SidaSubSaharaV1, Istex, Corpus, bibRecord, 004105

A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With HumanImmunodeficiency Virus Infection

Identifieur interne : 004105 ( Istex/Corpus ); précédent : 004104; suivant : 004106

A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With HumanImmunodeficiency Virus Infection

Auteurs : Nasim Sabery ; Christopher Duggan

Source :

[ 0148-6071 ] ; 2009-NaN.

RBID : ISTEX:C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0

English descriptors

KwdEn :
- Acta paediatr, Active antiretroviral therapy, American society, Antiretroviral, Antiretroviral therapy, Baseline, Beta error, Body composition, Body composition studies, Body mass index, Breastfeeding, Case series, Cell counts, Childhood outcomes, Classification system, Clin nutr, Clinical guidelines, Clinical guidelines sabery, Clinical management, Clinical practice guidelines, Cohort, Cohort studies, Confidence interval, Contemporaneous controls, Coovadia, Coutsoudis, Crit care, Defic syndr, Disease control, Disease control surveillance summary, Disease progression, Dream program, Elemental diet, Energy intake, Enteral, Enteral nutrition, Enteral tube, Enteral tube feedings, Exclusive breastfeeding, Expert opinion, Fawzi, Fetal death, First year, Formula feed, Growth failure, Guideline, Guideline recommendation, Haart, Haart therapy, Healthcare professionals, High risk, Higher mortality, Higher risk, Hivld, Hospital care, Human immunodeficiency, Human immunodeficiency children, Human immunodeficiency infection, Human immunodeficiency virus, Human immunodeficiency virus type, Human immunodeficiency virus type children, Human immunodeficiency virusinfected children, Hypercholesterolemia, Immune deficiency syndrome, Immunodeficiency, Increase risk, Infant, Infant mortality, Infant outcomes, Infection, Interquartile range, Laboratory evaluation, Late transmission, Lean body mass, Less risk, Lipodystrophy, Lower weight, Metabolic, Metabolic abnormalities, Micronutrient, Micronutrient supplementation, Mortality, Mortality risk, Multivitamin, Nonrandomized cohort, Nutr, Nutrition, Nutrition assessment, Nutrition support, Odds ratio, Parenter enteral nutr, Parenteral, Patient care, Pediatr, Pediatr gastroenterol nutr, Pediatric, Pediatric patients, Pediatrics, Placebo, Postnatal, Postnatal transmission, Pregnancy outcomes, Pregnant women, Preterm delivery, Prognostic indicator, Prospective cohort study, Protease, Protease inhibitor, Public health, Randomised trial, Randomized, Randomized trial, Redistribution, Relative risk, Resourcepoor settings, Risk factors, Sanchez torres, Standard deviation, Standard error, Standard pregnancy, Study groups, Study groups vitamin, Study table, Supplemental vitamin, Supplementation, Tanzania, Tract infections, Uncontrolled studies, Uninfected children, Units retinyl palmitate, Units vitamin, Vertical transmission, Viral, Viral load, Vitamin, Vitamin supplements, Weight gain, Zinc supplementation.
Teeft :
- Acta paediatr, Active antiretroviral therapy, American society, Antiretroviral, Antiretroviral therapy, Baseline, Beta error, Body composition, Body composition studies, Body mass index, Breastfeeding, Case series, Cell counts, Childhood outcomes, Classification system, Clin nutr, Clinical guidelines, Clinical guidelines sabery, Clinical management, Clinical practice guidelines, Cohort, Cohort studies, Confidence interval, Contemporaneous controls, Coovadia, Coutsoudis, Crit care, Defic syndr, Disease control, Disease control surveillance summary, Disease progression, Dream program, Elemental diet, Energy intake, Enteral, Enteral nutrition, Enteral tube, Enteral tube feedings, Exclusive breastfeeding, Expert opinion, Fawzi, Fetal death, First year, Formula feed, Growth failure, Guideline, Guideline recommendation, Haart, Haart therapy, Healthcare professionals, High risk, Higher mortality, Higher risk, Hivld, Hospital care, Human immunodeficiency, Human immunodeficiency children, Human immunodeficiency infection, Human immunodeficiency virus, Human immunodeficiency virus type, Human immunodeficiency virus type children, Human immunodeficiency virusinfected children, Hypercholesterolemia, Immune deficiency syndrome, Immunodeficiency, Increase risk, Infant, Infant mortality, Infant outcomes, Infection, Interquartile range, Laboratory evaluation, Late transmission, Lean body mass, Less risk, Lipodystrophy, Lower weight, Metabolic, Metabolic abnormalities, Micronutrient, Micronutrient supplementation, Mortality, Mortality risk, Multivitamin, Nonrandomized cohort, Nutr, Nutrition, Nutrition assessment, Nutrition support, Odds ratio, Parenter enteral nutr, Parenteral, Patient care, Pediatr, Pediatr gastroenterol nutr, Pediatric, Pediatric patients, Pediatrics, Placebo, Postnatal, Postnatal transmission, Pregnancy outcomes, Pregnant women, Preterm delivery, Prognostic indicator, Prospective cohort study, Protease, Protease inhibitor, Public health, Randomised trial, Randomized, Randomized trial, Redistribution, Relative risk, Resourcepoor settings, Risk factors, Sanchez torres, Standard deviation, Standard error, Standard pregnancy, Study groups, Study groups vitamin, Study table, Supplemental vitamin, Supplementation, Tanzania, Tract infections, Uncontrolled studies, Uninfected children, Units retinyl palmitate, Units vitamin, Vertical transmission, Viral, Viral load, Vitamin, Vitamin supplements, Weight gain, Zinc supplementation.

Url:

https://api.istex.fr/document/C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0/fulltext/pdf

