The impact of the human immunodeficiency virus type 1 on the management ofsevere malnutrition in Malawi

A study was undertaken in a central nutritional rehabilitation unit in sout hern Malawi to assess the impact of HIV infection on clinical presentation and case fatality rate. HIV seroprevalence in 250 severely malnourished chi ldren over 1 year of age was 34.4% and overall mortality was 28%. HIV infec tion was associated significantly more frequently with marasmus (62.2%) tha n with kwashiorkor (21.7%) (p < 0.0001). Breastfed children presenting with severe malnutrition were significantly more likely to be HN-seropositive ( p < 0.001). Clinical and radiological features were generally not helpful i n distinguishing HIV-seropositive from HIV-seronegative children. The case fatality rate was significantly higher for HIV-seropositive children (RR 1. 6 [95% CI 1.14-2.24]). The increasing difficulties of managing the growing impact of HIV infection on severely malnourished children in Malawi are dis cussed in the context of reduced support: for nutritional rehabilitation un its.