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Gastrointestinal Tract Function and Malnutrition in HIV-Infected Children¹

Harvard Medical School, Boston University School of Medicine, Boston, MA 02118

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.

KEY WORDS: • HIV infection • gastrointestinal function • growth • immune fuction • malnutrition

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.