DOI: 10.1177/0148607109346276

Links to Exploration step

ISTEX:C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0

Le document en format XML

<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With HumanImmunodeficiency Virus Infection</title>
<author><name sortKey="Sabery, Nasim" sort="Sabery, Nasim" uniqKey="Sabery N" first="Nasim" last="Sabery">Nasim Sabery</name>
<affiliation><mods:affiliation>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</mods:affiliation>
</affiliation>
</author>
<author><name sortKey="Duggan, Christopher" sort="Duggan, Christopher" uniqKey="Duggan C" first="Christopher" last="Duggan">Christopher Duggan</name>
<affiliation><mods:affiliation>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</mods:affiliation>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">ISTEX</idno>
<idno type="RBID">ISTEX:C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0</idno>
<date when="2009" year="2009">2009</date>
<idno type="doi">10.1177/0148607109346276</idno>
<idno type="url">https://api.istex.fr/document/C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0/fulltext/pdf</idno>
<idno type="wicri:Area/Istex/Corpus">004105</idno>
<idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">004105</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With HumanImmunodeficiency Virus Infection</title>
<author><name sortKey="Sabery, Nasim" sort="Sabery, Nasim" uniqKey="Sabery N" first="Nasim" last="Sabery">Nasim Sabery</name>
<affiliation><mods:affiliation>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</mods:affiliation>
</affiliation>
</author>
<author><name sortKey="Duggan, Christopher" sort="Duggan, Christopher" uniqKey="Duggan C" first="Christopher" last="Duggan">Christopher Duggan</name>
<affiliation><mods:affiliation>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</mods:affiliation>
</affiliation>
</author>
</analytic>
<monogr></monogr>
<series><title level="j"></title>
<title level="j" type="abbrev">JPEN J Parenter Enteral Nutr</title>
<idno type="ISSN">0148-6071</idno>
<idno type="eISSN">1941-2444</idno>
<imprint><publisher>SAGE Publications</publisher>
<date type="published" when="2009-NaN">2009-NaN</date>
<biblScope unit="volume">33</biblScope>
<biblScope unit="issue">6</biblScope>
<biblScope unit="page" from="588">588</biblScope>
<biblScope unit="page" to="606">606</biblScope>
</imprint>
<idno type="ISSN">0148-6071</idno>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><idno type="ISSN">0148-6071</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acta paediatr</term>
<term>Active antiretroviral therapy</term>
<term>American society</term>
<term>Antiretroviral</term>
<term>Antiretroviral therapy</term>
<term>Baseline</term>
<term>Beta error</term>
<term>Body composition</term>
<term>Body composition studies</term>
<term>Body mass index</term>
<term>Breastfeeding</term>
<term>Case series</term>
<term>Cell counts</term>
<term>Childhood outcomes</term>
<term>Classification system</term>
<term>Clin nutr</term>
<term>Clinical guidelines</term>
<term>Clinical guidelines sabery</term>
<term>Clinical management</term>
<term>Clinical practice guidelines</term>
<term>Cohort</term>
<term>Cohort studies</term>
<term>Confidence interval</term>
<term>Contemporaneous controls</term>
<term>Coovadia</term>
<term>Coutsoudis</term>
<term>Crit care</term>
<term>Defic syndr</term>
<term>Disease control</term>
<term>Disease control surveillance summary</term>
<term>Disease progression</term>
<term>Dream program</term>
<term>Elemental diet</term>
<term>Energy intake</term>
<term>Enteral</term>
<term>Enteral nutrition</term>
<term>Enteral tube</term>
<term>Enteral tube feedings</term>
<term>Exclusive breastfeeding</term>
<term>Expert opinion</term>
<term>Fawzi</term>
<term>Fetal death</term>
<term>First year</term>
<term>Formula feed</term>
<term>Growth failure</term>
<term>Guideline</term>
<term>Guideline recommendation</term>
<term>Haart</term>
<term>Haart therapy</term>
<term>Healthcare professionals</term>
<term>High risk</term>
<term>Higher mortality</term>
<term>Higher risk</term>
<term>Hivld</term>
<term>Hospital care</term>
<term>Human immunodeficiency</term>
<term>Human immunodeficiency children</term>
<term>Human immunodeficiency infection</term>
<term>Human immunodeficiency virus</term>
<term>Human immunodeficiency virus type</term>
<term>Human immunodeficiency virus type children</term>
<term>Human immunodeficiency virusinfected children</term>
<term>Hypercholesterolemia</term>
<term>Immune deficiency syndrome</term>
<term>Immunodeficiency</term>
<term>Increase risk</term>
<term>Infant</term>
<term>Infant mortality</term>
<term>Infant outcomes</term>
<term>Infection</term>
<term>Interquartile range</term>
<term>Laboratory evaluation</term>
<term>Late transmission</term>
<term>Lean body mass</term>
<term>Less risk</term>
<term>Lipodystrophy</term>
<term>Lower weight</term>
<term>Metabolic</term>
<term>Metabolic abnormalities</term>
<term>Micronutrient</term>
<term>Micronutrient supplementation</term>
<term>Mortality</term>
<term>Mortality risk</term>
<term>Multivitamin</term>
<term>Nonrandomized cohort</term>
<term>Nutr</term>
<term>Nutrition</term>
<term>Nutrition assessment</term>
<term>Nutrition support</term>
<term>Odds ratio</term>
<term>Parenter enteral nutr</term>
<term>Parenteral</term>
<term>Patient care</term>
<term>Pediatr</term>
<term>Pediatr gastroenterol nutr</term>
<term>Pediatric</term>
<term>Pediatric patients</term>
<term>Pediatrics</term>
<term>Placebo</term>
<term>Postnatal</term>
<term>Postnatal transmission</term>
<term>Pregnancy outcomes</term>
<term>Pregnant women</term>
<term>Preterm delivery</term>
<term>Prognostic indicator</term>
<term>Prospective cohort study</term>
<term>Protease</term>
<term>Protease inhibitor</term>
<term>Public health</term>
<term>Randomised trial</term>
<term>Randomized</term>
<term>Randomized trial</term>
<term>Redistribution</term>
<term>Relative risk</term>
<term>Resourcepoor settings</term>
<term>Risk factors</term>
<term>Sanchez torres</term>
<term>Standard deviation</term>
<term>Standard error</term>
<term>Standard pregnancy</term>
<term>Study groups</term>
<term>Study groups vitamin</term>
<term>Study table</term>
<term>Supplemental vitamin</term>
<term>Supplementation</term>
<term>Tanzania</term>
<term>Tract infections</term>
<term>Uncontrolled studies</term>
<term>Uninfected children</term>
<term>Units retinyl palmitate</term>
<term>Units vitamin</term>
<term>Vertical transmission</term>
<term>Viral</term>
<term>Viral load</term>
<term>Vitamin</term>
<term>Vitamin supplements</term>
<term>Weight gain</term>
<term>Zinc supplementation</term>
</keywords>
<keywords scheme="Teeft" xml:lang="en"><term>Acta paediatr</term>
<term>Active antiretroviral therapy</term>
<term>American society</term>
<term>Antiretroviral</term>
<term>Antiretroviral therapy</term>
<term>Baseline</term>
<term>Beta error</term>
<term>Body composition</term>
<term>Body composition studies</term>
<term>Body mass index</term>
<term>Breastfeeding</term>
<term>Case series</term>
<term>Cell counts</term>
<term>Childhood outcomes</term>
<term>Classification system</term>
<term>Clin nutr</term>
<term>Clinical guidelines</term>
<term>Clinical guidelines sabery</term>
<term>Clinical management</term>
<term>Clinical practice guidelines</term>
<term>Cohort</term>
<term>Cohort studies</term>
<term>Confidence interval</term>
<term>Contemporaneous controls</term>
<term>Coovadia</term>
<term>Coutsoudis</term>
<term>Crit care</term>
<term>Defic syndr</term>
<term>Disease control</term>
<term>Disease control surveillance summary</term>
<term>Disease progression</term>
<term>Dream program</term>
<term>Elemental diet</term>
<term>Energy intake</term>
<term>Enteral</term>
<term>Enteral nutrition</term>
<term>Enteral tube</term>
<term>Enteral tube feedings</term>
<term>Exclusive breastfeeding</term>
<term>Expert opinion</term>
<term>Fawzi</term>
<term>Fetal death</term>
<term>First year</term>
<term>Formula feed</term>
<term>Growth failure</term>
<term>Guideline</term>
<term>Guideline recommendation</term>
<term>Haart</term>
<term>Haart therapy</term>
<term>Healthcare professionals</term>
<term>High risk</term>
<term>Higher mortality</term>
<term>Higher risk</term>
<term>Hivld</term>
<term>Hospital care</term>
<term>Human immunodeficiency</term>
<term>Human immunodeficiency children</term>
<term>Human immunodeficiency infection</term>
<term>Human immunodeficiency virus</term>
<term>Human immunodeficiency virus type</term>
<term>Human immunodeficiency virus type children</term>
<term>Human immunodeficiency virusinfected children</term>
<term>Hypercholesterolemia</term>
<term>Immune deficiency syndrome</term>
<term>Immunodeficiency</term>
<term>Increase risk</term>
<term>Infant</term>
<term>Infant mortality</term>
<term>Infant outcomes</term>
<term>Infection</term>
<term>Interquartile range</term>
<term>Laboratory evaluation</term>
<term>Late transmission</term>
<term>Lean body mass</term>
<term>Less risk</term>
<term>Lipodystrophy</term>
<term>Lower weight</term>
<term>Metabolic</term>
<term>Metabolic abnormalities</term>
<term>Micronutrient</term>
<term>Micronutrient supplementation</term>
<term>Mortality</term>
<term>Mortality risk</term>
<term>Multivitamin</term>
<term>Nonrandomized cohort</term>
<term>Nutr</term>
<term>Nutrition</term>
<term>Nutrition assessment</term>
<term>Nutrition support</term>
<term>Odds ratio</term>
<term>Parenter enteral nutr</term>
<term>Parenteral</term>
<term>Patient care</term>
<term>Pediatr</term>
<term>Pediatr gastroenterol nutr</term>
<term>Pediatric</term>
<term>Pediatric patients</term>
<term>Pediatrics</term>
<term>Placebo</term>
<term>Postnatal</term>
<term>Postnatal transmission</term>
<term>Pregnancy outcomes</term>
<term>Pregnant women</term>
<term>Preterm delivery</term>
<term>Prognostic indicator</term>
<term>Prospective cohort study</term>
<term>Protease</term>
<term>Protease inhibitor</term>
<term>Public health</term>
<term>Randomised trial</term>
<term>Randomized</term>
<term>Randomized trial</term>
<term>Redistribution</term>
<term>Relative risk</term>
<term>Resourcepoor settings</term>
<term>Risk factors</term>
<term>Sanchez torres</term>
<term>Standard deviation</term>
<term>Standard error</term>
<term>Standard pregnancy</term>
<term>Study groups</term>
<term>Study groups vitamin</term>
<term>Study table</term>
<term>Supplemental vitamin</term>
<term>Supplementation</term>
<term>Tanzania</term>
<term>Tract infections</term>
<term>Uncontrolled studies</term>
<term>Uninfected children</term>
<term>Units retinyl palmitate</term>
<term>Units vitamin</term>
<term>Vertical transmission</term>
<term>Viral</term>
<term>Viral load</term>
<term>Vitamin</term>
<term>Vitamin supplements</term>
<term>Weight gain</term>
<term>Zinc supplementation</term>
</keywords>
</textClass>
<langUsage><language ident="en">en</language>
</langUsage>
</profileDesc>
</teiHeader>
</TEI>
<istex><corpusName>sage</corpusName>
<keywords><teeft><json:string>guideline</json:string>
<json:string>immunodeficiency</json:string>
<json:string>supplementation</json:string>
<json:string>haart</json:string>
<json:string>breastfeeding</json:string>
<json:string>enteral</json:string>
<json:string>growth failure</json:string>
<json:string>placebo</json:string>
<json:string>lipodystrophy</json:string>
<json:string>antiretroviral</json:string>
<json:string>pediatr</json:string>
<json:string>fawzi</json:string>
<json:string>nutr</json:string>
<json:string>human immunodeficiency virus</json:string>
<json:string>parenteral</json:string>
<json:string>clinical guidelines</json:string>
<json:string>viral</json:string>
<json:string>pediatric</json:string>
<json:string>cohort</json:string>
<json:string>pediatrics</json:string>
<json:string>randomized</json:string>
<json:string>viral load</json:string>
<json:string>active antiretroviral therapy</json:string>
<json:string>coovadia</json:string>
<json:string>enteral nutrition</json:string>
<json:string>tanzania</json:string>
<json:string>postnatal</json:string>
<json:string>study table</json:string>
<json:string>micronutrient</json:string>
<json:string>multivitamin</json:string>
<json:string>redistribution</json:string>
<json:string>antiretroviral therapy</json:string>
<json:string>hypercholesterolemia</json:string>
<json:string>coutsoudis</json:string>
<json:string>risk factors</json:string>
<json:string>hivld</json:string>
<json:string>pregnant women</json:string>
<json:string>vitamin</json:string>
<json:string>confidence interval</json:string>
<json:string>baseline</json:string>
<json:string>study groups</json:string>
<json:string>exclusive breastfeeding</json:string>
<json:string>defic syndr</json:string>
<json:string>energy intake</json:string>
<json:string>zinc supplementation</json:string>
<json:string>protease inhibitor</json:string>
<json:string>human immunodeficiency</json:string>
<json:string>body mass index</json:string>
<json:string>odds ratio</json:string>
<json:string>nutrition assessment</json:string>
<json:string>weight gain</json:string>
<json:string>units vitamin</json:string>
<json:string>american society</json:string>
<json:string>body composition</json:string>
<json:string>human immunodeficiency children</json:string>
<json:string>protease</json:string>
<json:string>micronutrient supplementation</json:string>
<json:string>elemental diet</json:string>
<json:string>formula feed</json:string>
<json:string>human immunodeficiency infection</json:string>
<json:string>relative risk</json:string>
<json:string>standard deviation</json:string>
<json:string>disease progression</json:string>
<json:string>vitamin supplements</json:string>
<json:string>cell counts</json:string>
<json:string>randomized trial</json:string>
<json:string>clinical guidelines sabery</json:string>
<json:string>prognostic indicator</json:string>
<json:string>lean body mass</json:string>
<json:string>parenter enteral nutr</json:string>
<json:string>pregnancy outcomes</json:string>
<json:string>enteral tube feedings</json:string>
<json:string>clin nutr</json:string>
<json:string>vertical transmission</json:string>
<json:string>pediatr gastroenterol nutr</json:string>
<json:string>metabolic</json:string>
<json:string>infection</json:string>
<json:string>high risk</json:string>
<json:string>supplemental vitamin</json:string>
<json:string>mortality risk</json:string>
<json:string>lower weight</json:string>
<json:string>disease control</json:string>
<json:string>infant mortality</json:string>
<json:string>body composition studies</json:string>
<json:string>expert opinion</json:string>
<json:string>guideline recommendation</json:string>
<json:string>haart therapy</json:string>
<json:string>beta error</json:string>
