Children with HIV and AIDS

HIV-infected children should be routinely assessed for nutritional status, including weight and height at scheduled visits, particularly after initiation of ART, HIV-infected children on or off ART who are symptomatic, have conditions requiring increased energy (e.g. TB, chronic lung disease, chronic OIs or malignancies), or have weight loss or evidence of poor growth should be provided with 25 – 30% additional energy. HIV-infected children who are severely malnourished should be managed as per the guidelines for uninfected children and provided with 50 – 100% additional energy. AND should receive one recommended daily allowance (RDA) of micronutrients daily. If this cannot be assured through the diet, or there is evidence of deficiency, then supplementation should be given. The evidence base of the interaction between HIV and nutrition, which is specifically derived from observations or studies in HIV-infected children, is limited. However, some general points can be extrapolated from research findings related to the nutritional status of HIV-infected adults and additional points can be drawn from children who are malnourished but not HIV-infected. A summary of key nutritional points and interventions relevant to the care of HIV-infected children before or during ARV is presented below. Undernutrition, Food intake of insufficient quantity or quality to meet nutritional needs for growth and development Poor growth or growth faltering Ideally these should be determined using more than one-time measurements to indicate changes over time and whether a child is following an appropriate growth curve/trajectory. In the absence of several measurements, it is possible to consider proxy measurements such as: Weight-for-age less than -2 z-score (underweight) Height-for-age less than -2 z-score (stunting) Weight-for-height less than -2 z-score (wasting) Mid-upper arm circumference (MUAC) less than -2 z-score (see WHO growth reference charts) Very low weight for age Weight-for-age less than -3 z-score Weight loss Weight loss of >5% since last visit Nutritional assessment, i.e. the systematic evaluation of nutritional status, diet (including caregiving practices and family food security) and nutrition-related symptoms, is essential for the early identification of malnutrition and growth faltering. Growth monitoring can also contribute to monitoring HIV disease progression and treatment efficacy of children on ARV.