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Original Article

REVISTA PAULISTA DE MEDICIN A

Evolution of nutritional status of infants infe cte d

with the human immunode ficie ncy virus

Pediatric Immunodeficiency Service, Department of Pediatrics, Faculty of Medical Sciences,

Universidade Estadual de Campinas, Campinas, Brazil.

a b s t r a c t

CON TEX T: There are to day o nly a limited number o f studies defining g ro wth parameters and nutritio nal status fo r HIV children.

OBJECTIVE: To study the nutritio nal status o f infants infected with the human immuno deficiency virus.

TYPE OF STUDY: Lo ng itudinal study.

SETTIN G: Department o f Pediatrics, Faculty o f Medical Sciences, UN ICAMP, Campinas, Braz il.

PARTICIPAN TS: O ne hundred and twenty-fo ur children bo rn to HIV infected mo thers were evaluated fro m birth until the ag e o f two years. They were subdivided into two g ro ups: 7 1 infected children and 5 3 no n-infected children.

M AIN M EASUREM EN TS: G ro wth was evaluated in bo th g ro ups by co mparing Z-sco res fo r weig ht/ ag e (W / A), leng th/ ag e (H/ A) and weig ht/ leng th (W / H) (using the N CHS curves as reference).

RESULTS: The Z-sco re analyses sho wed that there was a sig nificant difference between the two g ro ups fo r all the variables studied, ex-cept fo r the H/ A value at 3 mo nths o f ag e and the W / H value at 2 1 mo nths o f ag e, which sho wed P > 0 .0 5 .

CON CLUSION S: The g ro wth o f infected infants was o bserved to be severely affected in co mpariso n with that o f sero reversed infants in the same ag e g ro ups. Altho ug h clinical manifestatio ns may take time to appear, the o nset o f g ro wth chang es beg in so o n after birth.

KEY W ORDS: G ro wth and develo pment. N utritio nal status. Chil-dren. HIV. Acquired immuno deficiency syndro me.

• Vânia Aparecida Leandro -Merhi • Maria Marluce do s Santo s Vilela • Marco s N o lasco da Silva • Fábio Anco na Lo pez • Antô nio de Az evedo Barro s Filho

INTRODUCTION

AIDS has caused a tremendo us impact ever since the first adult and child cases were repo rted at the Center fo r Disease Co ntro l, Atlanta, USA1 andhas be-co me o ne o f the greatest health pro blem all o ver the wo rld. Acco rding to the estimates in 1994, there were appro ximately 2 millio n children infected with HIV in the wo rld. In the United States o f America, there are 12,000 infected children.2

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Up to August 1998, there had been 140,362 cases o f AIDS repo rted in Brazil. Of these, 4815 (3.4%) were children belo w the age o f 13, which demo nstrated that in this age gro up there had been an increase in this disease. Amo ng infant cases, 3825 (79.4%) acquired the disease thro ugh vertical transmissio n, 205 (4.3%) were hemo philiacs, 279 (5.8%) acquired it thro ugh transfu-sio ns and 489 (10.2 %) fro m unkno wn so urces, and 1986 (41.2%) o f these infant cases had died.3

The clinical manifestatio ns generally sho wn by such children are: generalized lymphadeno pathy, hepato sple-no megaly, o ral candidiasis and recurring infectio ns.6-9

There are to day o nly a limited number o f studies defining gro wth parameters fo r HIV children.10,11

Halsey, et al.12 (1990), studied a po pulatio n sample in Haiti and fo und that the weight o f the babies bo rn to mo thers po sitive fo r HIV type were similar, independent o f the state o f infectio n during that perio d, but different fro m the weight o f babies bo rn to mo thers negative fo r HIV type. Altho ugh the ingestio n o f nutrients and the bo dy mass were no t repo rted, the weight o f children po sitive fo r HIV at 3 mo nths differed fro m the weight o f children sero negative fo r HIV and the HIV negative co ntro l gro up. Miller, et al.10

(1993) o bserved that at birth, no rmal chil-dren and HIV infected chilchil-dren had similar weight, ges-tatio nal age and percentile weight but at between 19 and 21 mo nths, their percentile weights differed sig-nific antly and the le ng ths re m aine d the s am e . McKinney, et al.11