<json:string>laboratory evaluation</json:string>
<json:string>enteral tube</json:string>
<json:string>clinical management</json:string>
<json:string>standard error</json:string>
<json:string>cohort studies</json:string>
<json:string>public health</json:string>
<json:string>interquartile range</json:string>
<json:string>first year</json:string>
<json:string>immune deficiency syndrome</json:string>
<json:string>sanchez torres</json:string>
<json:string>metabolic abnormalities</json:string>
<json:string>case series</json:string>
<json:string>tract infections</json:string>
<json:string>units retinyl palmitate</json:string>
<json:string>classification system</json:string>
<json:string>study groups vitamin</json:string>
<json:string>less risk</json:string>
<json:string>preterm delivery</json:string>
<json:string>higher mortality</json:string>
<json:string>increase risk</json:string>
<json:string>standard pregnancy</json:string>
<json:string>fetal death</json:string>
<json:string>contemporaneous controls</json:string>
<json:string>higher risk</json:string>
<json:string>dream program</json:string>
<json:string>late transmission</json:string>
<json:string>postnatal transmission</json:string>
<json:string>disease control surveillance summary</json:string>
<json:string>patient care</json:string>
<json:string>pediatric patients</json:string>
<json:string>clinical practice guidelines</json:string>
<json:string>prospective cohort study</json:string>
<json:string>nutrition support</json:string>
<json:string>nonrandomized cohort</json:string>
<json:string>uninfected children</json:string>
<json:string>human immunodeficiency virus type children</json:string>
<json:string>uncontrolled studies</json:string>
<json:string>childhood outcomes</json:string>
<json:string>infant outcomes</json:string>
<json:string>human immunodeficiency virus type</json:string>
<json:string>acta paediatr</json:string>
<json:string>crit care</json:string>
<json:string>healthcare professionals</json:string>
<json:string>human immunodeficiency virusinfected children</json:string>
<json:string>randomised trial</json:string>
<json:string>resourcepoor settings</json:string>
<json:string>hospital care</json:string>
<json:string>mortality</json:string>
<json:string>nutrition</json:string>
<json:string>infant</json:string>
</teeft>
</keywords>
<author><json:item><name>Nasim Sabery</name>
<affiliations><json:string>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</json:string>
</affiliations>
</json:item>
<json:item><name>Christopher Duggan</name>
<affiliations><json:string>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</json:string>
</affiliations>
</json:item>
</author>
<language><json:string>eng</json:string>
</language>
<originalGenre><json:string>research-article</json:string>
</originalGenre>
<qualityIndicators><score>7.012</score>
<pdfVersion>1.7</pdfVersion>
<pdfPageSize>603 x 783 pts</pdfPageSize>
<refBibsNative>true</refBibsNative>
<abstractCharCount>0</abstractCharCount>
<pdfWordCount>8267</pdfWordCount>
<pdfCharCount>52820</pdfCharCount>
<pdfPageCount>19</pdfPageCount>
<abstractWordCount>1</abstractWordCount>
</qualityIndicators>
<title>A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With HumanImmunodeficiency Virus Infection</title>
<corporate><json:item><name>the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors</name>
<affiliations><json:string>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</json:string>
</affiliations>
</json:item>
</corporate>
<genre><json:string>research-article</json:string>
</genre>
<host><title>Journal of Parenteral and Enteral Nutrition</title>
<language><json:string>unknown</json:string>
</language>
<issn><json:string>0148-6071</json:string>
</issn>
<eissn><json:string>1941-2444</json:string>
</eissn>
<volume>33</volume>
<issue>6</issue>
<pages><first>588</first>
<last>606</last>
</pages>
<genre><json:string>journal</json:string>
</genre>
</host>
<categories><wos><json:string>science</json:string>
<json:string>nutrition & dietetics</json:string>
</wos>
<scienceMetrix><json:string>health sciences</json:string>
<json:string>biomedical research</json:string>
<json:string>nutrition & dietetics</json:string>
</scienceMetrix>
</categories>
<publicationDate>2009</publicationDate>
<copyrightDate>2009</copyrightDate>
<doi><json:string>10.1177/0148607109346276</json:string>
</doi>
<id>C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0</id>
<score>1</score>
<fulltext><json:item><extension>pdf</extension>
<original>true</original>
<mimetype>application/pdf</mimetype>
<uri>https://api.istex.fr/document/C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0/fulltext/pdf</uri>
</json:item>
<json:item><extension>zip</extension>
<original>false</original>
<mimetype>application/zip</mimetype>
<uri>https://api.istex.fr/document/C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0/fulltext/zip</uri>
</json:item>
<istex:fulltextTEI uri="https://api.istex.fr/document/C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With HumanImmunodeficiency Virus Infection</title>
</titleStmt>
<publicationStmt><authority>ISTEX</authority>
<publisher scheme="https://publisher-list.data.istex.fr">SAGE Publications</publisher>
<availability><licence><p>American Society for Parenteral and Enteral Nutrition</p>
</licence>
<p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-0J1N7DQT-B">sage</p>
</availability>
<date>2009</date>
</publicationStmt>
<notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note>
<note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note>
<note>Address correspondence to: Charlene W. Compher, PhD, RD, FADA, LDN, CNSC, University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217; e-mail: compherc@nursing.upenn.edu.</note>
</notesStmt>
<sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With HumanImmunodeficiency Virus Infection</title>
<author role="org"><orgName>the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors</orgName>
<affiliation>Address correspondence to: Charlene W. Compher, PhD, RD, FADA, LDN, CNSC, University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217; e-mail: compherc@nursing.upenn.edu.</affiliation>
<affiliation>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</affiliation>
</author>
<author xml:id="author-0000"><persName><forename type="first">Nasim</forename>
<surname>Sabery</surname>
</persName>
<affiliation>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</affiliation>
</author>
<author xml:id="author-0001"><persName><forename type="first">Christopher</forename>
<surname>Duggan</surname>
</persName>
<affiliation>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</affiliation>
</author>
<idno type="istex">C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0</idno>
<idno type="ark">ark:/67375/M70-GBJXX17D-8</idno>
<idno type="DOI">10.1177/0148607109346276</idno>
<idno type="href">11JPEN09_588-606</idno>
<idno type="local">10.1177_0148607109346276</idno>
</analytic>
<monogr><title level="j"></title>
<title level="j" type="abbrev">JPEN J Parenter Enteral Nutr</title>
<idno type="pISSN">0148-6071</idno>
<idno type="eISSN">1941-2444</idno>
<idno type="PublisherID-hwp">sppen</idno>
<idno type="PublisherID-nlm-ta">JPEN J Parenter Enteral Nutr</idno>
<imprint><publisher>SAGE Publications</publisher>
<date type="published" when="2009-NaN"></date>
<biblScope unit="volume">33</biblScope>
<biblScope unit="issue">6</biblScope>
<biblScope unit="page" from="588">588</biblScope>
<biblScope unit="page" to="606">606</biblScope>
</imprint>
</monogr>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><creation><date>2009</date>
</creation>
<langUsage><language ident="en">en</language>
</langUsage>
</profileDesc>
<revisionDesc><change when="2009-NaN">Published</change>
</revisionDesc>
</teiHeader>
</istex:fulltextTEI>
<json:item><extension>txt</extension>
<original>false</original>
<mimetype>text/plain</mimetype>
<uri>https://api.istex.fr/document/C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0/fulltext/txt</uri>
</json:item>
</fulltext>
<metadata><istex:metadataXml wicri:clean="corpus sage not found" wicri:toSee="no header"><istex:document><article xml:lang="en" article-type="research-article" dtd-version="2.3"><front><journal-meta><journal-id journal-id-type="hwp">sppen</journal-id>
<journal-id journal-id-type="nlm-ta">JPEN J Parenter Enteral Nutr</journal-id>
<journal-title>Journal of Parenteral and Enteral Nutrition</journal-title>
<abbrev-journal-title abbrev-type="publisher">JPEN J Parenter Enteral Nutr</abbrev-journal-title>
<issn pub-type="ppub">0148-6071</issn>
<issn pub-type="epub">1941-2444</issn>
<publisher><publisher-name>SAGE Publications</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="other">10.1177_0148607109346276</article-id>
<article-id pub-id-type="doi">10.1177/0148607109346276</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Clinical Guidelines</subject>
</subj-group>
</article-categories>
<title-group><article-title>A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With Human
Immunodeficiency Virus Infection</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Sabery</surname>
<given-names>Nasim</given-names>
</name>
<degrees>MD, MPH</degrees>
<xref rid="AFF1">1</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Duggan</surname>
<given-names>Christopher</given-names>
</name>
<degrees>MD, MPH</degrees>
<xref rid="AFF2">2</xref>
</contrib>
<contrib contrib-type="author" xlink:type="simple"><collab collab-type="author" xlink:type="simple">the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)
Board of Directors</collab>
</contrib>
<aff>From <target target-type="aff" id="AFF1"></target>
<label>1</label>Pediatric Gastroenterology and Nutrition,
Children's Hospital Boston, Harvard School of Public Health, Boston,
Massachusetts; and <target target-type="aff" id="AFF2"></target>
<label>2</label>Division of Gastroenterology and
Nutrition, Children's Hospital, Boston, Massachusetts.</aff>
</contrib-group>
<author-notes><corresp>Address correspondence to: Charlene W. Compher, PhD, RD, FADA, LDN, CNSC,
University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie
Boulevard, Philadelphia, PA 19104-4217; e-mail:
<ext-link xlink:href="compherc@nursing.upenn.edu" ext-link-type="email" xlink:type="simple">compherc@nursing.upenn.edu</ext-link>
.</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>NOVEMBER-DECEMBER</month>
<year>2009</year>
</pub-date>
<volume>33</volume>
<issue>6</issue>
<fpage>588</fpage>
<lpage>606</lpage>
<permissions><copyright-statement>American Society for Parenteral and Enteral
Nutrition</copyright-statement>
<copyright-year>2009</copyright-year>
</permissions>
<self-uri content-type="arthw-pdf" xlink:href="11JPEN09_588-606" xlink:type="simple"></self-uri>
<custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>hwp-legacy-fpage</meta-name>
<meta-value>588</meta-value>
</custom-meta>
<custom-meta xlink:type="simple"><meta-name>cover-date</meta-name>
<meta-value>NOVEMBER-DECEMBER 2009</meta-value>
</custom-meta>
<custom-meta xlink:type="simple"><meta-name>hwp-legacy-dochead</meta-name>
<meta-value>Article</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body><sec><title></title>
<p>The clinical characteristics of human immunodeficiency virus (HIV)/acquired
immune deficiency syndrome (AIDS) in children differ substantially from those
in adults, and these differences are important to consider in providing both
medical and nutrition care. Growth failure, wasting, and loss of active lean
tissue are all associated with increased mortality and accelerated disease
progression. The use of highly active antiretroviral therapy (HAART) has
improved the prognosis and life span of children infected with HIV (HIV+) and
has reduced rates of wasting. However, the emergenceof HIV-associated
lipodystrophy (HIVLD) has emphasized the extensive nutrition and metabolic
manifestations of HIV infection. Maintaining the nutrition status of the HIV+
child is therefore crucial for optimal health outcomes.</p>
</sec>
<sec><title>Methodology</title>
<p>The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) is
an organization comprised of healthcare professionals representing the
disciplines of medicine, nursing, pharmacy, dietetics, and nutrition science.
The mission of A.S.P.E.N. is to improve patient care by advancing the science
and practice of nutrition support therapy. A.S.P.E.N. vigorously works to
support quality patient care, education, and research in the fields of
nutrition and metabolic support in all healthcare settings. These clinical
guidelines were developed under the guidance of the A.S.P.E.N. Board of
Directors. Promotion of safe and effective patient care by nutrition support
practitioners is a critical role of the A.S.P.E.N. organization. The
A.S.P.E.N. Board of Directors has been publishing clinical guidelines since
1986.<sup><xref rid="REF1">1</xref>
-<xref rid="REF3">3</xref>
</sup>
Starting in 2007, A.S.P.E.N. has revised these clinical guidelines on an
ongoing basis, reviewing about 20% of the chapters each year in order to keep
them as current as possible.</p>
<p>These A.S.P.E.N. Clinical Guidelines are based upon general conclusions of
health professionals who, in developing such guidelines, have balanced
potential benefits to be derived from a particular mode of medical therapy
against certain risks inherent with such therapy. However, the professional
judgment of the attending health professional is the primary component of
quality medical care. Because guidelines cannot account for every variation in
circumstances, practitioners must always exercise professional judgment in
their application. These Clinical Guidelines are intended to supplement but
not replace professional training and judgment.</p>
<p>These clinical guidelines were created in accordance with Institute of
Medicine recommendations as “systematically developed statements to
assist practitioner and patient decisions about appropriate healthcare for
specific clinical
circumstances.”<sup><xref rid="REF4">4</xref>
</sup>
These clinical guidelines are for use by healthcare professionals who provide
nutrition support services and offer clinical advice for managing adult and
pediatric (including adolescent) patients in inpatient and outpatient
(ambulatory, home, and specialized care) settings. The utility of the clinical
guidelines is attested to by the frequent citation of these documents in
peer-reviewed publications and their frequent use by A.S.P.E.N. members and
other healthcare professionals in clinical practice, academia, research, and
industry. They guide professional clinical activities, they are helpful as
educational tools, and they influence institutional practices and resource
