3 results
9 - Growth, nutrition, and metabolism
-
- By Caroline J. Chantry, Department of Clinical Pediatrics, University of California Davis Medical Center, Sacramento, CA, Jack Moye, Jr., Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, NIH, Bethesda, MD
- Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
-
- Book:
- Handbook of Pediatric HIV Care
- Published online:
- 23 December 2009
- Print publication:
- 04 May 2006, pp 273-308
-
- Chapter
- Export citation
-
Summary
In recent years, growth, nutrition and metabolism of HIV-infected children have received increased attention for several reasons. It has been recognized for the past decade that HIV-infected children generally do not grow as well as their uninfected counterparts, but more recent evidence suggests that this is often true even in the face of adequate virologic control. Given also that growth is a predictor of survival, there has been closer scrutiny of nutritional and metabolic factors that can contribute to poor growth. Additionally, potentially serious metabolic complications of HIV infection and/or antiretroviral therapies overlap with nutritional aspects of the infection and have prompted attention to the pathophysiology of malnutrition in these children.
The current state of knowledge regarding the complex interrelationships of nutrition, HIV disease, antiretroviral therapy, and growth is reviewed in this chapter. Recommendations for nutritional monitoring and support are discussed, as are therapies for certain recognized causes of malnutrition in HIV-infected children. Briefly described are the complications and recommended treatments for fat redistribution, hyperlipidemia, insulin resistance, osteonecrosis, and mitochondrial toxicity. Finally, nutritional issues most germane to resource-poor settings are highlighted.
Definitions: malnutrition, growth failure
Pediatric HIV disease may lead to multiple nutritional deficiencies. Deficiencies of adequate macronutrients (protein or calories) and/or micronutrients (vitamins, minerals) to maintain optimal health status is referred to as undernutrition or, more commonly, malnutrition. Many definitions for growth failure or failure to thrive (FTT) exist.
26 - Gastrointestinal disorders
-
- By Harland S. Winter, Division of Pediatric Gastroenterology and Nutrition, VBK 107, Massachusetts General Hospital for Children, Boston, MA, Jack Moye, Jr., Pediatric, Adolescent, and Maternal AIDS Branch, NICHID, Bethesda, MD
- Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
-
- Book:
- Handbook of Pediatric HIV Care
- Published online:
- 23 December 2009
- Print publication:
- 04 May 2006, pp 602-617
-
- Chapter
- Export citation
-
Summary
Introduction
Gastrointestinal (GI) dysfunction, a common occurrence in children with HIV disease, can be related to infectious agents, malnutrition, immunodeficiency or HIV infection itself, and can result in retardation of growth, increased caloric requirements, and/or diarrhea/malabsorption. The absorption and utilization of nutrients is a primary function of the GI tract, but the immune system of the gut has been shown to be the major site of CD4+ lymphocyte depletion and viral replication [1]. The mucosal immune and enteric nervous systems interact with the epithelium to regulate intestinal function. Lymphocytes and macrophages produce cytokines and vasoactive peptides that can alter brush border epithelial cell enzyme expression, secretion, motility or mucosal blood flow. These factors ultimately affect nutrient absorption. As immune function deteriorates in the HIV-infected child, intestinal function declines to a degree greater than might be expected due to opportunistic infections alone. The goal of this chapter is to present the GI aspects of HIV disease so that clinicians will begin intervention in the early stages of the disease, thereby minimizing the impact on growth and development.
GI problems of HIV-infected children
During acute infection with HIV, GI symptoms are rare. Older children can experience a “flu-like” illness, but most infants infected through MTCT are asymptomatic. One of the earliest clinical manifestations of HIV infection in children is growth retardation and slow weight gain. These changes in growth can occur as early as two months of age and do not appear to be related to concomitant, e.g., opportunistic, infection [2–4].
33 - Gastrointestinal disorders
- from Part IV - Clinical manifestations of HIV infection in children
-
- By Harland S. Winter, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA, Jack Moye, Jr, Pediatric, Adolescent, and Maternal AIDS Branch, NICHD, Bethesda, MS
- Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
-
- Book:
- Textbook of Pediatric HIV Care
- Published online:
- 03 February 2010
- Print publication:
- 28 April 2005, pp 510-520
-
- Chapter
- Export citation
-
Summary
Introduction
Gastrointestinal (GI) dysfunction, a common occurrence in children with HIV disease, can be related to infectious agents, malnutrition, immunodeficiency, or HIV infection itself, and can result in retardation of growth, increased caloric requirements, and/or diarrhea/malabsorption. The absorption and utilization of nutrients is a primary function of the GI tract, but the immune system of the gut has been shown to be the major site of CD4+ lymphocyte depletion and viral replication [1]. The mucosal immune and enteric nervous systems interact with the epithelium to regulate intestinal function. Lymphocytes and macrophages produce cytokines and vasoactive peptides that can alter brush border epithelial cell enzyme expression, secretion, motility, or mucosal blood flow. These factors ultimately affect nutrient absorption. As immune function deteriorates in the HIV-infected child, intestinal function declines to a degree greater than might be expected due to opportunistic infections alone. The goal of this chapter is to present the GI aspects of HIV disease so that clinicians will begin intervention in the early stages of the disease, thereby minimizing the impact on growth and development.
The role of the GI tract in pathogenesis of HIV
HIV is acquired via the mucosa of the genital tract in most cases of heterosexual transmission and via the GI tract in most cases of mother-to-child transmission (MTCT). HIV infection of a child can occur through swallowing infected amniotic fluid in utero, or infected blood or cervical secretions during delivery and/or through ingesting infected breast milk in the postnatal period [2].