(1993) analyzed the gro wth rate o f children during the first two years o f life and fo und that

the gro wth index o f HIV infected children during the first fo ur mo nths was significantly less than that o f no n-infected children regarding weight as well as length in relatio n to age and that the linear gro wth as well as the gain in weight were pro po rtio nally reduced. Mo ye, et al.13 (1996) studied the magnitude o f the infectio n caused by the human immuno deficiency virus, acquired either perinatally o r co ngenitally, o n so matic gro wth fro m birth up to the age o f 18 mo nths. They co ncluded that the infected children sho wed a pro gressive decline in bo dy mass index fro m birth to the age o f 6 mo nths. Gro wth mo nito ring is an impo rtant to o l fo r evalu-ating the child’s health. We were able to study this ques-tio n pro fo undly because o f the info rmaques-tio n available regarding the weight and length o f sero reversed infected children, who were being treated at the Outpatient Pe-diatrics Department, Ho spital das Clínicas, State Uni-versity o f Campinas, SP, Brazil. The o bjective o f this re-search was to study the nutritio nal status with regard to weight and length o f children with the human im-muno deficiency virus aged zero to 24 mo nths, and to co mpare these results with tho se o f no n-infected chil-dren with mo thers who were po sitive fo r HIV.

METHODS

The pro cedures that fo llo w were in acco rdance with the ethical standards o f the co mmittee respo n-sible fo r human experimentatio n and with the Helsinki declaratio n o f 1975, as revised in 1993.

Table 1. Characte ristics of the population studie d

Children

Cha ra cteristics Infected (n = 7 1 ) N on-infected (n = 5 3 ) Tota l (n = 1 2 4 )

N o. % N o. % N o. %

Sex

Male 3 4 4 7 .9 3 1 5 8 .5 6 5 5 2 .4

Female 3 7 5 2 .1 2 2 4 1 .5 5 9 4 7 .6

Situatio n

Fo llo w-up 3 2 4 5 .1 3 0 5 6 .6 6 2 5 0

Discharg ed - - 1 2 2 2 .6 1 2 9 .7

Died(* ) 2 3 3 2 .4 - - 2 3 1 8 .5

Abando ned 1 3 1 8 .4 1 0 1 8 .8 2 3 1 8 .6

Transferred 3 4 .2 1 1 .9 2 3 3 .2

Mo ther’s educatio n (* * )

Middle scho o l co mplete 5 9 .4 - - 5 5 .7

Middle scho o l inco mplete 3 5 6 6 .0 2 7 7 9 .4 6 2 7 1 .3 Hig h scho o l co mplete 6 1 1 .3 4 1 1 .8 1 0 1 1 .5

Hig h Scho o l inco mplete 3 5 .7 2 5 .9 5 5 .7

University 4 7 .5 1 2 .9 5 5 .7

Childbirth (* * * )

Cesarean 2 3 3 5 .9 1 9 3 8 .8 4 2 3 7 .2

Vag inal 4 1 6 4 .1 3 0 6 1 .2 7 1 6 2 .8

Breast feeding (* * * * )

Yes 4 1 6 4 .1 1 9 3 7 .3 6 0 5 2 .2

N o 2 3 3 5 .9 3 2 6 2 .7 5 5 4 7 .8

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Table 2. Infe cte d and non-infe cte d childre n according to the ir we ight and le ngth at birth and the ir ge stational age

Children W eight a t birth (k g) Length a t birth (cm) Gesta tiona l a ge (w eek s)

Infected n = 5 9 * n = 3 6 * n = 2 9 *

Mean 2 .9 5 4 8 .6 3 9 .4

SD 0 .6 9 2 .8 5 1 .7 0

Median 2 .9 0 4 8 .5 4 0 .0

N o n-infected n = 3 8 * n = 3 3 * n = 2 5 *

Mean 2 .9 5 4 8 .6 3 9 .3

SD 0 .6 9 2 .6 2 1 .9 8

Median 2 .9 2 4 9 .0 4 0 .0

To tal (n = 1 2 4 ) n = 9 7 * n = 6 9 * n = 5 4 *

Mean 2 .9 5 4 8 .6 3 9 .3

SD 0 .6 8 2 .7 2 1 .8 2

Median 2 .9 0 4 9 .0 4 0 .0

* Patients who se info rmatio n was available; sd = standard deviatio n.