allocation.<sup><xref rid="REF5">5</xref>
</sup>
</p>
<p>These clinical guidelines are formatted to promote the ability of the end
user of the document to understand the strength of the literature used to
grade each recommendation. Each guideline recommendation is presented as a
clinically applicable statement of care and should help the reader make the
best patient-care decision. The best available literature was obtained and
carefully reviewed. Chapter author(s) completed a thorough literature review
using MEDLINE®, the Cochrane Central Registry of Controlled Trials, the
Cochrane Database of Systematic Reviews, and other appropriate reference
sources. These results of the literature search and review formed the basis of
an evidence-based approach to the clinical guidelines. Chapter editors work
with authors to ensure compliance with the author's directives regarding
content and format. Then the initial draft is reviewed internally to ensure
consistency with the other A.S.P.E.N. Guidelines and Standards and reviewed
externally (either by experts in the field within our organization and/or
outside of our organization) for appropriateness of content. The final draft
is then reviewed and approved by the A.S.P.E.N. Board of Directors.</p>
<p>The system used to categorize the level of evidence for each study or
article used in the rationale of the guideline statement and to grade the
guideline recommendation is outlined in
<xref rid="TBL1">Table
1</xref>
.<sup><xref rid="REF6">6</xref>
</sup>
</p>
<p><table-wrap id="TBL1" position="float"><label><bold>Table 1.</bold>
</label>
<caption><p>Grading of Guidelines and Levels of Evidence</p>
</caption>
<table><tbody><tr><td colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
Grading of Guidelines<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
<hr></hr>
</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">A</td>
<td colspan="1" rowspan="1" align="left" valign="top">Supported by at least two level I investigations</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">B</td>
<td colspan="1" rowspan="1" align="left" valign="top">Supported by one level I investigation</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">C</td>
<td colspan="1" rowspan="1" align="left" valign="top">Supported by at least one level II investigation</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">D</td>
<td colspan="1" rowspan="1" align="left" valign="top">Supported by at least one level III investigation</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
E<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
Supported by level IV or V evidence<hr></hr>
</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
Levels of Evidence<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">I</td>
<td colspan="1" rowspan="1" align="left" valign="top">Large randomized trials with clear-cut results; low risk of false-positive
(alpha) and/or false-negative (beta) error</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">II</td>
<td colspan="1" rowspan="1" align="left" valign="top">Small, randomized trials with uncertain results; moderate to high risk of
false-positive (alpha) and/or false-negative (beta) error</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Nonrandomized cohort with contemporaneous controls</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">IV</td>
<td colspan="1" rowspan="1" align="left" valign="top">Nonrandomized cohort with historical controls</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
V<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
Case series, uncontrolled studies, and expert opinion<hr></hr>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>Reproduced from Dellinger RP, Carlet JM, Masur H. Introduction. <italic>Crit
Care Med.</italic> 2004;32(11 suppl):S446 with permission of the publisher.
Copyright 2004 Society of Critical Care Medicine.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</p>
<p>The grade of a guideline is based on the levels of evidence of the studies
used to support the guideline. A randomized controlled trial (RCT), especially
one that is double-blind in design, is considered to be the strongest level of
evidence to support decisions regarding a therapeutic intervention in clinical
medicine.<sup><xref rid="REF7">7</xref>
</sup> A
systematic review (SR) is a specialized type of literature review that
analyzes the results of several RCTs. A high-quality SR usually begins with a
clinical question and a protocol that addresses the methodology to answer this
question. These methods usually state how the literature is identified and
assessed for quality, what data are extracted, how they are analyzed, and
whether there were any deviations from the protocol during the course of the
study. In most instances, meta-analysis (MA), a mathematical tool to combine
data from several sources, is used to analyze the data. However, not all SRs
use MA.</p>
<p>A level of I, the highest level, will be given to large RCTs where results
are clear and the risk of alpha and beta error is low (well-powered). A level
of II will be given to RCTs that include a relatively low number of patients
or are at moderate to high risk for alpha and beta error (underpowered). A
level of III is given to cohort studies with contemporaneous controls or
validation studies, while cohort studies with historic controls will receive a
level of IV. Case series, uncontrolled studies, and articles based on expert
opinion alone will receive a level of V.</p>
<sec><title>Practice Guidelines and Rationales</title>
<p><xref rid="TBL2">Table 2</xref> provides the entire
set of guideline recommendations for nutrition support in children infected
with HIV.</p>
<p><table-wrap id="TBL2" position="float"><label><bold>Table 2.</bold>
</label>
<caption><p>Nutrition Support Guideline Recommendations in Children with Human
Immunodeficiency Virus (HIV) Infection</p>
</caption>
<table><thead><tr><th colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
Guideline Recommendations<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Grade<hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">1. Nutrition assessment of children who are HIV+ should be performed at
baseline and then serially.</td>
<td colspan="1" rowspan="1" align="center" valign="top">D</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">2. Anthropometry and body composition studies should be performed.</td>
<td colspan="1" rowspan="1" align="center" valign="top">E</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">3. Oral nutritional supplements or enteral tube feedings may improve weight
and growth in children who are HIV+ with growth failure.</td>
<td colspan="1" rowspan="1" align="center" valign="top">C</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">4. Antiretroviral therapy improves growth in children who are HIV+.</td>
<td colspan="1" rowspan="1" align="center" valign="top">E</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">5. Children with HIV lipodystrophy should have laboratory evaluation and
clinical management of hypertriglyceridemia and hypercholesterolemia.</td>
<td colspan="1" rowspan="1" align="center" valign="top">D</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">6. Supplementation with multivitamins should be provided to pregnant and
lactating women who are HIV+.</td>
<td colspan="1" rowspan="1" align="center" valign="top">B</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">7. Micronutrient supplementation should be considered in children who are
HIV+.</td>
<td colspan="1" rowspan="1" align="center" valign="top">C</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
8. Women who are HIV+ in resource-rich settings are advised to formula feed
exclusively, while in resource-poor settings, exclusive breastfeeding is
recommended.<hr></hr>
</td>
<td colspan="1" rowspan="1" align="center" valign="top">
B<hr></hr>
</td>
</tr>
</tbody>
</table>
</table-wrap>
</p>
<p>1. Nutrition assessment of children who are HIV+ should be performed at
baseline and serially. (Grade: D)</p>
<p><italic>Rationale:</italic> Growth failure is common in children who are HIV+ and
is associated with greater mortality risk. While birth weights and gestational
ages are not different among children who are HIV+ and uninfected
(HIV–), by age 3
months<sup><xref rid="REF8">8</xref>
,<xref rid="REF9">9</xref>
</sup>
and up to 5
years,<sup><xref rid="REF10">10</xref>
</sup> children
who are HIV+ have lower weight and height. In fact, wasting syndrome is among
the Centers for Disease Control and Prevention (CDC) criteria used to
categorize children in clinical category C (severely
symptomatic)<sup><xref rid="REF11">11</xref>
</sup>
(<xref rid="TBL3">Table 3</xref>). Clinical and
laboratory factors associated with this malnutrition include history of
pneumonia, maternal illicit drug use during pregnancy, lower infant CD4 count,
and increased HIV-1 RNA viral
load.<sup><xref rid="REF10">10</xref>
</sup> Decreased
nutrient intake, increased energy requirement, malabsorption, and psychosocial
issues may all contribute to undernutrition in the pediatric HIV population.
Growth failure is a prognostic indicator of mortality in pediatric HIV
infection.<sup><xref rid="REF12">12</xref>
-<xref rid="REF14">14</xref>
</sup>
</p>
<p><table-wrap id="TBL3" position="float"><label><bold>Table 3.</bold>
</label>
<caption><p>Human Immunodeficiency Virus (HIV) Clinical Categories</p>
</caption>
<table><thead><tr><th colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
N: No signs or symptoms<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
A: Mild Signs and Symptoms (2 or more of the following criteria, but not in B
or C)<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
B: Moderate Signs and Symptoms<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
C: Severe Signs and Symptoms<hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Lymphadenopathy</td>
<td colspan="1" rowspan="1" align="left" valign="top">Anemia, neutropenia, or thrombocytopenia</td>
<td colspan="1" rowspan="1" align="left" valign="top">Bacterial infections of the following types, >2 in 1 y: septicemia,
pneumonia, meningitis, bone or joint infection, abscess</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Hepatomegaly</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Splenomegaly</td>
<td colspan="1" rowspan="1" align="left" valign="top">Bacterial infection (1)</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Dermatitis</td>
<td colspan="1" rowspan="1" align="left" valign="top">Oral candidiasis (>2 mo duration)</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Parotitis</td>
<td colspan="1" rowspan="1" align="left" valign="top">Cardiomyopathy</td>
<td colspan="1" rowspan="1" align="left" valign="top">Candidiasis</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Recurrent or persistent respiratory tract infections, sinusitis, or otitis
media</td>
<td colspan="1" rowspan="1" align="left" valign="top">Cytomegalovirus (onset less than age 1 mo)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Cryptococcus</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Cryptosporidium</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Diarrhea, recurrent</td>
<td colspan="1" rowspan="1" align="left" valign="top">Cytomegalovirus</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Hepatitis</td>
<td colspan="1" rowspan="1" align="left" valign="top">Encephalopathy</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Herpes stomatitis, recurrent (>2 episodes within 1 y)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Herpes simplex ulcer >1 mo</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Histoplasmosis</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Herpes bronchitis, pneumonitis, or esophagitis (onset less than age 1 mo)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Kaposi's sarcoma</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Mycobacterium tuberculosis, disseminated</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Herpes zoster, >2 episodes</td>
<td colspan="1" rowspan="1" align="left" valign="top">Mycobacterium avium intracellulare</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Leiomyosarcoma</td>
<td colspan="1" rowspan="1" align="left" valign="top"><italic>Pneumocystis carinii</italic>
 pneumonia</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Lymphocytic interstitial pneumonitis</td>
<td colspan="1" rowspan="1" align="left" valign="top">Progressive multifocal leukoencephalopathy</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Nephropathy</td>
<td colspan="1" rowspan="1" align="left" valign="top">Toxoplasmosis</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Nocardiosis</td>
<td colspan="1" rowspan="1" align="left" valign="top">Wasting syndrome (failure to thrive)</td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
<td colspan="1" rowspan="1" align="left" valign="top">Persistent fever</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
Varicella, disseminated<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>Adapted from U.S. Centers for Disease Control and Prevention. 1994 Revised
classification system for human immunodeficiency infection in children less
than 13 years of age. In: MMWR, ed. <italic>Vol 43: Center for Disease Control
Surveillance Summary</italic>
; 1994:1-9.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</p>
<p>See Tables <xref rid="TBL3">3</xref> and
<xref rid="TBL4">4</xref>
.</p>
<p><table-wrap id="TBL4" position="float"><label><bold>Table 4.</bold>
</label>
<caption><p>Nutrition Assessment in Children With HIV Infection</p>
</caption>
<table><thead><tr><th colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
Study<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Population<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Study Groups<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Results<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Comments<hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">Villamor et al<sup><xref rid="REF14">14</xref>
</sup>
2005 III</td>
<td colspan="1" rowspan="1" align="left" valign="top">687 children admitted to hospital in Tanzania with pneumonia, 1993-1997</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV- (n = 590), HIV+ (n = 58); mean age at enrollment18 mo</td>
<td colspan="1" rowspan="1" align="left" valign="top">Risk factors for mortality: HIV+ (RR 3.92, 95% CI 2.34-6.55, <italic>P</italic> <
.0001); age <24 mo, low MAC, anemia; stunting and wasting independently
predict mortality; HIV+ stronger predictor in children with wasting (RR 5.16,
