Prevalence of HIV-1 Infection and Symptomatology of AIDS in Severely Malnourished Children in Dar Es Salaam, Tanzania

Cs, Mgone; Fs, Mhalu; Jf, Shao; Britton, Sven; Sandström, Anita; Bredberg-Rådén, Ulla; Biberfeld, Gunnel

doi:10.1097/00126334-199109000-00013

Cited by 29 publications

(18 citation statements)

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“…17 CD4 percentages of HIV-infected children without edema were significantly lower than those with edema. Our study is consistent with others in finding that SM without edema is more common in the HIV-infected than uninfected [25][26][27] and more common in the severely than the moderately immunosuppressed HIV-infected children. 5 Nutritional edema is classically found after weaning and is an acute disease.…”

Section: Discussionsupporting

confidence: 93%

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

Hughes

Amadi²,

Mwiya³

et al. 2009

Pediatrics

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Section: Discussionsupporting

confidence: 93%

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

Hughes

Amadi²,

Mwiya³

et al. 2009

Pediatrics

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“…HIV-1 infection has increased the burden of disease in children 18,19 and led to an increase in paediatric admissions in sub-Saharan Africa along with the associated high mortality. [20][21][22][23][24] In Malawi, HIV-1 infection is a major contributor to mortality in severely malnourished children. 25 In this study, the proportion of severely malnourished, HIV-1-infected children and their mortality rate were similar to reports from elsewhere in the region.…”

Section: Discussionmentioning

confidence: 99%

Reduction of unnecessary transfusion and intravenous fluids in severely malnourished children is not enough to reduce mortality

Bachou

Tumwine²,

Mwadime³

et al. 2008

Annals of Tropical Paediatrics

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Aim: To test whether standardising the use of blood transfusions and intravenous (IV) infusions could reduce fatality in severely malnourished children admitted to Mulago Hospital, Kampala. Methods: Improved adherence to the WHO protocol for blood transfusion and IV fluids was effected in patients with severe malnutrition by continuous medical education. A 'before and after' design was used to study 450 severely malnourished children (weight-for-height ,23 Z-score or presence of oedema) under 60 months of age. A total of 220 pre-and 230 post-'improved practice' patients were enrolled consecutively during the periods September to November 2003 and September to December 2004, respectively. Patients were followed up until discharge or death. The Kaplan-Meier survival curve and the Cox regression hazard model were used for univariate and multivariate analyses, respectively. Results: Overall case fatality was 23.6% (52/220) in the pre-period and 24.8% (57/230) in the post-period (p50.78). Most of the deaths occurred in the 1st week of admission (73%, 38/52 in the pre-period and 61%, 35/57 in the post-period) and were of children who had received blood transfusion or IV infusion or both in the pre-period. Mortality in children transfused and/or infused was significantly reduced in the post-period (82%, 31/38 in the preperiod vs 23%, 8/35 in the post-period, p50.008). In the post-period, there was a significant reduction in the number of inappropriate blood transfusions (18%, 34/194 vs 3.5%, 8/230, p50.01) and IV fluid infusions (27%, 52/194 vs 9%, 20/230, p,0.001). Survival improved in children who received blood transfusions in the post-period [hazards ratio (HR) 0.22, 95% CI 0.30-1.67 vs HR 4.80, 95% CI 1.71-13.51], as did that of children who received IV infusions (HR 2.10, 95% CI 0.84-5.23 vs HR 3.91, 95% CI 1.10-14.04). Conclusion: Management according to the WHO protocol for severe malnutrition can reduce the need for blood and IV infusions. However, further studies are required to verify whether full implementation of the WHO protocol reduces the high case fatality in sub-Saharan hospitals.

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“…13,14 The ® nding that marasmus is particularly associated with HIV infection is also consist- ent with these earlier studies from the region. 6,10± 12 Severe wasting is a recognized feature of paediatric AIDS in African cohort studies of perinatally infected children. 5,7,8 A report from Co Ã te d'Ivoire found a signi® cantly higher HIV seroprevalence in marasmus than in kwashiorkor.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have shown signi® cant associations with generalized lymphadenopathy and oral thrush. 11,12 As yet, no study has demonstrated clinical features suf® ciently sen- 6 Behavioural changes such as anorexia and apathy as well as infections that cause diarrhoea, cough and oral thrush are very common in any malnourished population. The pattern of chest radiographic (CXR) abnormalities was very similar in the HIVinfected and non-HIV-infected groups.…”

Section: Discussionmentioning

confidence: 99%

“…However, clinical de® nition is not highly predictive of HIV infection in severely malnourished children. 6 HIV testing is uncommon in practice, partly because most children will have been admitted, discharged or died before a result is available. Thus, an unknown number of marasmic children (failing to thrive owing to maternal sickness or TB) who are not infected with HIV are labelled clinically HIV-infected and managed from the perspective of a poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

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The impact of the human immunodeficiency virus type 1 on the management of severe malnutrition in Malawi

Kessler

Daley

Malenga

et al. 2000

Annals of Tropical Paediatrics

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A study was undertaken in a central nutritional rehabilitation unit in southern Malawi to assess the impact of HIV infection on clinical presentation and case fatality rate. HIV seroprevalence in 250 severely malnourished children over 1 year of age was 34.4% and overall mortality was 28%. HIV infection was associated significantly more frequently with marasmus (62.2%) than with kwashiorkor (21.7%) (p < 0.0001). Breastfed children presenting with severe malnutrition were significantly more likely to be HIV-seropositive (p < 0.001). Clinical and radiological features were generally not helpful in distinguishing HIV-seropositive from HIV-seronegative children. The case fatality rate was significantly higher for HIV-seropositive children (RR 1.6 [95% CI 1.14-2.24]). The increasing difficulties of managing the growing impact of HIV infection on severely malnourished children in Malawi are discussed in the context of reduced support for nutritional rehabilitation units.

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Prevalence of HIV-1 Infection and Symptomatology of AIDS in Severely Malnourished Children in Dar Es Salaam, Tanzania

Cited by 29 publications

References 0 publications

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

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

Reduction of unnecessary transfusion and intravenous fluids in severely malnourished children is not enough to reduce mortality

The impact of the human immunodeficiency virus type 1 on the management of severe malnutrition in Malawi

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