Design

A mixed lo ngitudinal study was co nducted dur-ing the fo llo w-up perio d fro m August 1985 to April 1996.

Setting

Department o f Pediatrics, State University o f Campinas.

Participants

Children who se mo thers were fo und to be po si-tive fo r HIV at the Outpatient Department, Pediatric Im-muno deficiency Service, Ho spital das Clínicas, State University o f Campinas. The fo llo wing variables were analyzed: age, sex, gestatio nal age at birth, weight at birth, weight and length during the fo llo w-up perio d. The study was co nducted o n 124 patients who fulfilled the criteria established. Children who weighed less than 2500g and tho se who started treatment after the age o f two years were excluded.

The criteria fo r inclusio n were:

a) Bo rn after full gestatio nal term and with weight

2500 g.16

b) Absence o f co ngenital diseases that co uld interfere in the develo pment o f the child and its nutritio nal state. c) Only ve rtically infe cte d childre n we re include d

(mo ther

child).

The children were classified into two gro ups: a) Infected Children: tho se children who were sero lo

gi-cally po sitive fo r the human immuno deficiency vi-ru s afte r c o n d u c tin g th e e n zym e - lin ke d immuno abso rbent assay (ELISA) and co nfirmed by the Western Blo t o r Immuno fluo rescence test after the age o f 18 mo nths o r befo re this date, if the child sho wed sympto ms o f the disease.

b) Non-infected Children (seroreversed): the children were co nsidered to be no n-infected when they sho wed a c o m p le te re ve rsal o f the se ro lo gic al re sults

(ELISA) up to 18 mo nths o f age, with no rmal im-muno lo gy and witho ut any sympto ms o f the hu-man immuno deficiency virus infectio n.

Main Measurements

Anthropometry.A nutritio nal evaluatio n was co n-ducted with the help o f weight and length measure-ments and utilizing the curves o f the “Natio nal Center fo r Health Statistics”,14

which have been reco mmended by the Wo rld Health Organizatio n (WHO). The relatio n-ships weight/length, length/age and weight/age were ex-pressed in terms o f “Z-sco res”.15 In o rder to analyze the Z sco res, children between the ages o f zero and 24 mo nths and infected with the human immuno deficiency virus were cho sen, and also children between zero and 24 mo nths who were sero po sitive at the beginning and became negative by the age o f 18 mo nths.

Statistical Methods

The Student T test was used in the case o f indepen-dent samples when the no rmality suppo sitio n was satis-fied and the Mann-Whitney U test was used fo r the rest. The tests were co nducted fo r a 5% significance (

α

) level.

The patients were classified acco rding to their ages fo r statistical analysis:

a) Between 0 and 6 mo nths: The measurements clo s-est to three mo nths were taken fo r the calculatio n o f the Z-sco res.

b) Between 6 and 12 mo nths: The measurements clo s-est to nine mo nths were taken fo r the calculatio n o f the Z-sco res.

c) Between 12 and 18 mo nths: The measurements clo s-est to fifteen mo nths were taken fo r the calculatio n o f the Z-sco re.

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Z-sco res were calculated fo r weight/age, length/ age and weight/length in the cases o f bo th the infected and the no n-infected gro ups o f children.

RESULTS

The children were divided into two gro ups – in-fected and no n-inin-fected – and classified acco rding to their sex, co lo r, mo ther’s educatio n, type o f birth and whether they were breast-fed (Table 1).

It was o bserved that with regard to the sex o f chil-dren in the infected gro up, 34 chilchil-dren (47.9%) were male and 37 (52.1%) were female. In the case o f no n-infected children, 31 (58.5%) were males and 22 (41.5%) were females. During the survey perio d, the fo llo w-up ser-vice at the Pediatric Immuno deficiency Department was regularly used by 32 infected children (45.1%); 13 chil-dren (18.4%) abando ned the fo llo w-up; 3 chilchil-dren (4.2%) were transferred to ano ther service and 23 children (32.4%) died. Thirteen o f the children (56.5%) who died did so befo re the age o f 2, and 10 children (43.4%) died after the age o f 2. The infected children repo rted at the clinic acco rding to the evo lutio n o f the disease, which was usually weekly. In the gro up o f no n-infected chil-dren, 30 children (56.6%) had a regular fo llo w up, 10 children (18.8%) abando ned the pro gram, 1 child (1.9%) was transferred to ano ther pro gram and 12 (22.6%) chil-dren were discharged. No ne o f the chilchil-dren fro m this gro up died. Mo st o f the children came fro m a back-gro und o f lo w inco me and mo ther’s educatio n.