95% CI 2.52-10.6) than those without wasting (RR 1.56, 95% CI 0.53-4.57,
<italic>PInt</italic>
 = .05)</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ and undernutrition strong predictors of mortality</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Newell et al<sup><xref rid="REF15">15</xref>
</sup> 2003
III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children born to HIV+ mothers followed at 11 centers in 8 European countries</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV- (n = 1403), HIV+ (n = 184); followed from age 0-10 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">Birth, no difference ht or wt; age 6-12 mo, HIV- 1.6% taller, 6.2% heavier
than HIV+; age 8-10 y, HIV- 10% taller, 44% heavier than HIV+; age 10 y, HIV-
7 kg heavier, 7.5 cm taller than HIV+</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ children with poor growth relative to HIV- children</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Verweel et al<sup><xref rid="REF16">16</xref>
</sup>
2002 III</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ children on HAART therapy</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 24); age 0.4-16.3 y at baseline</td>
<td colspan="1" rowspan="1" align="left" valign="top">48 wk before HAART median HAZ decreased from -0.088 to -1.22 at baseline;
baseline to 96 wk after HAART, median HAZ increased from 0.20 to 0.95
(<italic>P</italic> = .052); 48 wk before HAART median WAZ decreased from 0.041 to
-0.74 at baseline; baseline to 96 wk after HAART, median WAZ increased from
0.34 to 0.60 (<italic>P</italic> = .056); No significant change in BMI-Z after 96 wk
HAART</td>
<td colspan="1" rowspan="1" align="left" valign="top">HAZ & WAZ but not BMI improved with HAART therapy in HIV+</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Miller et al<sup><xref rid="REF17">17</xref>
</sup> 2001
III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children of pregnant, HIV+ mothers in 4 cities in the United States</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 92), HIV- (n = 439); age 0-5 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">Age 6 mo, HIV+ lower wt (<italic>P</italic>
 = .01), ht (<italic>P</italic> < .001), WHZ
(<italic>P</italic>
 = .03), remained low until age 5 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">Malnutrition at age 6 mo significant through age 5 y</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Bailey et al<sup><xref rid="REF8">8</xref>
</sup> 1999
III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children (HIV- and HIV+) born to HIV+ mothers vs healthy controls</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 68) from HIV+ mothers, HIV- (n = 190) from HIV+ mothers,
indeterminate HIV status (n = 63), HIV- (n = 256) from HIV- mothers</td>
<td colspan="1" rowspan="1" align="left" valign="top">Age 3 mo, HIV+ significantly lower ht; low WAZ in HIV+ vs HIV- (RR 2.54, 95%
CI 1.66-3.89, <italic>P</italic> < .0001); controlled for mother's ht, RR of
stunting in HIV+ vs HIV- (RR 2.10, 95% CI 1.30-3.39, <italic>P</italic> = .003); RR of
underweight in HIV+ vs HIV- (RR 2.56, 95% CI 1.63-4.03, <italic>P</italic>
 = .001)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Stunting and wasting significant in untreated HIV+ children by age 3 mo</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Berhane et al<sup><xref rid="REF12">12</xref>
</sup>
1997 III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children born to HIV+ Ugandan women 1990-1992, and controls from HIV- mothers</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV- (n = 251) from HIV+ mothers, HIV+ (n = 84) from HIV+ mothers, HIV- (n =
124) controls; followed at ages 0 and 6 wk, and 6, 12, and > 15 mo</td>
<td colspan="1" rowspan="1" align="left" valign="top">At birth, HIV- from HIV+ mother with lower birth wt, length than from HIV-
mother; at age 1 y, mortality increased with low WAZ; WAZ <+0.75 vs>
+0.75 (OR 2.74, 95% CI 1.12-6.67, <italic>P</italic> = .03); WAZ <+1.0 vs>
+1.0 (OR 3.39, 95% CI 1.28-8.97, <italic>P</italic> = .021); WAZ <-1.5 vs>
-1.5 (OR 4.87, 95% CI 1.27-18.67, <italic>P</italic>
 = .024)</td>
<td colspan="1" rowspan="1" align="left" valign="top">In HIV+, low WAZ predicts mortality</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Lepage et al<sup><xref rid="REF13">13</xref>
</sup> 1996
III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children born to HIV+ mothers or those born to HIV- mothers in Rwanda,
enrollment of mothers 1988-1989</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 46) from HIV+ mothers, HIV- (n = 140) from HIV+ mothers, HIV- (n =
218) from HIV- mothers; followed at age 0 and every 3 mo until age 4 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">Until age 30 mo, WAZ and HAZ in HIV+ < HIV- (<italic>P</italic> < .017); Between
12-36 mo, WAZ score lowest; After age 9 mo HAZ score <2 SD in HIV+
children; only at ages 3, 6, 24, and 36 mo is WHZ low in HIV- (<italic>P</italic> <
.017); WAZ and HAZ in HIV- not different from controls</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ more likely stunted than HIV-</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
Miller et al<sup><xref rid="REF18">18</xref>
</sup> 1993
III<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
Children born to HIV+ mothers and referred to HIV clinic in Massachusetts,
1986-1991<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
HIV- (n = 37), HIV+ (n = 52); followed from age 0-21 mo<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
Age 21 mo, HIV- vs HIV+ WAZ [SE]: 0.12 [0.18] vs -0.68 [0.16], <italic>P</italic> =
.002; WHZ [SE]: +0.55 [0.16] vs +0.11 [0.26], <italic>P</italic> = .03; MAC: 64%
[5.32] vs 43% [6.54], <italic>P</italic>
 = .01<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
Birth wt not different, by age 21 mo HIV+ more malnourished<hr></hr>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>BMI-Z, body mass index <italic>z</italic> score; CI, confidence interval; HAART,
highly active antiretroviral therapy; HAZ, height-for-age <italic>z</italic> score;
ht, height; MAC, mid—upper arm circumference; OR, odds ratio; <italic>Plnt,
P</italic> Interaction term; RR, relative risk; SD, standard deviation; SE,
standard error; WAZ, weight-for-age <italic>z</italic> score; WHZ, weight-for-height
<italic>z</italic>
 score; wt, weight.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</p>
<p>2. Anthropometry and body composition studies should be performed. (Grade:
E)</p>
<p><italic>Rationale:</italic> Children with HIV infection can have a significant loss
of lean body mass, even in the absence of weight
loss.<sup><xref rid="REF18">18</xref>
</sup> Weight in
children who are HIV+ can be misleading, since fluid shifts caused by
vomiting, diarrhea, and altered fluid status can transiently alter the
measured weight. Additionally, body mass changes associated with HIV wasting
such as preferential loss of fat, loss of lean body mass, and changes in body
composition due to HIVLD may not be adequately assessed without body
composition evaluation. Anthropometric measures, including mid–arm
muscle area, subscapular skinfold, and triceps skinfold, can better reflect
fat and lean body mass compared with weight and height measurements alone.
Quantification of lean and fat mass is of special importance in these patients
due to the increasing incidence of lipodystrophy.</p>
<p>See <xref rid="TBL5">Table 5</xref>
.</p>
<p><table-wrap id="TBL5" position="float"><label><bold>Table 5.</bold>
</label>
<caption><p>Anthropometry in Children With Human Immunodeficiency Virus (HIV)
Infection</p>
</caption>
<table><thead><tr><th colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
Study<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Population<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Study Groups<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Results<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Comments<hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">Taylor et al<sup><xref rid="REF19">19</xref>
</sup> 2004
V</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children enrolled in phase I/II HIV treatment protocols, 1999-2001</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 98); HAART (n = 59), protease inhibitor (n = 39)</td>
<td colspan="1" rowspan="1" align="left" valign="top">During puberty, 10% with lipodystrophy and dyslipidemia, 52% no lipodystrophy
but dyslipidemia, 38% neither</td>
<td colspan="1" rowspan="1" align="left" valign="top">Unidentified physiological changes with puberty may predispose patients
treated with protease inhibitors to lipodystrophy and dyslipidemia</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Jaquet et al<sup><xref rid="REF20">20</xref>
</sup> 2000
V</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ French children</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 39), varied antiretroviral therapy; age 9.1 ± 4 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">Lipodystrophy in 33%, with higher fasting insulin levels; dyslipidemia in 23%
with no lipodystrophy</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
Arpadi et al<sup><xref rid="REF21">21</xref>
</sup> 1998
IV<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
HIV clinic in New York<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
HIV+ (n = 34) age 4-11 y; growth failure (n = 18), no growth failure (n = 16),
healthy controls (n = 52); FM, FFM by DXA<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
In HIV+ boys with growth failure, lower FFM, HAZ, WAZ than healthy boys; In
HIV+ girls with growth failure, lower FFM, ht, BCM/ht, HAZ, WAZ than HIV-
girls without growth failure and healthy girls; FM not different from healthy
controls<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
FFM, BCM depleted in HIV+ and/or growth failure, but FM maintained<hr></hr>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>BCM, body cell mass; DXA, dual energy x-ray absorptiometry; FFM, fat-free
mass; FM, fat mass; HAART, highly active antiretroviral therapy; HAZ,
height-for-age <italic>z</italic>
 score; ht, height; WAZ, weight-for-age <italic>z</italic>
score.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</p>
<p>3. Oral nutritional supplements or enteral tube feedings may improve weight
and growth in children who are HIV+ with growth failure. (Grade: C)</p>
<p><italic>Rationale:</italic> When the nutrition assessment indicates that a child
fails to meet growth standards, nutritional supplements have restored weight
and growth in some
children.<sup><xref rid="REF22">22</xref>
</sup> If oral
interventions fail, enteral tube feeding improves weight gain in children with
growth
failure.<sup><xref rid="REF23">23</xref>
,<xref rid="REF24">24</xref>
</sup>
In the circumstance of severe malnutrition, nutrition therapy with an
elemental diet may be more effective than higher caloric intake of a standard
formula for weight
gain.<sup><xref rid="REF25">25</xref>
</sup> Accurate
energy and protein requirements for children who are HIV+ have not yet been
established.</p>
<p>See <xref rid="TBL6">Table 6</xref>
.</p>
<p><table-wrap id="TBL6" position="float"><label><bold>Table 6.</bold>
</label>
<caption><p>Oral Nutritional Supplements or Enteral Tube Feedings in Children With
Human Immunodeficiency Virus (HIV) and Growth Failure</p>
</caption>
<table><thead><tr><th colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
Study<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Population<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Study Groups<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Results<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Comments<hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">Rollins et al<sup><xref rid="REF22">22</xref>
</sup>
2007 II</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ South African children with prolonged diarrhea</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ with standard support (n = 83) milk + porridge (100-110 kcal/kg/d,
protein 2.2 g/kg/d) vs HIV+ protein-supplemented milk formula (n = 86) (150
kcal/kg/d, protein 4-5.5 g/kg/d) for 8 wk; age 6-36 mo</td>
<td colspan="1" rowspan="1" align="left" valign="top">At 26 wk, improved WAZ (-2.63 vs -1.32; <italic>P</italic> < .05) and HAZ (-3.14 vs
-2.82; no <italic>P</italic>
 value provided) in supplemented vs standard support</td>
<td colspan="1" rowspan="1" align="left" valign="top">Weight gain better with protein-supplemented formula; mortality high in both
groups (22%, 29%)</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Amadi et al<sup><xref rid="REF25">25</xref>
</sup> 2005
I</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ children with malnutrition in Zambia</td>
<td colspan="1" rowspan="1" align="left" valign="top">Elemental diet (EN n = 100) 70 kcal/mL vs 100 oral liquid formula diet soy +
skim milk 100 kcal/mL (control n = 100) for 4 wk</td>
<td colspan="1" rowspan="1" align="left" valign="top">Weight gain improved in EN vs control (<italic>z</italic> score increase +1.23 IQR
(0.89-1.57) > control +0.87 IQR (0.47, -1.25; <italic>P</italic>
 = .002)</td>
<td colspan="1" rowspan="1" align="left" valign="top">In severely malnourished population, improved wt gain in EN vs soy + skim milk
in spite of widespread intestinal infection</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Miller et al<sup><xref rid="REF23">23</xref>
</sup> 1995
V</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ children in Massachusetts with growth failure</td>
<td colspan="1" rowspan="1" align="left" valign="top">6 mo gastric EN with 110 kcal/kg/d (n = 27); age 0-6 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">Weight gain with improved energy intake (<italic>r</italic>
 = 0.65, <italic>P</italic> =
.002); WAZ increased -2.1 SE [0.14] to -1.6 SE [0.14], WHZ -0.98 SE [0.16] to
-0.15 SE [0.17]; for every unit change in WAZ, 2.8-fold reduced risk of death</td>
<td colspan="1" rowspan="1" align="left" valign="top">Follow-up limited to 6 mo</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
Henderson et al<sup><xref rid="REF24">24</xref>
</sup>
1994 V<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
HIV+ children with growth failure in United States<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
8.5 mo polymeric formula (n = 18); age 3-159 mo<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
WAZ (SD) improved from baseline <italic>z</italic> -2.1 ± 1.0 to -1.5 ±
1.4, <italic>P</italic> = .04; WHZ (SD) from -1.1 ± 1 to +0.13 ± 1.0,
<italic>P</italic>
 = .01; and arm fat area <italic>z</italic> (SD) from -1.8 ± 1.3 to
