naive children with SAM who are hospitalized and receive nutritional rehabilitation tend to have a slower weight gain than do HIVnegative children. A study from Zambia showed that infected children with SAM remain severely immunosuppressed after recovery from SAM (18). It is important to document the effect of ART on the nutritional and immune recovery in HIV-infected children with SAM during nutritional rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Severe malnutrition and metabolic complications of HIV-infected children in the antiretroviral era: clinical care and management in resource-limited settings

Musoke¹,

Fergusson²

2011

The American Journal of Clinical Nutrition

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More than 2 million children globally are living with HIV infection and .90% of these reside in sub-Saharan Africa. Severe acute malnutrition (SAM) remains a major problem for HIV-infected children who live in resource-limited settings (RLS), and SAM is an important risk factor for mortality. SAM in HIV-infected children is associated with complications including electrolyte disorders, micronutrient deficiencies, and severe infections, which contribute to the high mortality. Access to antiretroviral therapy (ART) has significantly improved the survival of HIV-infected children, although the response to ART of children with SAM remains undocumented in the literature. Immune and virologic responses to ART in RLS are similar to those of infected children in resource-rich settings, but delays in initiation of therapy have led to a high early mortality. Antiretroviral drug toxicities have been described in children who receive therapy and may affect their quality of life and long-term survival. Metabolic complications of ART include lipodystrophy, dyslipidemia, lactic acidosis, insulin resistance, and osteopenia. These complications have been well described in adults and children from developed countries, but data from RLS are limited, and these complications may be compounded by SAM. In this article we review the epidemiology, clinical presentation, and complications of SAM in HIV-infected children and the metabolic complications of HIV-infected children in the era of ART, and discuss future research priorities for RLS.Am J Clin Nutr 2011;94(suppl):1716S-20S.

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CD4 Counts Decline Despite Nutritional Recovery in HIV-Infected Zambian Children With Severe Malnutrition

Abstract: Severe malnutrition did not reduce the CD4 counts of children without HIV. HIV-infected children with severe malnutrition may respond well to nutritional rehabilitation, despite low CD4 counts, but nearly all require early antiretroviral therapy to prevent disease progression.

Cited by 32 publications

References 24 publications

Features associated with underlying HIV infection in severe acute childhood malnutrition: a cross sectional study

Features associated with underlying HIV infection in severe acute childhood malnutrition: a cross sectional study

Effects of nutritional education and lifestyle modification on the nutritional status of HIV positive patients: results of a cluster randomized intervention over a period of six months

Severe malnutrition and metabolic complications of HIV-infected children in the antiretroviral era: clinical care and management in resource-limited settings

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