Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

HIV · AIDS · Nutrition · Breastfeeding ·

Complementary feeding · Malnutrition ·

Micronutrients · Antiretroviral therapy

Key Messages

• HIV infection has greater nutritional consequences
  for children than for adults, mainly because chil-
  dren have the additional nutritional demands of
  growth and development


• The WHO recommends exclusive breastfeeding for
  the first 6 months of life followed by complemen-
  tary foods and continued breastfeeding through 12
  months of age, accompanied by postnatal infant
  or maternal antiretroviral prophylaxis, for HIV-ex-
  posed infants (or antiretroviral therapy, ART, for
  infected infants)


• The focus of nutritional activity has moved from
  supporting undernourished HIV-infected infants
  and children to ensuring that infected children on
  ART are adequately nourished


• ART is associated with improvements in weight,
  weight-for-height, mid-arm circumference and
  lean body mass in HIV-infected children
  © 2015 S. Karger AG, Basel

Introduction

The field of postnatal and child HIV/AIDS has

experienced a number of exciting breakthroughs

in the past 5 years. Prevention of mother-to-child

transmission strategies are now more widely

available, even in resource-poor settings. Access

to antiretroviral therapy (ART) has also increased

and is now commenced earlier in HIV-infected

children, i.e. at first diagnosis, ideally in the first

2–3 months of life.

Transmission through breastfeeding remains

a problem. In the absence of antiretroviral pro-

phylaxis, postnatal transmission appears to be

highest in the first 4–6 weeks of life, ranging from

0.7 to 1% per week. However, the risk continues

for the duration of breastfeeding and is constant

throughout this period. Efforts have moved in

support of safer feeding by promoting exclusive

breastfeeding for 6 months coupled with con-

comitant antiretroviral prophylaxis delivered to

breastfeeding mothers or the infant.

Two essential tenets underpin the approach to

HIV: ART is essential to save and prolong lives,

and good nutrition is vital to ensure children’s

overall health. Thus, the focus of nutrition-relat-

ed activities has moved from supporting under-

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

3.7 HIV and AIDS

Haroon Saloojee  Peter Cooper

3