Association between steatorrhea, growth, and immunologic status in children with perinatally acquired HIV infection

Objective: To examine the prevalence of steatorrhea and exocrine pancreatic insufficiency (EPI) and their association with growth and immune status va riables in children with perinatally acquired human immunodeficiency virus (HIV) infection. Design: Cross-sectional study. Setting: Tertiary care HIV subspecialty practice. Participants: Children with perinatally acquired HIV infection. Exclusion c riteria included being younger than 1 year and receiving mineral oil as a m edication. Methods: Weight, height, and upper arm anthropometric variables were measur ed. Spot stool samples were analyzed for steatorrhea using the Sudan III qu alitative test and for EPI using fecal elastase-1 enzyme assay. Hormone-sti mulated pancreatic function testing and 72-hour stool and dietary fat sampl e collection were performed when fecal elastase-1 enzyme was in the range o f EPI, defined as less than 200 mug/g. HIV RNA viral load, CD4 status, type of antiretroviral therapy, and biochemical evidence of hepatobiliary disea se were measured within 3 months of stool sample collection. z Scores were computed for height, weight, triceps skinfold, and upper arm muscle area. Results: We enrolled 44 patients (23 girls [52%]) with a mean+/-SD age of 7 .4+/-3.1 years. None had hepatobiliary disease. The prevalence of steatorrh ea was 39% (95% confidence interval, 23%-56%). The prevalence of EPI was 0% (95% confidence interval, 0%-9%). There were no associations between steat orrhea and EPI, growth, HIV RNA viral load, CD4 status, or type of antiretr oviral therapy. Older children had decreased z scores for height (r=-0.42; P=.006). Conclusions: The clinical significance of steatorrhea in children with HIV infection is unclear. Furthermore, its evaluation should focus on nonpancre as-based conditions. Continual close monitoring of growth is essential in c hildren with HIV infection.