GASTROINTESTINAL-TRACT FUNCTION AND MALNUTRITION IN HIV-INFECTED CHILDREN

Poor growth and/or weight gain was identified in the initial reports o f children with AIDS (Oleske et al. 1983, Rubinstein et al. 1983). How ever, in the past 12 years little progress has been made to understand the mechanisms for these observations. Data from the NIAID/NICHD mult icenter Women and Infants Transmission Study (WITS) demonstrated that a decline in weight occurred in the first four months of life followed by decreased linear growth (Rich et al. 1993). In older children weig ht and height seem to decline in parallel (McKinney et al. 1993), but loss of lean body mass may occur prior to a decline in weight (Miller et al. 1993). Adequate caloric intake can improve weight gain, but has little effect on height velocity and lean body mass (Henderson et al. 1994, Miller et al. 1992), Long-term survivors with HIV infection are shorter than anticipated, and these changes cannot be explained solel y by inadequate nutrition or by endocrine abnormalities. The immune sy stem, gastrointestinal tract function, malnutrition, and chronic or re current infection interact and contribute to the nutritional deficienc ies and problems with growth observed in the HIV-infected child.