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Historical Perspectives on the Evolution in Understanding the Importance of Nutritional Care in Pediatric HIV Infection¹

^* Department of Pediatrics, New Jersey Medical School and Children's Hospital of New Jersey, Newark, NJ 07103 ^** Department of Pediatrics, Boston University Medical School, Boston, MA 02118

Women, perinatally-infected infants, and sexually exposed and exploited youths and adolescents have become a major focus of the worldwide HIV/AIDS pandemic. Increased perinatal screening, improvement in early infant diagnosis, and the benefits of primary HIV therapies have increased the numbers identified and longevity of infants and children living with HIV. This increase in survival is associated with HIV/AIDS becoming a chronic multiorgan system disease that requires a multidiscipline comprehensive care approach. The combination of poor oral intake, increased loss, and increased metabolic needs of long-term surviving HIV-infected children are obstacles to both survival and quality of life. HIV-infected children and their families need supportive care services including nutritional as well as primary therapy. Clinical guidelines for effective nutrition interventions must be developed to prevent and treat failure to thrive and wasting syndrome. Gains in survival duration must be linked to enhanced quality of life through supportive care, including comprehensive nutritional services that have their efficacy documented by appropriate clinical trials.

KEY WORDS: • HIV/AIDS • malnutrition • wasting syndrome • failure to thrive

¹ Presented at the workshop entitled "Nutrition in Pediatric HIV Infection: Setting the Research Agenda" held in Bethesda, MD on September 28–29, 1995. The workshop was sponsored by the Office of AIDS Research of the National Institutes of Health, the National Institute of Child Health and Human Development, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Mental Health, Food and Drug Administration, Pediatric AIDS Foundation, National Dairy Council, Sandoz Nutrition Corporation, Bristol-Meyers Squibb Company, Clintec Nutrition Company, Ross Products Division-Abbott Laboratories, Serono Laboratories, Inc., and the American Institute of Nutrition. Workshop proceedings are published as a supplement to The Journal of Nutrition. Guest Editors for this supplement publication were Daniel J. Raiten and John M. Talbot, Life Sciences Research Office, Federation of American Societies for Experimental Biology, Bethesda, MD.

² To whom correspondence should be addressed: Department of Pediatrics, UMD-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103.