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. 2014 Jul 22;9(7):e102233.
doi: 10.1371/journal.pone.0102233. eCollection 2014.

Effects of HIV infection on the metabolic and hormonal status of children with severe acute malnutrition

Aaloke Mody  1 , Sarah Bartz  1 , Christoph P Hornik  2 , Tonny Kiyimba  3 , James Bain  4 , Michael Muehlbauer  4 , Elizabeth Kiboneka  3 , Robert Stevens  4 , John V St Peter  5 , Christopher B Newgard  4 , John Bartlett  6 , Michael Freemark  7
Affiliations

Effects of HIV infection on the metabolic and hormonal status of children with severe acute malnutrition

Aaloke Mody et al. PLoS One. .

Abstract

Background: HIV infection occurs in 30% of children with severe acute malnutrition in sub-Saharan Africa. Effects of HIV on the pathophysiology and recovery from malnutrition are poorly understood.

Methods: We conducted a prospective cohort study of 75 severely malnourished Ugandan children. HIV status/CD4 counts were assessed at baseline; auxologic data and blood samples were obtained at admission and after 14 days of inpatient treatment. We utilized metabolomic profiling to characterize effects of HIV infection on metabolic status and subsequent responses to nutritional therapy.

Findings: At admission, patients (mean age 16.3 mo) had growth failure (mean W/H z-score -4.27 in non-edematous patients) that improved with formula feeding (mean increase 1.00). 24% (18/75) were HIV-infected. Nine children died within the first 14 days of hospitalization; mortality was higher for HIV-infected patients (33% v. 5%, OR = 8.83). HIV-infected and HIV-negative children presented with elevated NEFA, ketones, and even-numbered acylcarnitines and reductions in albumin and amino acids. Leptin, adiponectin, insulin, and IGF-1 levels were low while growth hormone, cortisol, and ghrelin levels were high. At baseline, HIV-infected patients had higher triglycerides, ketones, and even-chain acylcarnitines and lower leptin and adiponectin levels than HIV-negative patients. Leptin levels rose in all patients following nutritional intervention, but adiponectin levels remained depressed in HIV-infected children. Baseline hypoleptinemia and hypoadiponectinemia were associated with increased mortality.

Conclusions: Our findings suggest a critical interplay between HIV infection and adipose tissue storage and function in the adaptation to malnutrition. Hypoleptinemia and hypoadiponectinemia may contribute to high mortality rates among malnourished, HIV-infected children.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: John V. St. Peter is an author on this study and concurrently employed by PepsiCo, Inc. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. The views expressed in this report are those of the authors and do not necessarily reflect the position or policy of PepsiCo, Inc.

Figures

Figure 1
Figure 1. Flowchart of Patient Outcomes.
Figure 2
Figure 2. Comparison of metabolic response to inpatient rehabilitation in 54 patients who completed treatment (10 HIV-infected and 44 HIV-negative children).
Analysis of leptin and HMW adiponectin excluded those patients taking ARVs. Data are represented as the mean±SEM.
See this image and copyright information in PMC

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