Aetiology and management of malnutrition in HIV-positive children

Abstract

Worldwide, more than 3 million children are infected with HIV and, without treatment, mortality among these children is extremely high. Both acute and chronic malnutrition are major problems for HIV-positive children living in resource-limited settings. Malnutrition on a background of HIV represents a separate clinical entity, with unique medical and social aetiological factors. Children with HIV have a higher daily calorie requirement than HIV-negative peers and also a higher requirement for micronutrients; furthermore, coinfection and chronic diarrhoea due to HIV enteropathy play a major role in HIV-associated malnutrition. Contributory factors include late presentation to medical services, unavailability of antiretroviral therapy, other issues surrounding healthcare provision and food insecurity in HIV-positive households. Treatment protocols for malnutrition have been greatly improved, yet there remains a discrepancy in mortality between HIV-positive and HIV-negative children. In this review, the aetiology, prevention and treatment of malnutrition in HIV-positive children are examined, with particular focus on resource-limited settings where this problem is most prevalent.

Keywords: HIV; Nutrition; Tropical Paediatrics.

Figure 1

Infants under the age of 6 months born to HIV-positive mothers should be exclusively breast fed unless breast milk substitutes fulfil the acceptable, feasible, affordable, sustainable and safe criteria, as defined by the Joint United Nations Programme on HIV/AIDS.

Figure 2

Guidelines for treatment of severe malnutrition in HIV-positive children, based on WHO guidelines. Although early initiation of antiretroviral treatment is advocated in these guidelines, this remains controversial, and delaying initiation of treatment until after the acute phase might be prudent.