HIV-1 INFECTION AMONG MALNOURISHED CHILDREN IN BUTARE, RWANDA

In order to investigate the relationship between human immunodeficienc y virus (HIV-1) infection and protein-energy malnutrition (PEM), all 1 01 malnourished children who were admitted to the Department of Pediat rics of the National University Hospital between February and July of 1989 (median age = 2.5 years), and who were accompanied by their mothe r were screened for HIV-1 antibody. Mothers were also screened and int erviewed. Mother-child pairs were followed-up 2 years later to determi ne mortality and clinical status. Fourteen per cent of malnourished ch ildren were HIV-1 seropositive. Only one seropositive child had a sero negative mother. This child had a history of multiple blood transfusio ns and injections. Among children above 15 months of age, HIV-1 seropo sitivity was more common among marasmic children than among malnourish ed children presenting with oedema at admission to the hospital. Also, HIV-1 infection was found more frequently among chronically malnouris hed children (low height for age and weight for age) than among acutel y malnourished children (low weight for height). Mortality during the 2-year follow-up was 75 per cent among HIV-1 seropositive children and 23 per cent among HIV-1 seronegatives (mortality density ratio = 6.2; 95 per cent confidence interval = 2.2-17.4). Severe, chronic PEM shou ld always alert health workers to the possible diagnosis of pediatric AIDS, and its implications for treatment and prognosis.