-0.62 ± 1.2, <italic>P</italic> = .0004 increased with EN; HAZ (SD) not
improved, <italic>z</italic>
 -1.9 ± 0.8 to -1.7 ± 1.6<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
Energy intake not reported<hr></hr>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>EN, enteral nutrition; HAZ, height-for-age <italic>z</italic> score; IQR,
interquartile range; <italic>r</italic>, correlation coefficient; SD, standard
deviation; SE, standard error; WAZ, weight-for-age <italic>z</italic> score; WHZ,
weight-for-height <italic>z</italic>
 score.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</p>
<p>4. Antiretroviral therapy improves growth in children who are HIV+. (Grade:
E)</p>
<p><italic>Rationale:</italic> Children born to mothers who are HIV+ in both
developing and developed countries have lower weight and height <italic>z</italic>
scores from birth to at least 5 years of
age.<sup><xref rid="REF15">15</xref>
,<xref rid="REF21">21</xref>
</sup>
Growth failure is a prognostic indicator of mortality in pediatric HIV
infection.<sup><xref rid="REF12">12</xref>
-<xref rid="REF14">14</xref>
</sup>
The incidence of wasting has fallen since the implementation of HAART;
however, multiple factors continue to contribute to growth failure. Children
with a virologic response (those who reach HIV viral load <400 or 500
copies/mL) or have significant reduction (>1.5 log) in viral load to
therapy tend to have a greater increase in weight and height compared with
virologic
nonresponders.<sup><xref rid="REF16">16</xref>
,<xref rid="REF26">26</xref>
</sup>
HAART therapy has been shown to increase weight- and height-for-age, while
body mass index (BMI) remains
unchanged.<sup><xref rid="REF16">16</xref>
,<xref rid="REF26">26</xref>
</sup>
</p>
<p>See <xref rid="TBL7">Table 7</xref>
.</p>
<p><table-wrap id="TBL7" position="float"><label><bold>Table 7.</bold>
</label>
<caption><p>Growth in Children With Human Immunodeficiency Virus (HIV) and Treated With
Antiretroviral Therapy</p>
</caption>
<table><thead><tr><th colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
Study<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Population<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Study Groups<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Results<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Comments<hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">Guillen et al<sup><xref rid="REF26">26</xref>
</sup>
2007 IV</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ Spanish children, 97% perinatal infection</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 212); changes from baseline wt, ht, BMI at 12, 24, 36, 48, and 60 mo
after HAART</td>
<td colspan="1" rowspan="1" align="left" valign="top">39% with lipodystrophy; HAART significantly increased WAZ and HAZ but not
BMI-Z at each time point</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ children with catch-up growth after HAART, with better response in those
with <500 HIV copies/mL</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Scherpbier et al<sup><xref rid="REF27">27</xref>
</sup>
2006 III</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ PI naive children treated with nelfinavir and 2 nucleoside reverse
transcriptase inhibitors in the Netherlands</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 39) followed median 227 wk; median age 4.7 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">In first year after HAART, increased WHZ -0.3 to 0.5 (no <italic>P</italic> value or
interquartile range available) but not HAZ or WHZ over 240 wk in virologic
responders (<italic>P</italic>
 = .50 and .57, respectively)</td>
<td colspan="1" rowspan="1" align="left" valign="top">In the first year of HAART therapy, WHZ but not WAZ or HAZ increased</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Nachman et al<sup><xref rid="REF28">28</xref>
</sup>
2005 IV</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ children in U.S. AIDS Clinical Trials studies</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 192); age 4 mo to 17 y; growth 16 wk after HAART</td>
<td colspan="1" rowspan="1" align="left" valign="top">At baseline, HIV+ shorter than HIV- with HAZ -0.57 (95% CI -0.73 to -0.41,
<italic>P</italic> < .001); HAART increased WAZ to normal by wk 48, HAZ toward
normal by wk 96; younger children gained ht more rapidly (<italic>P</italic> <
.001); children with greater baseline viral loads gained wt more rapidly
(<italic>P</italic>
 < .001)</td>
<td colspan="1" rowspan="1" align="left" valign="top">HAART improves average wt gain of HIV+ children by 1 y treatment, and ht to
nearly normal after 2 y</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Miller et al<sup><xref rid="REF17">17</xref>
</sup> 2001
IV</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ children in New York, New Jersey, and Massachusetts, 1996-1999</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ with PI therapy (n = 67), followed 2.4 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">Drug therapy improves WAZ 0.46 ± 0.11, (<italic>P</italic> < .001), WHZ 0.49±
 0.20 (<italic>P</italic>
 < .016), AMC 11.5 ± 3.8 cm (<italic>P</italic>
< .003); no change in HAZ 0.17 ± 0.10 (<italic>P</italic>
 = .1)</td>
<td colspan="1" rowspan="1" align="left" valign="top">In addition to reducing viral load, PI therapy in children improves growth</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
Arpadi<sup><xref rid="REF29">29</xref>
</sup>
 2000 III<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
U.S. children recruited from outpatient clinics, 1996-1997<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
HIV+/GF+ (n = 16) vs HIV+/GF- (n = 26)<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
In HIV+/GF+ mean viral load 1.5 log units > HIV+/GF-, 4.89 ± 1.08 vs
3.43 ± 1.63 × 102 copies/mL (<italic>P</italic> = .0009); energy intake
lower 5640 ± 653 vs 8305 ± 490 kJ/d (<italic>P</italic> = .003); energy
balance (based on REE and TEE) lower in HIV+/GF+ 674 ± 732 vs 1448±
 515 (<italic>P</italic>
 = .030)<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
In HIV+/GF+ children, poor energy intake and growth associated with increased
HIV replication<hr></hr>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>AIDS, acquired immune deficiency syndrome; AMC, arm muscle circumference;
BMI-Z, body mass index <italic>z</italic> score; CI, confidence interval; HAART,
highly active antiretroviral therapy; HAZ, height-for-age <italic>z</italic> score;
HIV+/GF+, HIV positive with growth failure; HIV+/GF-, HIV positive without
growth failure; ht, height; PI, protease inhibitor; REE, resting energy
expenditure; TEE, total energy expenditure; WAZ, weight-for-age <italic>z</italic>
score; WHZ, weight-for-height <italic>z</italic>
 score; wt, weight.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</p>
<p>5. Children with HIV lipodystrophy should have laboratory evaluation and
clinical management of hypertriglyceridemia and hypercholesterolemia. (Grade:
D)</p>
<p><italic>Rationale:</italic> While initiation of HAART includes many benefits, it
has transformed HIV into a chronic disease with the increased risk of
metabolic complications. HIVLD has 3 main components: abnormal blood lipid
profiles (hypertriglyceridemia and hypercholesterolemia), insulin resistance,
and body fat
redistribution.<sup><xref rid="REF30">30</xref>
</sup>
Children and adolescents who are HIV+ may exhibit features of lipohypertrophy,
lipoatrophy, or a combination of the 2. Lack of consensus of the definition of
HIVLD has made its characterization difficult. Moreover, signs of HIVLD are
more difficult to identify in children and adolescents than in adults because
of subtle fat redistribution and physical changes during puberty. Estimates of
the prevalence of HIVLD in children and adolescents range from 13% to
67%.<sup><xref rid="REF19">19</xref>
,<xref rid="REF27">27</xref>
,<xref rid="REF30">30</xref>
-<xref rid="REF34">34</xref>
</sup>
The development of symptoms has been linked to protease inhibitor (PI)
therapy,<sup><xref rid="REF33">33</xref>
-<xref rid="REF35">35</xref>
</sup>
duration of HAART
therapy,<sup><xref rid="REF30">30</xref>
,<xref rid="REF33">33</xref>
</sup>
nucleoside analog–containing regimens, and increasing doses of
medications.<sup><xref rid="REF36">36</xref>
</sup>
There is increased association of HIVLD with
puberty<sup><xref rid="REF33">33</xref>
,<xref rid="REF37">37</xref>
</sup>
and female
gender.<sup><xref rid="REF30">30</xref>
</sup>
Management of lipodystrophy complications in children who are HIV+ has not
been well studied.</p>
<p>See <xref rid="TBL8">Table 8</xref>
.</p>
<p><table-wrap id="TBL8" position="float"><label><bold>Table 8.</bold>
</label>
<caption><p>Lipodystrophy in Children With Human Immunodeficiency Virus (HIV)</p>
</caption>
<table><thead><tr><th colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
Study<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Population<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Study Groups<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Results<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Comments<hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">Ene et al<sup><xref rid="REF30">30</xref>
</sup> 2007
III</td>
<td colspan="1" rowspan="1" align="left" valign="top">All HIV+ children in Brussels clinic except those with severe illness,
steroids, or immunomodulators, 2002</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 88), 84% on ART, 89% African; age 11.1 (range 3-19) y; A = children
with fat redistribution, B = children with metabolic abnormalities only, C =
children with no fat redistribution or metabolic abnormalities</td>
<td colspan="1" rowspan="1" align="left" valign="top">A vs B vs C mean (SD) BMI: 19.5 ± 3.1 vs 18.4 ± 3.1 vs 18.4±
 2.4; WAZ: -0.04 ± 1.35 vs +0.42 ± 1.91 vs +0.02±
 1.40; HAZ: -0.89 ± 1.42 vs -0.11 ± 0.99 vs -0.40±
 1.37; no statistically significant differences among 3 groups</td>
<td colspan="1" rowspan="1" align="left" valign="top">No difference in BMI-Z, WAZ, or HAZ relative to fat redistribution or
metabolic abnormalities</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Carter et al<sup><xref rid="REF32">32</xref>
</sup> 2006
III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Population from Perinatal Collaborative Transmission Study (United States)</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 178); followed age 9-15 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">47% with hypercholesterolemia (>200 mg/dL on any measure), 67% with
hypertriglyceridemia (>150 mg/dL on any measure)</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Beregszaszi et al<sup><xref rid="REF33">33</xref>
</sup>
2005 III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Population from 3 pediatric clinics</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 130); mean age 10 y (2-18 y)</td>
<td colspan="1" rowspan="1" align="left" valign="top">24.6% with lipodystrophy; 19% with HDL <1 mm/L; 22% with cholesterol or
triglycerides >2 SD above the mean; 13.2% with insulin resistance</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Farley et al<sup><xref rid="REF34">34</xref>
</sup> 2005
III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children of HIV+ women in United States and Puerto Rico</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 1812), HIV- (n = 187); age 4-19 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">Hypercholesterolemia prevalence 13% (95% CI 11.1-14.3) in HIV+ vs 4.8% (95% CI
2.2-8.8) in HIV-; adjusted for confounders, risk factors include PI use (OR
5.3, 95% CI 3.1-9.2), age 4-6 y (OR 2.9, 95% CI 1.7-4.9), age 6-12 y (OR 1.9,
95% CI 1.3-2.9), Hispanic (OR 1.8, 95% CI 1.2-2.5), White (OR 2.2, 95% CI
1.4-3.3), and HIV RNA <400 copies/mL (OR 2.3, 95% CI 1.7-3.2)</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">European Lipodystrophy
Group<sup><xref rid="REF38">38</xref>
</sup>
 2004 V</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ children in Europe from 30 clinics</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 477); median age 9.7 y (3-18 y)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Fat distribution = 26% (22.1-30.2), central lipohypertrophy = 8% (5.4-10.3),
peripheral lipohypertrophy = 7.55% (7.15-12.7), hypercholesterolemia (>200
mg/dL) = 27% (21.6%-32.7%), hypertriglyceridemia (>150 mg/dL) = 21%
(16.4-26.4); risk factors female gender, increased age, symptomatic HIV,
length of time on ART</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
Sanchez Torres et
al<sup><xref rid="REF31">31</xref>
</sup>
 2005 V<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
HIV+ children in Spain<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
HIV+ (n = 56); mean age 9.5 y (21 mo to 18 y)<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
Hypercholesterolemia (>180 mg/dL) = 57%, hypertryglyceridemia (>130) =
71%, lipodystrophy = 25%, lipohypertrophy = 12.5%; fat redistribution more
common in children age >11 y; 87% on ART, 77% on HAART<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>ART, antiretroviral therapy; BMI, body mass index; BMI-Z, body mass index z
score; CI, confidence interval; HAART, highly active antiretroviral therapy;
HAZ, height-for-age z score; HDL, high-density lipoprotein; OR, odds ratio;
PI, protease inhibitor; RNA, ribonucleic acid; SD, standard deviation; WAZ,
weight-for-age z score.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</p>
<p>6. Supplementation with multivitamins should be provided to pregnant and
lactating women who are HIV+. (Grade: B)</p>
<p><italic>Rationale:</italic> Supplementation with standard pregnancy multivitamins
in pregnant and lactating women in the developing world has been associated
with improved fetal and childhood outcomes in 1 large randomized control
trial.<sup><xref rid="REF39">39</xref>
-<xref rid="REF42">42</xref>
</sup>
In this trial, multivitamin supplementation was shown to improve infant
outcomes (eg, decrease prematurity, increase birth weight, decrease the
incidence of small gestational age infants) and to improve childhood outcomes
(higher CD4 counts, decreased diarrhea, and improved
development).<sup><xref rid="REF39">39</xref>
-<xref rid="REF42">42</xref>
</sup>
Another trial investigated the effects of zinc supplementation vs placebo on
pregnant women and found no adverse effects on woman or infants compared with
pregnant mothers who received
placebo.<sup><xref rid="REF43">43</xref>
</sup>
</p>
<p>Because of its recognized modulation of the immune system, supplemental
vitamin A was investigated in pregnant women who are HIV+. While some trials