Table 2 sho ws the distributio n o f the children in the infected and no n-infected gro ups with regard to the weight and length at birth and gestatio nal age.

It was verified that the weight and length at birth

and the gestatio nal age were similar fo r the two gro ups. The results o f the Z-sco re analyses are sho wn in Table 3. It can be seen that there is a difference be-tween all the variables fo r bo th gro ups except in the case o f length/age at 3 mo nths and weight/length at 21 mo nths as the value o btained fo r P was > 0.05.

DISCUSSION

The analysis o f the gro wth o f children bo rn to HIV+ mo thers reveals the so cial and affective facto rs invo lved in these children’s families. Children o f HIV+ mo thers are raised in an enviro nment highly affected by the disease and the circumstances that fo llo w it. The children that develo p infectio n have a path o f highs and lo ws depending o f the availability o f the treatment and the respo nse that each patient presents to this treat-ment. This wo rk refers to children treated befo re the recently pro po sed drug therapy, and the o bjective o f this study was no t, at this time, to evaluate the effect o f clinical treatment o n the patients.

HIV can be transmitted vertically during pregnancy, at birth and o r during breast feeding. Acco rding to the clinical data, at least 50% o f the transmissio ns seem to o ccur at birth. This suppo sitio n is based o n the fact that in the case o f mo st children, it is difficult to detect viral particles during the first weeks o f life witho ut the viral multiplicatio n o r the fo rmatio n o f antibo dies which o c-curs aro und the seco nd mo nth.17

It is pro bably at this stage that the virus co mes o ut o f latency and begins the phase o f viral replicatio n which is pro po rtio nal to the stimulus o ffered by the immune system.

Children bo rn to mo thers who are sero po sitive fo r HIV, are usually bo rn sero po sitive because o f the

Table 3. Z-score value s for the infe cte d and non-infe cte d groups of childre n according to the anthropome tric inde x and age

Children

Group Infected N on-Infected P-va lue

Z-score n M ea n SD M edia n n M ea n SD M edia n

H/ A - 3 mo nths 2 1 -1 .3 7 1 .1 6 -1 .3 5 3 0 -0 .9 8 1 .3 0 -0 .7 8 0 .1 6 5 2 (* * ) H/ A -9 mo nths 2 5 -2 .4 6 1 .1 6 -2 .4 9 2 8 -0 .9 1 1 .2 6 -0 .8 9 0 .0 0 0 0 (* ) H/ A - 1 5 mo nths 2 8 -2 .5 9 1 .4 6 -2 .7 6 2 9 -1 .0 6 0 .9 6 -0 .8 8 0 .0 0 0 0 (* ) H/ A - 2 1 mo nths 3 7 -2 .1 2 1 .4 8 -2 .5 1 2 5 -0 .5 9 1 .1 9 -0 .3 7 0 .0 0 0 1 (* )

W / H - 3 mo nths 2 1 -0 .3 9 0 .8 2 -0 .6 2 3 0 0 .7 3 1 .8 7 0 .3 1 0 .0 0 0 5 (* ) (* * ) W / H - 9 mo nths 2 5 -0 .9 5 1 .1 7 -0 .7 6 2 8 -0 .0 3 0 .9 9 0 .1 0 0 .0 0 3 3 (* ) W / H - 1 5 mo nths 2 8 -0 .8 6 1 .0 6 -0 .8 6 2 9 -0 .2 2 1 .0 4 -0 .0 6 0 .0 2 4 9 (* ) W / H - 2 1 mo nths 3 7 -0 .6 6 1 .2 5 -0 .5 7 2 5 -0 .3 9 1 .0 7 -0 .6 2 0 .3 7 4 7

