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E ditoria l
REVISTA PAULISTA DE MEDICIN ANutritional e valuation and
support for childre n
infe cte d with HIV
• Helo ísa Helena de So usa Marques
The nutritio nal deficiencies fro m infectio n by HIV are frequently mo re serio us in children than in adults, due to children’s need to demand additio nal nutrients fo r their gro wth and develo pment. The co m-pro mising o f nutritio n is related to the increase in the number o f episo des o f infectio us co mplaints and also co ntributes to a slo wer reco very fro m these. In the United States in 1994, the so -called “wasting” syn-dro me, a serio us co nditio n o f denutritio n acco mpa-nied by weight lo ss, diarrhea and/o r fever, affected 17% o f children infected by HIV.1
Aro und 40% o f the 300 c hild re n infe c te d b y HIV and ad m itte d into the Instituto da Criança in the perio d fro m 1985 to 1998 presented a histo ry o f weight lo ss and/o r denutritio n at diagno sis.
The article “Evo lutio n o f nutritio nal status o f infants infected with Human Immuno deficiency Vi-rus”,2 presented in this issue, fo rms a relevant co ntri-butio n to wards the kno wledge o f nutritio nal co ndi-tio ns amo ng Brazilian children expo sed perinatally to HIV. Fro m the evaluatio ns o f the series, the article d e m o nstrate s the e arly c o m p ro m ising o f gro wth amo ng the infected children, co mparing the Z-sco res (weight/age, height/age and weight/height) with tho se o f no n-infected (sero negative) children.
This evidence can be asso ciated to that o f an-o ther recent publicatian-o n:3 a pro spective evaluatio n o f the e ne rgy b alanc e and anthro p o m e tric analysis amo ng unweaned children o f mo thers sero po sitive to HIV, which revealed significant co mpro mising o f nu-tritio n in the infected children and average values fo r energy expenditure at rest that were 30% greater than tho se o bserved in the no n-infected infants. Bo th wo rks
co nclude that in clinical practice early nutritio nal in-terventio n must be co mmended so as to guarantee the maintenance o f immuno lo gical equilibrium and muscle mass, and a better quality o f life fo r the chil-dren infected by HIV.
One wide-ranging pro po sal fo r nutritio nal sup-po rt fo r such a clientele is presented in two very re-cent reviews.4,5 They emphasize that the attendance must be pro vided by a multidisciplinary team, with the inclusio n o f a pro fessio nal in the field o f nutri-tio n. Careful guidelines fo r the appro ach must b e drawn up that include:
a) The analysis o f the anthro po metric data (weight, height, brain perimeter, arm circumference, mea-surements o f the triceptal and subscapular creases) at the start o f the fo llo w-up and then at every 1 to 3 mo nths depending o n the age and general co ndi-tio ns o f each child, and bio chemical evaluandi-tio n; b) Reco rd-keeping o f alimentatio n and pro tein-calo ric
calculatio n o f fo o d ingested, as well as analysis o f the adequacy o f the menu;
c) Offer o f a diet with raised levels o f pro tein and calo -ries, and with an appro priate co mpo sitio n o f o ther nutrients and vitamins. The energy needs are ex-pected to reach between 100% and 150% o f the Daily Re c o m m e nd e d Calc ulatio n, re m e m b e ring that these depend o n the age and the intercurrences presented by the patients;
d) Nutritio nal inte rve ntio n m ust b e starte d e arly when faced with any evidence o f alteratio ns in the evo lutive parameters, and also when an increase in energy demand is anticipated, with the use o f nutritio nal supplements (co mmercially availab le
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fo rm ulae ). The use o f ap p e tite stim ulato rs fo r sho rt perio ds, such as megestro l acetate, appears to b e useful in so me cases. When there is a fail-ure in o ral interventio n, metho ds that can b e co n-sidered range fro m the use o f naso gastric pro b e to gastro sto my, depending o n the patient and his clinical situatio n.
The survival o f HIV-infected children has
in-1. Centers fo r Disease Co ntro l and Preventio n. HIV/AIDS Surveillance Repo rt 1994;6:1-39.
2. Leandro -Merthi VA, Vilela MMS, Silva MN, Lo pes FA, Barro s Filho AA. Evo lutio n o f nutritio nal status o f infants infected with the Human Im m uno d e fic ie nc y Virus. São Paulo Me d J/Re v Paul Me d 2000; 118:(5):148-53.
3. Hamamo to LA, Cardo so AL, Marques HHS, Go mes C. Balanço de
References
energia em lactentes filho s de mães so ro po sitivas para o HIV. J Pediatr 2000;76:119-24.
4. Heller LS. Nutritio nal suppo rt fo r children with HIV/AIDS. The AIDS Reader 2000;10:109-14.
5. Laufer M, Sco tt GB. Medical management o f HIV disease in children. Ped Clin NA 2000;47:127-53.
creased significantly o ver recent years since the intro -ductio n o f co mbined anti-retro viral therapy allied to the impro vement in medical care and thus, to pro -mo te no rmal gro wth, avo iding weight lo ss must be a prio rity in the care o f the HIV-infected child.
He loísa He le na de Sousa Marque s, MD. Infecto lo gy Unit, Instituto da Criança do Ho spital das Clínicas, Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil.
