|Year : 2015 | Volume
| Issue : 1 | Page : 10-12
Health & nutritional status of HIV infected children
Rakesh Lodha, SK Kabra
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India
|Date of Web Publication||2-Apr-2015|
S K Kabra
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Lodha R, Kabra S K. Health & nutritional status of HIV infected children. Indian J Med Res 2015;141:10-2
Nutrition plays an important role in infections. Malnutrition may predispose to infections, result in severe illness and may affect recovery from infection. Malnutrition is a common complication of HIV infection and AIDS. The interaction between malnutrition and HIV infection is complicated but it may place additional stress on an already weakened immune system and may complicate the treatment of the disease by affecting the ability of the intestinal tract to absorb drugs as also the ability to absorb various nutrients.
Malnutrition in children is particularly devastating because children are in the process of growth and development. Malnutrition places even higher energy demands on their bodies and immune system. It has been estimated that over 90 per cent of children with HIV infection/AIDS will experience delayed growth; major contributors are poor socio-economic status, poor nutritional intake, malabsorption and the disease itself. In severely malnourished children with HIV infection, low CD4+ levels are associated mainly with HIV infection  . The availability of anti-retroviral therapy (ART) has improved the survival of HIV-infected children and converted a rapidly fatal disease to a chronic disease. In such a scenario, there is going to be an increasing challenge of managing various aspects of chronic care in children; nutrition is one of the most important ones.
Several studies in HIV infected children from different parts of the world have shown varying degree of malnutrition predominantly wasting and stunting with anaemia. It may be related to stage of illness in population under study, availability of food, associated co-morbidities and medications received specifically zidovudine ,,,, . Loss of body mass is associated with increased mortality ,, .
Additional factors have to be taken into account while considering wasting. It is critical to distinguish between classical wasting and HIV-associated lipodystrophy. Classical wasting is more likely to occur in the context of virological or immunological failure, secondary infection or clinically significant diarrhoea or anorexia  . In contrast, in patients with loss of subcutaneous fat in the appendages, buttocks or face in the presence of fat in the central region, malnutrition per se is unlikely to be the primary factor.
In this issue Swetha et al present their data on nutritional status and morbidity in children infected with HIV in two orphanages in south India. They included 77 children aged between 1.6-15.5 yr both those on ART and those not on ART. They observed that almost half of children were underweight and stunted, micronutrient deficiencies were widely prevalent, and morbidity was more in children not on ART. Authors conclude that acute, chronic malnutrition and micronutrient deficiencies are very common, especially in children not on ART and having morbidity.
Data on nutritional status in children with HIV infection in India are available in a few studies ,, . The results of the study by Swetha et al are similar to the previously published studies. The data generated from the study may help policymakers to decide about interventions in these patients in India. However, data generated in this study are associated with limitations which may be considered while planning further studies or making some policy for intervention. First, the study was carried out in children staying in two out of five orphanages and they were being regularly monitored for illnesses by physicians even before enrolled in the study. Therefore, the data may be useful only for similar setting. Secondly, the study population was heterogeneous, distributed in wide age group, varying severity of illness, some were receiving ART while others were getting only supportive care. Subgroup analysis is unlikely to give meaningful results because of small sample size. The dietary intake data were available for only 66 children of the 77 enrolled.
The aim of such studies should be to document magnitude of problem, identify reasons, to establish cause and effect relationship and suggest interventions that may improve the outcome. It is very difficult to establish causal relationship and suggest corrective measures. For example, fortified sorghum meal in adults with HIV infection in Botswana did not influence serum retinol, CD4 cell count and HIV viral load  .
It is important to understand that ART improves nutritional and immunological outcome of children with HIV infection. A couple of studies have documented better outcome of malnourished children treated with nutritional supplements along with ART , . Food supplementation at ART centers has also been demonstrated to improve the adherence to clinic visits and antiretroviral therapy  . However, a study in south India reported that macronutrient supplementation did not result in significantly increased weight gain compared with standard care (including nutritional counselling) among ART naïve adults with moderately advanced HIV disease  . There is inadequate evidence to support any particular nutritional intervention strategy to improve the outcomes in HIV infected individuals  .
A multipronged strategy will be required to improve the nutritional status of HIV infected children. Given the high prevalence of undernutrition, the first step is to screen children for their nutritional status and treat all the undernourished children, not only the ones with severe acute malnutrition. Micronutrient deficiencies must be identified and treated. Some children who are not undernourished are likely to benefit from counselling regarding food intake and nutrition. As many of the families are impoverished, provision of food supplementation either from the programme or food security programme of the s0 tate may be beneficial. Early initiation and regular administration of HAART in whom it is indicated will also be beneficial in improving the nutritional status. As the HIV-infection is now a chronic condition, there is a need for evaluation of nutritional status and growth monitoring on an ongoing basis to identify abnormalities and treat early.