found improved infant outcomes (<xref rid="TBL9">Table
9</xref>), 2 large trials suggested an increased rate of mother-to-child
HIV transmission in a subset of the population with high-dose supplemental
vitamin
A,<sup><xref rid="REF44">44</xref>
,<xref rid="REF45">45</xref>
</sup>
while other smaller trials found no
effect.<sup><xref rid="REF46">46</xref>
,<xref rid="REF47">47</xref>
</sup>
High-dose vitamin A supplementation in HIV+ mothers is not currently
recommended, since it does not
reduce<sup><xref rid="REF47">47</xref>
-<xref rid="REF49">49</xref>
</sup>
and may increase mother-to-child HIV
transmission.<sup><xref rid="REF44">44</xref>
</sup>
</p>
<p><table-wrap id="TBL9" position="float"><label><bold>Table 9.</bold>
</label>
<caption><p>Multivitamin (MV) Supplementation in Mothers With Human Immunodeficiency
Virus (HIV) Infection</p>
</caption>
<table><thead><tr><th colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
Study<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Population<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Study Groups<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Results<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Comments<hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">Humphrey et al<sup><xref rid="REF44">44</xref>
</sup>
2006 I</td>
<td colspan="1" rowspan="1" align="left" valign="top">Infants of HIV+ women in Zimbabwe</td>
<td colspan="1" rowspan="1" align="left" valign="top">Infants randomly assigned within 96 h of delivery to 1 of 4 treatment groups:
mothers and infants received vitamin A (n = 1103), mothers received vitamin A
and infants received placebo (n = 1126), mothers received placebo and infants
received vitamin A (n = 1144), and mothers and infants received placebo (n =
1122); vitamin A doses: 400,000 units in mothers and 50,000 in the mothers and
infants; all infants BF</td>
<td colspan="1" rowspan="1" align="left" valign="top">Vitamin A supplementation did not impact mother-to-child HIV transmission or
mortality to age 2 y; in infants HIV- at birth but HIV+ at age 6 wk, neonatal
vitamin A reduced mortality 28% (<italic>P</italic> = .01) but maternal
supplementation had no effect; in infants HIV- at 6 wk, all vitamin A regimens
associated with ∼2-fold higher mortality (<italic>P</italic>
 < .05)</td>
<td colspan="1" rowspan="1" align="left" valign="top">While vitamin A supplementation to HIV+ neonates improves survival,
supplementation may increase risk of death in breast-fed HIV- children</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Fawzi et al<sup><xref rid="REF50">50</xref>
</sup> 2003
I</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ pregnant women in Tanzania and their children</td>
<td colspan="1" rowspan="1" align="left" valign="top">Pregnancy and lactational maternal vitamin A supplement as 30 mgβ
-carotene + 5000 IU vitamin A (n = 397), pregnancy MV with no vitamin A
(n = 388), pregnancy MV with vitamin A (n = 400), placebo (n = 391); HIV+
children (n = 108), HIV- children (n = 556) at age 1.5-24 mo</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children with MV less diarrhea than those with no MV (RR 0.83, 95% CI
0.71-0.98, <italic>P</italic> = .03); no difference in diarrhea with vitamin A; HIV+
children's mean CD4 count higher in MV vs no MV group (<italic>P</italic>
 = .0006)</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Kumwenda et al<sup><xref rid="REF46">46</xref>
</sup>
2002 I</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ pregnant women in Malawi</td>
<td colspan="1" rowspan="1" align="left" valign="top">Iron and folate (n = 357), 10,000 units vitamin A (n = 357)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Vitamin A with no effect on mother-to-child HIV transmission; vitamin A with
less risk of low birth wt (14% vs 21%, <italic>P</italic> = .03), anemia at age 6 wk
(23.4% vs 40.6%, <italic>P</italic>
 < .001)</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Coutsoudis et al<sup><xref rid="REF47">47</xref>
</sup>
1999 I</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ pregnant women in South Africa</td>
<td colspan="1" rowspan="1" align="left" valign="top">Maternal vitamin A as 5000 units retinyl palmitate and 30 mg β-carotene
3rd trimester and 200,000 units retinyl palmitate at delivery (n = 368);
placebo (n = 360)</td>
<td colspan="1" rowspan="1" align="left" valign="top">No difference in HIV+ in children at age 3 mo; women with vitamin A had less
risk of preterm delivery (11.4% vs 17.4%, <italic>P</italic>
 = .03)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Vitamin A supplementation protects against preterm delivery</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
Fawzi et al<sup><xref rid="REF40">40</xref>
</sup> 1998
I<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
HIV+ women 12-27 wk gestation in Tanzania<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
Vitamin A as 30 mg β-carotene + 5000 units vitamin A (n = 269), standard
pregnancy MV and no vitamin A (n = 270), standard pregnancy MV (n = 270);
placebo (n = 267); all with 200,000 units vitamin A orally at delivery<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
In MV vs placebo, fetal death (RR 0.61, 95% CI 0.39-0.94, <italic>P</italic> = .02);
low birth wt (RR 0.56, 95% CI 0.38-0.82, <italic>P</italic>
 = .003); preterm birth<34 wk (RR 0.61, 95% CI 0.38-0.96, <italic>P</italic> = .03); SGA birth (RR 0.57,
95% CI 0.39-0.82, <italic>P</italic> = .002) all reduced; vitamin A supplement with no
added benefit; infant wt gain over 2 y greater MV than placebo (+459 g; 95% CI
35-882, <italic>P</italic> = .03) but not for vitamin A groups; WAZ +0.42 (95% CI
0.07-0.68), WHZ score +0.38 (95% CI 0.07-0.68, <italic>P</italic> = .01) at 24 mo
higher than placebo but vitamin A supplement reduced these benefits. Bailey
development scores in a subset of 327 children, MV with increased psychomotor
index (RR 2.6, 95% CI 0.1-5.1), less developmental delay (RR 0.4, 95% CI 0.2,
0.7) but no effect on mental development; no effect of vitamin A on
development<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
MV, but not vitamin A, supplementation with decreased fetal death, low birth
weight, prematurity; MV with no vitamin A supplementation to pregnant and
lactating mothers with better nutrition outcomes in children to age 2 y;
vitamin A and β-carotene reduced benefits seen with no vitamin A<hr></hr>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>BF, breast-fed; CI, confidence interval; RR, relative risk; SGA, small for
gestational age; WAZ, weight-for-age <italic>z</italic> score; WHZ, weight-for-height
<italic>z</italic>
 score.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</p>
<p>See <xref rid="TBL9">Table 9</xref>
.</p>
<p>7. Micronutrient supplementation should be considered in children who are
HIV+. (Grade: C) <italic>Rationale:</italic> The micronutrient status of children who
are HIV+ continues to be an area of intense research. Supplementation of
multivitamins and micronutrients, at the required dietary allowance dosage,
may be indicated in children who are HIV+. In the United States, children who
are HIV+ may have reduced dietary intake of vitamin
E,<sup><xref rid="REF51">51</xref>
</sup> calcium, and
vitamin D.<sup><xref rid="REF52">52</xref>
</sup>
Consumption of a multivitamin is associated with better bone mineral density
in children who are
HIV+.<sup><xref rid="REF52">52</xref>
</sup> Selenium
deficiency has been linked with increased mortality risk in children who are
HIV+.<sup><xref rid="REF53">53</xref>
</sup> The
majority of research to date has been conducted in developing countries where
micronutrient deficiencies are common regardless of HIV status, making it
difficult to differentiate the etiology of nutrient deficiencies secondary to
HIV/AIDS or background rates of micronutrient malnutrition. In 1 study,
vitamin A supplementation in children who are HIV+ was shown to decrease
diarrhea, upper respiratory tract infections, and
mortality.<sup><xref rid="REF54">54</xref>
,<xref rid="REF55">55</xref>
</sup>
In another study, zinc supplementation was associated with no change in
respiratory tract infection, CD4 counts, or HIV viral load, but it decreased
diarrhea illness in children who are
HIV+.<sup><xref rid="REF56">56</xref>
</sup>
</p>
<p>See <xref rid="TBL10">Table 10</xref>
.</p>
<p><table-wrap id="TBL10" position="float"><label><bold>Table 10.</bold>
</label>
<caption><p>Micronutrient Supplementation in Children With Human Immunodeficiency Virus
(HIV) Infection</p>
</caption>
<table><thead><tr><th colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
Study<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Population<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Study Groups<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Results<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Comments<hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">Tremeschin et al<sup><xref rid="REF57">57</xref>
</sup>
2007 IV</td>
<td colspan="1" rowspan="1" align="left" valign="top">Brazilian children</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 20), HIV- (n = 20) of HIV+ mothers, HIV- (n = 10) of HIV- mothers</td>
<td colspan="1" rowspan="1" align="left" valign="top">Adequate niacin, tryptophan, zinc, pyridoxine, and energy intake by FFQ in
all, adequate niacin excretion, and nitrogen status</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ children with stable clinical course with no niacin deficiency</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Bobat<sup><xref rid="REF56">56</xref>
</sup>
 2005 I</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children with HIV infection in South Africa</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 96); 10 mg zinc supplement (n = 46), placebo (n = 50); mean age 40.1
vs 36.6 mo</td>
<td colspan="1" rowspan="1" align="left" valign="top">In zinc vs placebo, no difference in HIV-1 viral load 0.03 (95% CI 0.23-0.28)
or the % CD4 T lymphocytes (difference -0.8, 95% CI 0.4-3.0). Zinc
supplementation with less watery diarrhea (7.4 vs 14.5%, <italic>P</italic> = .001)
but no difference in respiratory or ear infections (<italic>P</italic>
 = .16)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Zinc supplementation to HIV+ children does not increase viral load, may reduce
diarrhea</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Semba et al<sup><xref rid="REF58">58</xref>
</sup> 2005
II</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ Ugandan children</td>
<td colspan="1" rowspan="1" align="left" valign="top">Vitamin A as 60 mcg retinol every 3 mo (n = 87); 94 placebo (n = 94); from age
15-30 mo</td>
<td colspan="1" rowspan="1" align="left" valign="top">In vitamin A vs placebo, mortality (RR 0.54, 95% CI 0.30-0.98, <italic>P</italic> =
.04), persistent cough (RR 0.47, 95% CI 0.23-0.96, <italic>P</italic> = .038),
diarrhea (RR 0.48, 95% CI 0.19-1.18, <italic>P</italic>
 = .11)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Vitamin A reduces mortality and infectious diarrhea in HIV+ children</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Kruzich et al<sup><xref rid="REF51">51</xref>
</sup>
2004 III</td>
<td colspan="1" rowspan="1" align="left" valign="top">U.S. youth with early HIV disease</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 264), HIV- (n = 127)</td>
<td colspan="1" rowspan="1" align="left" valign="top">By FFQ, 30% take MV, vitamin C, or iron supplements; 40% with low vitamin E
intake; 18.7% inadequate vitamin A intake; 10.5% inadequate zinc intake, no
difference by HIV status, HIV+ with CD4 >500 copies/mL with decreased iron
intake (<italic>P</italic>
 < .05)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Cross-sectional study describes behavior, not results of intervention</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Campa et al<sup><xref rid="REF53">53</xref>
</sup> 1999
V</td>
<td colspan="1" rowspan="1" align="left" valign="top">U.S. children with perinatal HIV+ followed for 5 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 24); from age 0-5 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">With CD4 <200 mortality (RR 7.05, 95% CI 1.87-26.5, <italic>P</italic> = .004);
with low plasma selenium mortality (RR 5.96, 95% CI 1.32-26.81, <italic>P</italic> =
.02); in children who died, those with low selenium levels died at younger
age, suggesting more rapid disease progression</td>
<td colspan="1" rowspan="1" align="left" valign="top">Low plasma selenium predicts mortality in HIV+ children</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Fawzi et al<sup><xref rid="REF54">54</xref>
</sup> 1999
II</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ Tanzanian children</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 58); 200,000 units vitamin A (n = 31) at hospital admission, 4 mo, 8
mo after discharge vs placebo (n = 27)</td>
<td colspan="1" rowspan="1" align="left" valign="top">With vitamin A, all-cause mortality (RR 0.37, 95% CI 0.14-0.95, <italic>P</italic> =
.04); AIDS-related deaths (RR 0.32, 95% CI 0.1-0.99, <italic>P</italic>
 = .05) reduced</td>
<td colspan="1" rowspan="1" align="left" valign="top">Clear benefit to HIV+ children of vitamin A supplements</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
Coutsoudis et al<sup><xref rid="REF55">55</xref>
</sup>
1995 II<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
South African children<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
HIV+ (n = 281), HIV- (n = 57), of HIV+ mothers; vitamin A as 50,000 units at 1
and 3 mo, 100,000 units at 5 mo, 200,000 units at 10 and 15 mo vs placebo (no
vitamin A)<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
Vitamin A protective against diarrhea (OR 0.62, 95% CI 0.39-0.98); no
difference in respiratory infections<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>AIDS, acquired immune deficiency syndrome; CI, confidence interval; FFQ,
Food Frequency Questionnaire; MV, multiple vitamin; OR, odds ratio; RR,
relative risk.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</p>
<p>8. Women who are HIV+ in resource-rich settings are advised to formula feed
exclusively, while in resource-poor settings, exclusive breastfeeding is
recommended. (Grade: B)</p>
<p><italic>Rationale:</italic> HIV transmission through breastfeeding may account for
as much as 12%–16% of postnatal
transmission.<sup><xref rid="REF59">59</xref>
-<xref rid="REF61">61</xref>
</sup>
In developed countries, it is recommended that mothers who are HIV+
exclusively formula feed to avoid the risk of HIV
transmission.<sup><xref rid="REF62">62</xref>
</sup> In
resource-poor settings, the practical aspects of implementation of formula
