Guidelines for nutritional support of HIV-infected children

Abstract

Pediatric HIV disease often leads to marked failure to thrive and multiple nutritional deficiencies, particularly protein calorie malnutrition. Nutrition management may be difficult when children develop recurrent fevers, respiratory distress, diarrhea and malabsorption, vomiting, developmental delays, neurologic impairment, or other conditions that alter caloric needs, interfere with food intake, or reduce nutrient absorption. Malnutrition itself may produce an acquired irnmunodeficiency similar to that caused by HIVfl 2 Cellular immunity defects (including lymphopenia, anergy, and reversed T4 to T8 lymphocyte ratios), abnormal macrophage function, wasting, recurrent fevers, gastrointestinal dysfunction. and increased susceptibility to opportunistic infections all have been described in patients with protein calorie malnutrition and other nutritional deficiencies. Thus, although malnutrition may ultimately be the inescapable result of progressive HIV disease, early nutritional intervention may reduce susceptibility to or severity of infections, provide some protection to the immune system, and lead to a better quality of life for HIV-infected children. Few studies have addressed the nutritional needs of HIV-infected adults or children. 35 These guidelines therefore combine what little is known with pragmatic approaches to common nutritional problems encountered in the management of HIV-infected children.