W / A - 3 mo nths 2 2 -1 .3 5 1 .0 5 -1 .3 7 3 0 -0 .4 7 1 .1 5 -0 .4 1 0 .0 0 6 7 (* ) W / A - 9 mo nths 2 6 -2 .5 0 1 .3 5 -2 .4 0 2 8 -0 .7 8 1 .0 7 -0 .6 1 0 .0 0 0 0 (* ) W / A - 1 5 mo nths 2 8 -2 .2 8 1 .3 8 -2 .3 7 2 9 -0 .8 5 0 .8 5 -0 .9 3 0 .0 0 0 0 (* ) W / A - 2 1 mo nths 3 9 -1 .6 9 1 .4 6 -1 .7 5 2 6 -0 .6 2 1 .1 0 -0 .8 5 0 .0 0 3 0 (* )

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1. Co o p e r ER, Pe lto n SJ, Le m ay M. Ac q uire d ID Synd ro m e : a ne w p o p u l a ti o n o f c h i l d re n a t ri s k. Pe d i a tr Cl i n N o rth Am 1988;35(6):1365-8.

2. Davis SF, Byers RH, Lindegren ML, Caldwell MB, Karo n JM, Gwinn M. Prevalence and incidence o f vertically acquired HIV infectio n in the United Stated. JAMA 1995;274:952-5.

REFERENCES

passage o f antibo dies o f class IgG thro ugh the placenta. The maternal antibo dies may remain detectable until the 15th mo nth o f life and as a result, the ELISA and the Western Blo t tests do no t diagno se HIV infectio n.

A de finite diagno sis o f infe ctio n in childre n yo unger than 15 mo nths o ld can o nly be do ne by di-rectly researching the virus o r its co mpo nents: viral cultures, the presence o f antigenemia (antigen P24), the po lymerase chain reactio n (PCR) and viral lo ad.1

The gro wth o f children bo rn to mo thers infected with the human immuno deficiency virus was evaluated in this study. Tho se who develo ped the infectio n were co mpared to the sero reversed children. Bo th these gro ups belo nged to the same so cial-eco no mic class. It was o bserved that the gro wth o f the infected children was already co mpro mised at 3 mo nths. During the first year o f life they were pro po rtio nally smaller in weight as well as length, altho ugh at 3 mo nths the mean length was le s s in the HIV p o s itive gro up than in the sero reversed gro up. At that stage, the difference was still no t significant, but sho wed that weight was co m-pro mised earlier than length.

Weight and length measurements have traditio n-ally been used as criteria fo r determining the nutritio nal state and health o f children.18 Children infected by the human immuno deficiency virus usually have nutritio nal pro blems and the “wasting” syndro me was described as a co nditio n that indicated AIDS in 17% o f the chil-dren in 1994.19

Oleske, et al.20

(1983) and Rubinstein et al21 (1983) have highlighted gro wth retardatio n and lo ss in weight in early repo rts o n children with AIDS, al-tho ugh very little pro gress has been made during re-cent years in understanding the mechanism o f these o bservatio ns.

It was o bserved that there was no difference re-garding weight and length at birth and the gestatio nal age between infected and no n-infected children. Other studies that have analyzed the gro wth o f HIV infected c hild re n have also c o nfirm e d the ab o ve o b se rva-tio n,10,22,23 but there are o ther researchers who have fo und differences between the gro ups.24

Abno rmalities in the develo pment o f the child mo st pro bably begin after birth and take place rapidly, even in asympto matic children. Gro wth mo dels are no t always fo reseeable, as the clinical co urse o f the dis-ease varies.

Other researchers have fo und that during the pre-natal perio d, the children infected by the virus sho wed

a reductio n in weight/age and length/age when co m-pared with no n-infected children during the first fo ur mo nths o f life. Reductio ns in weight and length were pro po rtio nal resulting in a nearly no rmal relatio nship – weight/pro ximal length.11 In this study, it was o bserved that the difference in weight when co mpared with length diminished at 15 mo nths and was no t significant at 21 mo nths. With time, length was co mpro mised and the relatio nship weight/length mo dified.

The failure to gro w is repo rted in appro ximately o ne third o f the children infected by the human immu-no deficiency virus and is asso ciated with a reduced rate o f survival. Lo ss o f weight o ccurs in the first mo nths o f life befo re there is a decline in the length o f children bo rn to mo thers infected with the virus. In lo ng term survivo rs, the reductio n in gro wth co ntinues and may be asso ciated with reduced bo dy mass.

Mo ye, et al.13 (1996) sho wed that infected and no n-infected children bo rn to infected mo thers had similar weight, length and gestatio nal age at birth. Ho w-ever, at the age o f 2 mo nths, the infected children re-vealed a significant reductio n in the circumference o f the head and in weight, but the length did no t diminish significantly until the age o f 4 mo nths. These differences were maintained fo r 18 mo nths.

