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Gastrointestinal tract function and malnutrition in HIV-infected children
1Harvard Medical School, Boston, MA 02118, USA.
Insights
Children with Human Immunodeficiency Virus (HIV) infection often experience poor growth and weight gain. This complex issue involves interactions between the immune system, gut health, nutrition, and infections, impacting overall development.
Area of Science:
- Pediatric Infectious Diseases
- Human Immunodeficiency Virus (HIV) Research
- Growth and Development Studies
Background:
- Early reports identified poor growth and weight gain in children with Acquired Immunodeficiency Syndrome (AIDS).
- Despite decades of research, the underlying mechanisms for growth issues in pediatric HIV remain poorly understood.
- Data from the Women and Infants Transmission Study (WITS) highlights early weight decline and subsequent impaired linear growth in infants.
Purpose of the Study:
- To investigate the mechanisms behind poor growth and weight gain in children with HIV infection.
- To understand the interplay of factors contributing to nutritional deficiencies and growth abnormalities in pediatric HIV.
- To identify the impact of HIV on body composition, including lean body mass and linear growth.
Main Methods:
- Analysis of data from the NIAID/NICHD multicenter Women and Infants Transmission Study (WITS).
- Review of existing literature on growth patterns, weight changes, and body composition in HIV-infected children.
- Examination of the effects of caloric intake on weight gain, height velocity, and lean body mass.
Main Results:
- Weight decline in the first four months of life followed by decreased linear growth was observed.
- In older children, weight and height decline in parallel, with potential loss of lean body mass preceding weight loss.
- Adequate caloric intake improves weight gain but has limited impact on height velocity and lean body mass.
Conclusions:
- Long-term survivors with HIV infection are often shorter than expected, not solely due to poor nutrition or endocrine issues.
- Growth problems in HIV-infected children result from a complex interaction of immune system dysfunction, gastrointestinal tract issues, malnutrition, and recurrent infections.
- Addressing nutritional deficiencies and growth problems requires a multifaceted approach targeting these interacting factors.
Abstract:
Poor growth and/or weight gain was identified in the initial reports of children with AIDS (Oleske et al. 1983, Rubinstein et al. 1983). However, in the past 12 years little progress has been made to understand the mechanisms for these observations. Data from the NIAID/NICHD multicenter Women and Infants Transmission Study (WITS) demonstrated that a decline in weight occurred in the first four months of life followed by decreased linear growth (Rich et al. 1993). In older children weight and height seem to decline in parallel (McKinney et al. 1993), but loss of lean body mass may occur prior to a decline in weight (Miller et al. 1993). Adequate caloric intake can improve weight gain, but has little effect on height velocity and lean body mass (Henderson et al. 1994, Miller et al. 1992). Long-term survivors with HIV infection are shorter than anticipated, and these changes cannot be explained solely by inadequate nutrition or by endocrine abnormalities. The immune system, gastrointestinal tract function, malnutrition, and chronic or recurrent infection interact and contribute to the nutritional deficiencies and problems with growth observed in the HIV-infected child.