Arch Dis Child. Published Online First: 31 October 2008. doi:10.1136/adc.2008.142646
Original articles |
Nutritional recovery in HIV infected and uninfected children with severe acute malnutrition
1 Liverpool School of Tropical Medicine/Action Against Hunger UK, United Kingdom
2 Action Against Hunger, Malawi, Malawi
3 Centre for International Health and Development, ICH, UCL, United Kingdom
4 Ministry of Health, Malawi
* To whom correspondence should be addressed. E-mail: pamela.fergusson{at}gmail.com.
Accepted 13 October 2008
Abstract
Objective: Few studies have reported on nutritional recovery, survival and growth among severely malnourished children with HIV. This study explores nutritional recovery in HIV infected and uninfected children during inpatient nutrition rehabilitation and four months of follow-up.
Design: prospective cohort study.
Setting: Lilongwe district, Malawi.
Main outcome measures: Weight gain, anthropometrics.
Results: In our sample of 454 children with severe acute malnutrition (SAM), 17.4% (n = 79) of children were HIV infected. None of the children were on ART upon admission. Among the HIV infected children, 35.4% (28/79) died, compared to 10.4% (39/375) in HIV uninfected children (p <.001). All children who survived achieved nutritional recovery (>85% weight for height and no oedema), regardless of HIV status. HIV infected children had similar weight gain to HIV uninfected children ( 8.9 vs. 8.0 g/kg/day,NS). Mean increases in Z scores for both subscapular (2.72 vs. 2.69, NS) and triceps (1.26 vs. 1.48, NS) skinfolds were similar between HIV infected and uninfected children respectively during nutrition rehabilitation. 362 children were followed for four months; at which time mean WHZ was similar in HIV infected and uninfected children (-0.85 vs. -0.64, NS).
Conclusions: HIV infected children with SAM have higher mortality rates than HIV uninfected children. Among those who survive, however, nutritional recovery is similar in HIV infected and uninfected children.
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