Assessment of Anthropometric, Nutritional and Immunologic Status in Children Born to Women Infected by Human Immunodeficiency Virus

Abstract

LEARNING OUTCOME: Infection with HIV was associated with significant decrements in growth, weight gain and CD4+ T-lymphocyte countPoor growth, weight loss, low energy intake and depletion of CD4+ T-lymphocyte cell counts are prominent findings in infants and children with human immunodeficiency virus infection (HIV). The purpose of this study was to analyze on a cross-sectional basis the relationship between growth, body weight, nutrient intake, CD4+ T-lymphocyte cell counts and HIV status in infants and children perinatally exposed to HIV infection. The children (n=48 HIV-infected, n=35 uninfected, age 0-12y) attended a pediatric infectious disease clinic in New York City. Anthropometric measurements and CD4+ T-lymphocyte counts were obtained from medical records and food intake was assessed from multiple 24-hour dietary recall records for 34 HIV-exposed children. Statistical analysis (T-tests, chi square tests) showed that infants and children infected with HIV weighed less (NCHS-weight for age z-score - .57 vs .01, p = .04) and were shorter in stature (length for age z-score - .90 vs - .42, p = .04) than uninfected children. The mean CD4+ T-lymphocyte count of infected children was significantly lower (743 vs 2316, p=.000) than that of uninfected children. Infected children, whose CD4+ levels <200 mm3/dl had lower weight for age z-scores than infected children with higher CD4+ cell levels (p = .000). Although infected children had a higher mean intake for energy, protein and most nutrients than the uninfected children, there was a wide variability in the adequacy of intake, with 32% of the infected children consuming less than 75% of the RDA for energy. The mean energy intake in the infected children reached 100% of the RDA; however, this level of intake appears insufficient to support normal growth and weight gain. The availability of aggressive nutritional support at an early stage of the disease is recommended for enhancing growth, decreasing morbidity and improving quality of life for HIV-infected children.