As the children became mo re sympto matic, diar-rhea, malabso rptio n and enteric infectio ns became mo re co mmo n and gro wth was affected.

In sho rt, during the first two years o f life, the Z-sco res fo r infected children regarding weight and length in the po pulatio n studied were less than tho se fo r no ninfected children. The gro wth o f the children was pro -po rtio nal but their size was inferio r when co mpared to their chro no lo gical age. HIV affects the infected chil-dren rapidly and is demo nstrated by premature gro wth retardatio n.

CONCLUSION

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r e s u m o

CON TEXTO: Atualmente há estudo s limitado s que definem parâmetro s de crescimento e estado nutricio nal em crianças co m HIV.

OBJETIVO: Estudar o estado nutricio nal de crianças infectadas co m o vírus da imuno deficiência humana.

TIPO DE ESTUDO: Estudo lo ng itudinal.

LOCAL: Serviço de imuno deficiência pediátrica da Universidade Estadual de Campinas, Campinas, Brasil.

PARTICIPAN TES: 1 2 4 crianças nascidas de mulheres infectadas co m o HIV fo ram avaliadas desde o nascimento até do is ano s de idade. Elas fo ram subdivididas em do is g rupo s: 7 1 crianças infectadas e 5 3 crianças não -infectadas.

PROCEDIMEN TOS: A avaliação do estado nutricional foi realizada pela comparação do Z-score para peso/ idade(P/ I),altura/ idade(A/ I) e peso/ altura(P/ A),usando as curvas do N CHS co mo referência. Para a comparação do Z-score foram utilizados os testes T de Student e U de Mann-W hitney. O s testes foram conduzidos ao nível de significância=5%.

RESULTADOS: A análise do Z-sco re revelo u que ho uve evidência de diferença entre o s do is g rupo s, para to das as variáveis estudadas, exceto o índice de A/ I ao s 3 meses e P/ A ao s 2 1 meses.

CON CLUSÕES: O estado nutricional das crianças infectadas foi grave-mente afetado em comparação com as crianças sororreversoras no mes-mo grupo de idade. Embora as manifestações clínicas possam demes-morar a aparecer, as alterações no crescimento surgem logo após o nascimento.

PALAV RAS-CH AV E: C re sc ime nto e d e se nvo lvime nto . Esta d o nutricio nal. Crianças. HIV. Síndro ma da imuno deficiência adquirida.

Vânia Apare cida Le andro-Me rhi, MSc. Nutritio nist, Department o f Nutritio n, Po ntifícia Universidade Cató lica de Campinas and Universidade Meto dista de Piracicaba, São Paulo , Brazil.

Maria Marluce dos Santos Vile la, PhD. Department o f Pediatrics, Faculty o f Medical Sciences, State University o f Campinas, Campinas, Brazil.

Marcos Nolasco da Silva, PhD. Department o f Pediatrics, Faculty o f Medical Sciences, State University o f Campinas, Campinas, Brazil.

Fábio Ancona Lope z, PhD. Department o f Pediatrics, Federal University o f São Paulo , São Paulo , Brazil.

Antônio de Aze ve do Barros Filho, PhD. Department o f Pediatrics, Faculty o f Medical Sciences, State University o f Campinas, Campinas, Brazil.

Source s of funding: No t declared

Conflict of inte re st: No t declared

Last re ce ive d: 14 March 2000

Acce pte d: 18 April 2000

Addre ss for corre sponde nce :

Vânia Aparecida Leandro -Merhi Av. Jo sé Bo nifácio , 1425 - Apto . 72 Campinas/SP – Brazil - CEP 13093-420 E-mail: vania@ acad.puccamp.br

p u b lis hin g in fo r m a t io n

3. Ministério da Saúde. AIDS – Bo letim Epidemio ló gico . Ano XI, no . 3, p.33 – Semana Epidemio ló gica – June-August 1998.

4. Centers fo r Disease Co ntro l. HIV/AIDS. Surveillance Repo rt 1993;5:1-19. 5. Ano nymo us. Update: Acquired immuno deficiency syndro me: United

States, 1994. MMWR 1995;44:64-7.

