Growth and micronutrient disturbances in stable, HIV-infected children in Cape Town

Abstract

This prospective study of 60 stable, HIV-infected children in an economically deprived setting was designed to document anthropometric and micronutrient disturbances. Investigations included CD4+ counts, anthropometry and plasma levels of albumin, transthyretin, retinol-binding protein (RBP), vitamins A, B6, E and B12, and folate, zinc and copper. The median age was 25 months. Thirty-two per cent had mild, 48% moderate and 20% severe clinical features, and 80% were moderately or severely immunosuppressed. Twenty-eight per cent had a weight Z-score <-2.0 and 58% a height Z-score <-2.0. Many children had micronutrient deficiencies: albumin (70%), transthyretin (100%), RBP (85%), vitamins A (80%), B6 (37%), E (37%) and B12 (5%), zinc (20%) and copper (25%). Sixty-two per cent had two or more trace element or vitamin deficiencies. There was a weak association between micronutrient status and disease status. Micronutrient concentrations did not correlate with chronological age, height-for-age or weight-for-age. CRP was elevated in 53% but did not correlate with any of the micronutrient concentrations. Micronutrient deficiencies were more common and micronutrient concentrations lower in children over 24 months of age.

Serum zinc levels in HIV infected children attending the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

“…Bilbis et al, 12 in Northern Nigeria also noted similar findings in their study. Within the same age group, mean serum zinc levels were lower in subjects than in the controls.…”

“…This was higher than the prevalence of 54.3% reported by Ndeezi et al 11 in Uganda and the 20% by Eley et al 12 in South Africa. The study investigated only HAART naïve HIV sero-positive children while Ndeezi et al combined children on HAART and those that were HAART naïve.…”

Nutrition Guidelines for HIV-infected Adults and Children in Southern Africa

“…24 Growth faltering and stunting are common in children with HIV infection and occur early in life. [25][26][27] In children, wasting is particularly associated with the loss of lean body mass and failure to gain height. 27 In adults both lean mass and fat are lost, though the loss of lean mass predominates.…”

“…24 Studies from the Cape and KwaZulu-Natal confirm generally low levels of micronutrients among HIV-infected South African children and adults. [25][26][27] Furthermore, micronutrient supplementation with vitamin A reduces morbidity, growth failure and death, while zinc supplementation reduces the duration of diarrhoea and associated fluid losses in young HIV-positive children. 27,28 Selenium and zinc also behave as acute-phase reactants: their levels fluctuate during infection.…”

The importance of nutritional care in HIV-infected children in resource-limited settings

“…Micronutrients are vitamins and trace minerals, which we typically give in medicinal form. Vitamin A, vitamin E, vitamin B6 and B-12, folate, zinc, iron, copper and glutathione are the micronutrients most commonly found to be low in HIV-infected children [8][9][10][11]. Most studies of micronutrient status only measure these serum levels; fewer studies exist that look at the clinical outcomes associated with supplementation with these micronutrients.…”