| References|| |
Ndagije F, Baribwira C, Coulter JB. Micronutrients and T-cell subsets: a comparison between HIV-infected and uninfected, severely malnourished Rwandan children. Ann Trop Paediatr
Schwenk A, Büger B, Wessel D, Stutzer H, Zeigenhagen D, Diehl V, et al
. Clinical risk factors for malnutrition in HIV-1-infected patients. AIDS
Mwiru RS, Spiegelman D, Duggan C, Seage GR 3 rd
, Semu H, Chalamilla G, et al
. Nutritional status and other baseline predictors of mortality among HIV-infected children initiating antiretroviral therapy in Tanzania. J Int Assoc Provid AIDS Care
Paton NI, Macallan DC, Jebb SA, Noble C, Baldwin C, Pazianas M, et al
. Longitudinal changes in body composition measured with a variety of methods in patients with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol
Mulligan K, Tai VW, Schambelan M. Cross-sectional and longitudinal evaluation of body composition in men with HIV infection. J Acquir Immune Defic Syndr Hum Retrovirol
Kimani-Murage EW, Norris SA, Pettifor JM, Tollman SM, Klipstein-Grobusch K, Gómez-Olivé XF, et al
. Nutritional status and HIV in rural South African children. BMC Pediatr
Suttmann U, Ockenga J, Selberg O, Hoogestraat L, Deicher H, Muller MJ. Incidence and prognostic value of malnutrition and wasting in human immunodeficiency virus-infected outpatients. J Acquir Immune Defic Syndr Hum Retrovirol
Guenter P, Muurahainen N, Simons G, Kosok A, Cohan GR, Rudenstein R, et al
. Relationships among nutritional status, disease progression, and survival in HIV infection. J Acquir Immune Defic Syndr
Thiebaut R, Malvy D, Marimoutou C, Davis F. Anthropometric indices as predictors of survival in AIDS adults. Aquitaine Cohort, France, 1985-1997. Groupe d-Epidemiologie Clinique du Sida en Aquitaine (GECSA). Eur J Epidemiol
Grinspoon S, Mulligan K; Department of Health and Human Services Working Group on the Prevention and Treatment of Wasting and Weight Loss. Weight loss and wasting in patients infected with human immunodeficiency virus. HIV related weight loss and wasting. Clin Infect Dis
(Suppl 2) : S69-78.
Swetha GK, Hemalatha R, Prasad UV, Murali V, Damayanti K, Bhaskar V. Health & nutritional status of HIV infected children in Hyderabad, India. Indian J Med Res
Kapavarapu PK, Bari O, Perumpil M, Duggan C, Dinakar C, Krishnamurthy S, et al
. Growth patterns and anaemia status of HIV-infected children living in an institutional facility in India. Trop Med Int Health
Padmapriyadarsini C, Pooranagangadevi N, Chandrasekaran K, Subramanyan S, Thiruvalluvan C, Bhavani PK, et al
. Prevalence of underweight, stunting, and wasting among children infected with human immunodeficiency virus in South India. Int J Pediatr
Shet A, Mehta S, Rajagopalan N, Dinakar C, Ramesh E, Samuel NM, et al
. Anemia and growth failure among HIV-infected children in India: a retrospective analysis. BMC Pediatr
Motswagole BS, Mongwaketse TC, Mokotedi M, Kobue-Lekalake RI, Bulawayo BT, Thomas TS, et al
. The efficacy of micronutrient-fortified sorghum meal in improving the immune status of HIV-positive adults. Ann Nutr Metab
Banerjee T, Pensi T, Banerjee D, Grover G. Impact of HAART on survival, weight gain and resting energy expenditure in HIV-1-infected children in India. Ann Trop Paediatr
Kundu CK, Samanta M, Sarkar M, Bhattacharyya S, Chatterjee S. Food supplementation as an incentive to improve pre-antiretroviral therapy clinic adherence in HIV-positive children--experience from eastern India. J Trop Pediatr
Swaminathan S, Padmapriyadarsini C, Yoojin L, Sukumar B, Iliayas S, Karthipriya J, et al
. Nutritional supplementation in HIV-infected individuals in South India: a prospective interventional study. Clin Infect Dis
Grobler L, Siegfried N, Visser ME, Mahlungulu SS, Volmink J. Nutritional interventions for reducing morbidity and mortality in people with HIV. Cochrane Database Syst Rev
|This article has been cited by|
||Understanding the association between caregiver sex and HIV infection among orphans and vulnerable children in Tanzania: learning from the USAID Kizazi Kipya project
| ||Amon Exavery,John Charles,Erica Kuhlik,Asheri Barankena,Alison Koler,Levina Kikoyo,Elizabeth Jere |
| ||BMC Health Services Research. 2020; 20(1) |
|[Pubmed] | [DOI]|
||An assessment of the nutritional status of ART receiving HIV-orphaned and vulnerable children in South-West Nigeria
| ||Adeniyi Francis Fagbamigbe,Ayo Stephen Adebowale,IkeOluwapo Ajayi |
| ||Heliyon. 2019; 5(12): e02925 |
|[Pubmed] | [DOI]|
||Vitamin D Status in Children Living with HIV on Highly Active Antiretroviral Therapy
| ||Andrea Aquino,Joan Collier,Eduardo Arathoon |
| ||Current Tropical Medicine Reports. 2017; |
|[Pubmed] | [DOI]|