Gastrointestinal and nutritional problems in children with immunodeficiency and AIDS

Abstract

Immunodeficient children pose a challenge to clinicians because of the interrelationship between infectious disease, metabolism, gastrointestinal tract function, psychosocial problems, and immune function. The interplay between these factors is not always clear, and frequently the best course of therapy is obscured because of an inability to determine which factors have the greatest impact on child health. To optimize therapeutic intervention, a multidisciplinary health care team must be involved with the management of children and their families.

Figure 1

Early infection of HIV that may infect T cells and macrophages after crossing the intestinal mucosa. Infected cells then migrate through the circulation and home to the lamina propria of the intestine.

Figure 2

Asymptomatic phase of HIV infection in which virus is trapped within lymphoid aggregates. During this phase, speculation is that IgA decreases, acid secretion declines, and brush-border enzymes decrease in specific activity. As a child enters the symptomatic period, malabsorption, epithelial cell dysfunction, and infections such as Candida become more evident.

Figure 3

Late or end stage of HIV disease is characterized by loss of follicular dendritic cells and increased circulating virus. CD4 count declines, and opportunistic infection and malignancy are more prevalent.

Figure 4

The relationship between malabsorption, malnutrition, enteric infection, immune deficiency, and HIV disease.