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Association between steatorrhea, growth, and immunologic status in children with perinatally acquired HIV infection
T A Sentongo1, R M Rutstein, N Stettler
1Division of Gastroenterology, Hepatology, and Nutrition, Children's Memorial Medical Center, 2300 Children's Plaza No. 65, Chicago, IL 60614. TSentongo@childrensmemorial.org
Insights
Steatorrhea (fatty stools) is common in children with perinatally acquired human immunodeficiency virus (HIV), but exocrine pancreatic insufficiency (EPI) is not. Further investigation into non-pancreatic causes of steatorrhea is recommended.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Nutritional Science
Background:
- Perinatally acquired human immunodeficiency virus (HIV) infection can impact gastrointestinal function and nutritional status in children.
- Steatorrhea and exocrine pancreatic insufficiency (EPI) are potential complications, but their prevalence and impact in this population require further elucidation.
Purpose of the Study:
- To determine the prevalence of steatorrhea and EPI in children with perinatally acquired HIV.
- To investigate the association between steatorrhea and EPI with growth parameters and immune status in these children.
Main Methods:
- A cross-sectional study was conducted in a tertiary care HIV subspecialty practice.
- Stool samples from 44 children (aged 1-10 years) with perinatally acquired HIV were analyzed for steatorrhea and EPI using fecal elastase-1.
- Anthropometric measurements, HIV viral load, CD4 counts, and antiretroviral therapy (ART) type were assessed.
Main Results:
- The prevalence of steatorrhea was 39%, while the prevalence of EPI was 0%.
- No significant associations were found between steatorrhea, EPI, growth parameters, HIV viral load, CD4 status, or ART type.
- Older children exhibited decreased height z scores.
Conclusions:
- The clinical significance of steatorrhea in children with HIV is uncertain, suggesting a need to explore non-pancreatic etiologies.
- Close monitoring of growth remains crucial for children living with HIV.
Objective:
To examine the prevalence of steatorrhea and exocrine pancreatic insufficiency (EPI) and their association with growth and immune status variables in children with perinatally acquired human immunodeficiency virus (HIV) infection.
Design:
Cross-sectional study.
Setting:
Tertiary care HIV subspecialty practice.
Participants:
Children with perinatally acquired HIV infection. Exclusion criteria included being younger than 1 year and receiving mineral oil as a medication.
Methods:
Weight, height, and upper arm anthropometric variables were measured. Spot stool samples were analyzed for steatorrhea using the Sudan III qualitative test and for EPI using fecal elastase-1 enzyme assay. Hormone-stimulated pancreatic function testing and 72-hour stool and dietary fat sample collection were performed when fecal elastase-1 enzyme was in the range of EPI, defined as less than 200 microgram/g. HIV RNA viral load, CD4 status, type of antiretroviral therapy, and biochemical evidence of hepatobiliary disease were measured within 3 months of stool sample collection. z Scores were computed for height, weight, triceps skinfold, and upper arm muscle area.
Results:
We enrolled 44 patients (23 girls [52%]) with a mean +/- SD age of 7.4 +/- 3.1 years. None had hepatobiliary disease. The prevalence of steatorrhea was 39% (95% confidence interval, 23%-56%). The prevalence of EPI was 0% (95% confidence interval, 0%-9%). There were no associations between steatorrhea and EPI, growth, HIV RNA viral load, CD4 status, or type of antiretroviral therapy. Older children had decreased z scores for height (r = -0.42; P =.006).
Conclusions:
The clinical significance of steatorrhea in children with HIV infection is unclear. Furthermore, its evaluation should focus on nonpancreas-based conditions. Continual close monitoring of growth is essential in children with HIV infection.
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