Gastrointestinal Tract Function and Malnutrition in HIV-Infected Children

Abstract

Poor growth and/or weight gain was identified in the initial reports of children with AIDS (Oleske et al. 1983, Rubinstein et al. 1983). However, in the past 12 years little progress has been made to understand the mechanisms for these observations. Data from the NIAID/NICHD multicenter Women and Infants Transmission Study (WITS) demonstrated that a decline in weight occurred in the first four months of life followed by decreased linear growth (Rich et al. 1993). In older children weight and height seem to decline in parallel (McKinney et al. 1993), but loss of lean body mass may occur prior to a decline in weight (Miller et al. 1993). Adequate caloric intake can improve weight gain, but has little effect on height velocity and lean body mass (Henderson et al. 1994, Miller et al. 1992). Long-term survivors with HIV infection are shorter than anticipated, and these changes cannot be explained solely by inadequate nutrition or by endocrine abnormalities. The immune system, gastrointestinal tract function, malnutrition, and chronic or recurrent infection interact and contribute to the nutritional deficiencies and problems with growth observed in the HIV-infected child.

Lack of association between nutritional status and change in clinical category among HIV-infected children in Brazil

“…Increased energy requirements, decreased calorie intake, intestinal malabsorption and economic problems contribute towards malnutrition among this population. 19,20 From the outset of follow-up, such patients undergo antiretroviral therapy, opportunistic infection prevention and early treat-ment for secondary bacterial infections. These actions may result in viral load reduction, improvement of clinical status and less wasting syndrome.…”

White Matter Development is Potentially Influenced in Adolescents with Vertically Transmitted HIV Infections: A Tract-Based Spatial Statistics Study

“…16,35 This finding suggests that a longer HIV treatment may be associated with possible neurotoxicity in the WM of HIV-infected adolescents. However, the HIV treatment is offered to patients with Ͻ350 CD4ϩ T cells/mm 3 or plasma HIV ribonucleic acid levels of Ͼ55,000 copies/mL, 36 so the earlier and longer HIV treatment may have been due to more virulent strains, thus accounting for direct viral effects on the WM by a very heterogeneous viral population. The early formation of myelin integrity may be disrupted irreversibly.…”

“…1 HIV is a neurotrophic virus affecting the cellular immune system through the infection and destruction of CD4 lymphocytes, which causes multiple organs, such as the respiratory system, 2 digestive system, 3 and CNS, to have relevant illnesses. 4 Cognitive impairment, HIV-associated dementia, and AIDS dementia complex are commonly observed.…”

Development of Immunocompetence: Role of Micronutrients and Microorganisms

“…Normal bacterial ora are altered in HIV infection as shown by frequency of bacteremia, in association with altered gastrointestinal function, diarrhea, and malabsorption. 43,44 HIV-associated failure-to-thrive is common in congenital HIV infection and may often be the cause of clinical presentation. 44 We have been studying the effect of adding back a normal commensal, Lactobacillus plantarum 299v(DSM 9843), LP299v, in the HIV-positive child.…”