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HIV-1 infection among malnourished children in Butare, Rwanda
J B Kurawige1, T Gatsinzi, V Kleinfeldt
1Department of Pediatrics, School of Medicine, National University of Rwanda, Butare.
Insights
Protein-energy malnutrition (PEM) in children is linked to human immunodeficiency virus type 1 (HIV-1) infection. HIV-1 seropositive malnourished children faced significantly higher mortality rates over two years.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nutrition
Background:
- Protein-energy malnutrition (PEM) is a significant health concern in children.
- The relationship between PEM and human immunodeficiency virus type 1 (HIV-1) infection requires further investigation.
Purpose of the Study:
- To investigate the association between HIV-1 infection and PEM in hospitalized children.
- To determine the clinical status and mortality of mother-child pairs with HIV-1 infection and PEM.
Main Methods:
- Screening of 101 malnourished children and their mothers for HIV-1 antibodies.
- Follow-up of mother-child pairs for two years to assess mortality and clinical status.
- Analysis of HIV-1 seropositivity based on malnutrition type (marasmus vs. edema) and chronicity (chronic vs. acute).
Main Results:
- 14% of malnourished children were HIV-1 seropositive.
- HIV-1 seropositivity was more prevalent in chronically malnourished children and those with marasmus (over 15 months).
- Mortality was significantly higher in HIV-1 seropositive children (75%) compared to seronegative children (23%) over two years.
Conclusions:
- Severe, chronic PEM in children should prompt consideration of pediatric AIDS.
- Early diagnosis and management of HIV-1 infection in malnourished children are crucial for improving prognosis.
- Findings highlight the critical link between nutritional status and HIV-1 outcomes in pediatric populations.
Abstract:
In order to investigate the relationship between human immunodeficiency virus (HIV-1) infection and protein-energy malnutrition (PEM), all 101 malnourished children who were admitted to the Department of Pediatrics of the National University Hospital between February and July of 1989 (median age = 2.5 years), and who were accompanied by their mother were screened for HIV-1 antibody. Mothers were also screened and interviewed. Mother-child pairs were followed-up 2 years later to determine mortality and clinical status. Fourteen per cent of malnourished children were HIV-1 seropositive. Only one seropositive child had a seronegative mother. This child had a history of multiple blood transfusions and injections. Among children above 15 months of age, HIV-1 seropositivity was more common among marasmic children than among malnourished children presenting with oedema at admission to the hospital. Also, HIV-1 infection was found more frequently among chronically malnourished children (low height for age and weight for age) than among acutely malnourished children (low weight for height). Mortality during the 2-year follow-up was 75 per cent among HIV-1 seropositive children and 23 per cent among HIV-1 seronegatives (mortality density ratio = 6.2; 95 per cent confidence interval = 2.2-17.4). Severe, chronic PEM should always alert health workers to the possible diagnosis of pediatric AIDS, and its implications for treatment and prognosis.