176 Saloojee Coopersuch as oil or margarine may be helpful. Commer-
cial nutritional supplements are an acceptable al-
ternative. Supplementation with specific macro-
nutrients such as amino acids, whey protein con-
centration or other dietary supplements (such as
spirulina) does not significantly alter clinical, an-
thropometric or immunological outcomes com-
pared with placebo in HIV-infected children [8].
Adequate micronutrient intake is best achieved
via an adequate diet. In keeping with WHO recom-
mendations, children younger than 5 years born to
HIV-infected mothers living in resource-limited
settings should receive periodic (6-monthly) vita-
min A supplements in the same dose as for other
children. There are no evidence-based guidelines
on the appropriate prescription of micronutrient
supplements for HIV-infected children.
Feeding the HIV-Infected Child on ART
Initiation of ART therapy is associated with im-
provements in many growth parameters for HIV-
infected children. Immediate gains first manifest in
weight and arm muscle circumference. Lean body
mass improves as well, while a height response oc-
curs more slowly and variably. Energy expenditure
in children on ART has not been studied.
Gains in weight correlate with treatment re-
sponse. Underlying malnutrition does not ad-
versely affect growth, immunologic or virologic
response to ART in HIV-infected children. Un-
derweight children exhibit an equally robust re-
sponse to ART as their well-nourished peers [9].
The BMI does not increase in all children, but
improvements are greatest in children with the
lowest baseline BMI and who have more ad-
vanced HIV disease.
Children are not spared from the metabolic
effects of ART, particularly protease inhibitors,
and they too have a significant (up to 33%) risk of
lipodystrophy syndrome, hyperlipidemia and pe-
ripheral insulin resistance. No therapeutic strate-
gies to diminish the clinical and biochemical fea-
tures of the fat redistribution syndrome have yet
been described for children.
Adolescents who acquired HIV infection in ear-
ly life have a unique development profile that in-
cludes stunting, delayed puberty and the complica-
tions of prolonged ART exposure. Dietary goals for
HIV-infected adolescents are similar to those for
their noninfected peers, including consumption of
a high-quality, nutrient-dense diet, establishing
good eating habits and avoiding obesity.
The integration of nutritional support for
HIV-infected children on ART is a recognized
need; however, the evidence for effective pro-
grammatic solutions is weak. Limited data exist
regarding the role of macro- or micronutrients in
children on ART.
The WHO has previously endorsed the use of
ready-to-use therapeutic foods to reduce case
fatality and undernutrition among community-
based, ART-naïve, HIV-positive children [10]. In
Tanzania, among HIV-positive children on ART,
the provision of ready-to-use therapeutic foods
for at least 4 months was associated with less un-
derweight, wasting and stunting [11].Conclusions- Nutritional advice and support should be a
priority component of the continuum of care
and support services for HIV-infected women
and children - A focus on the growth and nutrition of the
HIV-infected child at each visit is warranted.
An adequate diet, prevention of opportunistic
infections and ART all contribute to ensuring
satisfactory growth - There is limited evidence for routine macro-
and micronutrient supplementation in both
untreated and ART-treated HIV-infected chil-
dren - The special nutritional needs of adolescents
need to be considered as more children on
ART survive to this age
Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 173–177
DOI: 10.1159/000360332