Nutrition Management Guidelines for Pediatric HIV+ Patients

Abstract

Six regions of the United States developed multidisciplinary pediatric HIV-specialist working groups to address nutrition issues in pediatric HIV disease. Literature reviews and professional experiences were summarized and translated into nutrition assessment and management guidelines. The groups included physicians, nurses, nurse practitioners, dietitians, and social workers from Chicago, Los Angeles, Miami/Tampa, New York/New Jersey, San Francisco/Oakland, and Washington DC. Members of the groups agreed that cases of newborn transmission have been dramatically reduced while cases of long-term survivors infected prior to perinatal use of anti-HIV drugs, children of undiagnosed mothers, and sexually infected children and adolescents may be rising. Nutritional issues of failure-to-thrive still exist, especially in antiretroviral naive children. Cultural issues, family dynamics, inadequate housing, and health care access play a large role in the support of health and survival in the pediatric HIV patient and are often the higher priority above nutrition assessment and management. However, nutrition issues are considered an equal priority with other medical issues. The Centers for Disease Control definition of wasting in pediatric HIV disease was considered inadequate and alternate definitions for the identification of nutritional compromise varied from region to region. Nutrition-related interventions were primarily food-based with supplements as needed. Adjunctive therapies included appetite stimulants and anabolic therapies, though few were commonly used. Particular concern was expressed for culturally appropriate educational materials and methods. Multidisciplinary approaches were encouraged. Guidelines based on the input from the six groups and other reviewers were developed for field testing in the San Francisco/Oakland area and will be available for field-testing and as a basis for nutrition program development for pediatric HIV patients elsewhere in the United States.