6. Kamani N, Lightman, H, Leiderman I, Krilo v LR. Pediatric acquired immuno deficiency syndro me-related co mplex: clinical and immuno lo gical features. Pediatr Infect Dis J 1998;7:383-8.

7. Cap rille s Q u iró s JA, Co n d e JG, Go rrin JJ, Do n e s O R. Pe rfil so cio demo gráfico y medidas del crescimiento físico en pacientes pediátrico s co m el síndro me de imuno deficiência adquirida seguido s en el Ho spital Muncipal de San Juan: 1986-1990. Bo l Asso c Med PR 1991;83:479-84.

8. Ro d rigue z GEP, Ro b le s , MCG, Go nzale z FT. Sínd ro m e d e immuno deficiência adquirida en ninõ s. Experiência de 8 ano s en el Ho spital de Infecto lo gia del Centro Médico “La Raza”, Instituto Mexicano del Seguro So cial. Bo l Méd Ho sp Infant Méx 1992;49:581-4.

9. Prazuck T, Tall F, Nacro B, et al. HIV Infectio n and severe malnutritio n: a clinical and epidemio lo gical study in Burkina Faso . AIDS 1993;7:103-8. 10. Miller TL, Evans SJ, Orav EJ, Mo nis V, McInto sh K. Gro wth and bo dy

co mpo sitio n in children infected with the human immuno deficiency virus - 1. Am J Clin Nutr 1993;57:588-92.

11. McKinney RE Jr, Ro bertso n WR, Duke. Pediatric AIDS Clinical Trials Unit. Effect o f human immuno deficiency virus infectio n o n the gro wth o f yo ung children. J Pedriatr 1993;123:579-82.

12. Halsey NA, Bo ulo s R, Ho lt E, et al. Transmissio n o f HIV Infectio ns fro m mo thers to infants in Haiti. JAMA 1990;264:2088-92.

13. Mo ye J, Rich KC, Kalish LA, et al. Natural histo ry o f so matic gro wth in infants bo rn to wo men infected by human immuno deficiency virus. J Pediatr 1996;128:58-69.

14. Natio nal Center fo r Health Statistics. Gro wth curves fo r children birth 18 years United States. Washingto n, DC: VS Printing Office, 1977. (Vital and Health Statistics, Series 11, no . 165, DHW Pub. no . 78-1650). 15. Sullivan K, Go rteins J. Pro gramas para antro po metria nutricio nal. In: Dean

AG, De An JA, Burto n AH, Dicker RC. EPI INFO, versio n 5: a wo rld pro cessing database and statistics pro gram fo r epidemio lo gy micro co mputers. Center fo r Disease Co ntro l, Atlanta, Geo rgia, USA, 1990.

16. Battaglia FC, Lubchenco LO. A practical classificatio n o f newbo rn infants by weight and gestatio nal age. J Pediatr 1967;71:159-63.

17. Mo fenso n LM. The ro le o f antiretro viral therapy in the management o f HIV infectio n in wo men. Clin Obst Gyneco l 1996;39(2):361-85. 18. Wate rlo w JC. Basic co nce pts in the de te rm inatio n o f nutritio nal

requirements o f no rmal infants. In: Tsang R, Nicho ls B, edito rs. Nutritio n during infancy. St. Lo uis: CV Mo sby Co mpany; 1988:1-19.

19. Centers fo r Disease Co ntro l. 1994 Revised classificatio n system fo r human immuno deficiency virus (HIV) infectio n in children less than 13 years o f age. MMWR 1994;43:1-10.

20. Oleske J, Minnefo re A, Co o per R, et al. Immune deficiency syndro me in children. JAMA 1983;249:2345-9.

21. Rubinstein A, Sicklick M, Gupta A, et al. Acquired immuno deficiency with reversed T4/T8 ratio s in infants bo rn to pro miscuo us and drug addicted mo thers. JAMA 1983;249:2350-6.

22. Blanche S, Ro uzio ux C, Mo scto MG. A pro spective study o f infants bo rn to wo men sero po sitive fo r HIV type 1. N Engl J Med 1989;320:1643-8. 23. Po llack H, Glasberg H, Lee E, et al. Impaired early gro wth o f infants

perinatally infected with human immuno deficiency virus : co rrelatio n with viral lo ad. J Pediatric 1997;130:915-22.

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