feeding may be difficult due to unsafe water, lack of availability of milk
substitutes, varying cultural norms, and risk of maternal
stigmatization.<sup><xref rid="REF62">62</xref>
</sup>
Maternal characteristics that place infants at increased risk for HIV
transmission include higher plasma and milk HIV viral load, mastitis, and
decreased maternal CD4
count.<sup><xref rid="REF62">62</xref>
</sup>
Furthermore, the protective factors of breastfeeding in these environments may
include decreased diarrheal illness and decreased mortality. The World Health
Organization recommends that when replacement feeding is feasible, acceptable,
affordable, sustainable, and safe, then avoidance of breastfeeding by women
who are HIV+ is
recommended.<sup><xref rid="REF63">63</xref>
</sup>
Otherwise, in the developing world, the morbidity and mortality of infants
born to mothers who are HIV+, whether exclusively fed breast milk or formula,
may be
equivocal.<sup><xref rid="REF64">64</xref>
,<xref rid="REF65">65</xref>
,<xref rid="REF66">66</xref>
</sup>
Should breastfeeding be selected, exclusive breastfeeding is advised, as it is
associated with decreased vertical transmission and infant mortality compared
with mixed feeding
regimens.<sup><xref rid="REF60">60</xref>
,<xref rid="REF67">67</xref>
</sup>
Furthermore, a 6-month period of exclusive breastfeeding may be recommended,
as the risk of transmission significantly increases with
time.<sup><xref rid="REF67">67</xref>
</sup> Peripartum
maternal and infant antiretroviral prophylaxis during breastfeeding may also
decrease the risk of HIV transmission to the infant postnatally.</p>
<p>See <xref rid="TBL11">Table 11</xref>
.</p>
<p><table-wrap id="TBL11" position="float"><label><bold>Table 11.</bold>
</label>
<caption><p>Breastfeeding (BF) in Children With Human Immunodeficiency Virus (HIV)
Infection</p>
</caption>
<table><thead><tr><th colspan="1" rowspan="1" align="left" valign="top"><hr></hr>
Study<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Population<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Study Groups<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Results<hr></hr>
</th>
<th colspan="1" rowspan="1" align="center" valign="top"><hr></hr>
Comments<hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td colspan="1" rowspan="1" align="left" valign="top">Becquet et al<sup><xref rid="REF68">68</xref>
</sup>
2008 III</td>
<td colspan="1" rowspan="1" align="left" valign="top">BF infants of HIV+ mothers in Abidjan, Côte d'Ivoire, 2001-2003</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV- infants at age 30 d (n = 622); mothers proposed 2 feeding strategies: 1)
complete avoidance of BF with artificial milk provided or 2) exclusive BF with
aim of complete cessation by age 3-4 mo; all mothers given replacement
feedings through age 9 mo; children followed to age 2 y</td>
<td colspan="1" rowspan="1" align="left" valign="top">BF >6 mo increased odds of postnatal HIV transmission (OR 7.5, 95% CI
2.0-28.2, <italic>P</italic> = .003); mixed feeding during first mo of life increased
odds of postnatal HIV transmission (OR 6.3, 95% CI 1.1-36.4, <italic>P</italic>
 = .04)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Mothers received peripartum ART drug combination as in the context of a larger
maternal ART drug combination trial; presented results were controlled for ART
use</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Rollins et al<sup><xref rid="REF69">69</xref>
</sup>
2008 III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children born to HIV+ women in South Africa</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV- (n = 1193); Intensive feeding support and education, supply of formula
for 6 mo, frequent home visits</td>
<td colspan="1" rowspan="1" align="left" valign="top">Overall survival by age 18 mo <italic>not</italic> statistically different for HIV-
infants with BF ≤6 mo (RR 0.91, 95% CI 0.87-0.94, <italic>P</italic> = .03) or
replacement fed (RR 0.96, 95% CI 0.90-0.98, <italic>P</italic>
 = .25)</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Kuhn et al<sup><xref rid="REF70">70</xref>
</sup>
 2008 I</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children born to HIV+ women in Zambia</td>
<td colspan="1" rowspan="1" align="left" valign="top">Exclusive BF to age 4 mo with abrupt weaning (n = 481); BF as long as desired
with median duration 16 mo (n = 477); primary outcome HIV+ or death by 24 mo</td>
<td colspan="1" rowspan="1" align="left" valign="top">In BF to 4 mo, 69% stopped BF in <2 d; in infants BF longer and not HIV+ at
4 mo, no difference in HIV survival at 24 mo (83.9% vs 80.7%, <italic>P</italic> =
.27); in infants HIV+ by age 4 mo, higher mortality at 24 mo in the abrupt
weaning group (73.6% vs 54.8%, <italic>P</italic>
 = .007)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Early, abrupt cessation of BF by HIV+ mothers in low-resource settings is
harmful to HIV+ children</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Coovadia et al<sup><xref rid="REF67">67</xref>
</sup>
2007 III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children born to HIV+ women in South Africa</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV- (n = 1372)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Complete feeding data in 1276 pts. In exclusively BF, by age 6 wk 14.1% HIV+
(95% CI 12.1-16.4), by age 6 mo 19.5% HIV+ (95% CI 17.0-22.4); increased risk
of vertical transmission with maternal CD4 <200 copies/mL (HR 3.79, 95% CI
2.35-6.12), low birth wt (HR 1.81, 95% CI 1.07-3.06); in mixed-fed children,
higher risk of HIV+ than exclusively BF (HR 10.87, 95% CI 1.51-78.0,
<italic>P</italic> = .018) and than infants with mixed feeding at 3 mo (HR 1.82, 95%
CI 0.98-3.36, <italic>P</italic> = .057); mortality at age 3 mo in exclusive BF 6.1%
(95% CI 4.74%-7.92%) vs 15.1% (95% CI 7.63%-28.73%); death (HR 2.06, 95% CI
1.00-4.27, <italic>P</italic>
 = .05) in mixed feeding group</td>
<td colspan="1" rowspan="1" align="left" valign="top">Mixed BF and BF with solids with higher risk of HIV transmission than
exclusively BF</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Palombi et al<sup><xref rid="REF71">71</xref>
</sup>
2007 IV</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ women in Tanzania, Mozambique, and Malawi 2004-2006, enrolled in DREAM
Program; all received HAART from 25th wk gestation</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ pregnant women in 2 cohorts: strict FF guidelines from all 3 countries (n
= 809), BF guideline from Mozambique only (n = 341); all materials for FF
given until age 6 mo</td>
<td colspan="1" rowspan="1" align="left" valign="top">No difference in HIV transmission at age 1 mo (1.2% in BF vs 0.8% in FF) or
age 6 mo (0.8% BF, 1.8% FF, <italic>P</italic> = .38), no difference in mortality at
age 6 mo (27/1000 y in FF vs 28.5/1000 y in FF)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Outcomes from FF may be equivalent to BF when all resources and extensive
education provided</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Taha et al<sup><xref rid="REF72">72</xref>
</sup> 2007
III</td>
<td colspan="1" rowspan="1" align="left" valign="top">BF infants involved in ART prophylaxis trials in Malawi</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV- (n = 1256) at age 6-8 wk</td>
<td colspan="1" rowspan="1" align="left" valign="top">By end of study, 98 HIV+ and 1158 HIV- infants; cumulative risk of late
transmission by 24 mo 9.65 (95% CI 7.8-11.6); weaning at age 6 mo decreases
85% of late transmission; risk factors for postnatal transmission high
baseline maternal viral load (RR 3.67, 95% CI 2.55-5.27), maternal primiparity
(RR 4.82, 95% CI 1.46-15.91), mastitis (RR 4.94, 95% CI 1.53-16.02)</td>
<td colspan="1" rowspan="1" align="left" valign="top">Continuation of BF for >6 mo may increase risk of HIV infection by 7.5
times</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Thior et al<sup><xref rid="REF73">73</xref>
</sup> 2006
I</td>
<td colspan="1" rowspan="1" align="left" valign="top">Children born to 1200 HIV+ women treated peripartum with nevirapine vs placebo
in Botswana</td>
<td colspan="1" rowspan="1" align="left" valign="top">All infants with single dose nevirapine vs placebo; BF+zidovudine (n = 301),
FF (n = 299)</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV transmission higher in BF group (9.0% vs 5.6%; 95% CI for difference -6.4%
to -0.4%, <italic>P</italic> = .04); at age 6 mo, mortality from infectious disease
higher in FF than BF, 9.3% vs 4.9%, <italic>P</italic> < .003; by age 18 mo,
mortality not different</td>
<td colspan="1" rowspan="1" align="left" valign="top">BF with zidovudine prophylaxis not as effective as FF in preventing HIV
transmission, but infant mortality higher in FF group than BF group</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Iliff et al<sup><xref rid="REF60">60</xref>
</sup> 2005
III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Newborns born to HIV+ women in Zimbabwe</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV- (n = 2060) at age 6 wk; All BF</td>
<td colspan="1" rowspan="1" align="left" valign="top">Overall prenatal transmission 12.1%. Exclusive BF vs early mixed BF 4.03 (95%
CI 0.98-16.61), 3.79 (95% CI 1.40-10.29), and 2.60 (95% CI 1.21-5.55); greater
risk of transmission at ages 6, 12, and 18 mo, respectively</td>
<td colspan="1" rowspan="1" align="left" valign="top">Part of an ancillary study to a postpartum vitamin A supplementation trial</td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">Coutsoudis et al<sup><xref rid="REF74">74</xref>
</sup>
2003 III</td>
<td colspan="1" rowspan="1" align="left" valign="top">Infants born to HIV+ women in South Africa, also participating in vitamin A
intervention trial</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ (n = 62), HIV- (n = 301)</td>
<td colspan="1" rowspan="1" align="left" valign="top">HIV+ infants not BF with worse outcome than those BF (OR 4.05, 95% CI
0.91-20.1, <italic>P</italic>
 = .05)</td>
<td colspan="1" rowspan="1" align="left" valign="top"></td>
</tr>
<tr><td colspan="1" rowspan="1" align="left" valign="top">
Nduati et al<sup><xref rid="REF59">59</xref>
</sup> 2000
I<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
401 infant—mother pairs in Kenya, 1992-1998<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
HIV-, BF (n = 212), 213 FF (n = 213), followed through age 2 y<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
Median duration of BF 17 mo; cumulative incidence of HIV+ in BF vs FF 36.7%
(95% CI 29.4%-44.0%) vs 20.5% (95% CI 14.0%-27.0%, <italic>P</italic> = .001);
estimated rate of transmission through BF 16.2% (95% CI 6.5%-25.9%); rate of
HIV-free survival lower in BF than FF (58% vs 70%; <italic>P</italic>
 = .02)<hr></hr>
</td>
<td colspan="1" rowspan="1" align="left" valign="top">
96% compliance in BF vs 70% in FF<hr></hr>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>ART, antiretroviral therapy; CI, confidence interval; HR, hazard ratio; FF,
formula feeding; HAART, highly active antiretroviral therapy; OR, odds
ratio.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</p>
</sec>
</sec>
</body>
<back><fn-group content-type="arthw-misc"><fn xml:lang="en"><p><bold>A.S.P.E.N. Board of Directors Providing Final Approval</bold>
</p>
</fn>
<fn xml:lang="en"><p>Mark R Corkins, MD; Tom Jaksic, MD, PhD; Elizabeth M Lyman, RN, MSN;
Ainsley M Malone, RD, MS; Stephen A McClave, MD; Jay M Mirtallo, RPh, BSNSP;
Lawrence A Robinson, PharmD; Kelly A Tappenden, RD, PhD; Charles Van Way III,
MD; Vincent W Vanek, MD; and John R Wesley, MD.</p>
</fn>
<fn xml:lang="en"><p>We acknowledge the contributions of Tim Sentongo, MD, and Charlene Compher,
PhD, RD, FADA, LDN, CNSC.</p>
</fn>
</fn-group>
<ref-list><ref id="REF1"><label>1</label>
<citation xlink:type="simple">A.S.P.E.N. Board of Directors. Guidelines for use of total
parenteral nutrition in the hospitalized adult patient. <source>JPEN J Parenter
Enteral Nutr</source>
.<year>1986</year>
;<volume>10</volume>
(<issue>5</issue>
):<fpage>441</fpage>
-445.</citation>
</ref>
<ref><label>2</label>
<citation xlink:type="simple">A.S.P.E.N. Board of Directors. Guidelines for the use of parenteral
and enteral nutrition in adult and pediatric patients. <source>JPEN J Parenter
Enteral Nutr</source>
. <year>2002</year>
;<volume>26</volume>
(<issue>1 suppl</issue>
): <fpage>1SA</fpage>
-138SA.</citation>
</ref>
<ref id="REF3"><label>3</label>
<citation xlink:type="simple">A.S.P.E.N. Board of Directors. Guidelines for the Use of Parenteral
and Enteral Nutrition in Adult and Pediatric Patients. <source>JPEN J Parenter
Enteral Nutr</source>
. <year>1993</year>
;<volume>17</volume>
(<issue>suppl 4</issue>
): <fpage>1SA</fpage>
-52SA.</citation>
</ref>
<ref id="REF4"><label>4</label>
<citation xlink:type="simple">Committee to Advise Public Health Service on Clinical Practice
Guidelines (Institute of Medicine). <source>Clinical Practice Guidelines:
Directions for a New Program</source>
. Washington, DC: National Academy Press;<year>1990</year>
: <fpage>58</fpage>
.</citation>
</ref>
<ref id="REF5"><label>5</label>
<citation xlink:type="simple">Seres D, Compher C, Seidner D, Byham-Gray L, Gervasio J, McClave S.
2005 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)
Standards and Guidelines survey. <source>Nutr Clin Pract</source>
.<year>2006</year>
;<volume>21</volume>
(<issue>5</issue>
):<fpage>529</fpage>
-532.</citation>
</ref>
<ref id="REF6"><label>6</label>
<citation xlink:type="simple">Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign
guidelines for management of severe sepsis and septic shock. <source>Crit Care
Med</source>
. <year>2004</year>
;<volume>32</volume>
(<issue>3</issue>
):<fpage>858</fpage>
-873.</citation>
</ref>
<ref id="REF7"><label>7</label>
<citation xlink:type="simple">Guyatt GH, Haynes RB, Jaeschke RZ, et al. Users' Guides to the
Medical Literature, XXV: evidence-based medicine: principles for applying the
Users' Guides to patient care. Evidence-Based Medicine Working Group.<source>JAMA</source>
.<year>2000</year>
;<volume>284</volume>
(<issue>10</issue>
):<fpage>1290</fpage>
-1296.</citation>
</ref>
<ref id="REF8"><label>8</label>
<citation xlink:type="simple">Bailey RC, Kamenga MC, Nsuami MJ, Nieburg P, St Louis ME. Growth of
children according to maternal and child HIV, immunological and disease
characteristics: a prospective cohort study in Kinshasa, Democratic Republic
of Congo. <source>Int J Epidemiol</source>
.<year>1999</year>
;<volume>28</volume>
(<issue>3</issue>
):<fpage>532</fpage>
-540.</citation>
</ref>
<ref id="REF9"><label>9</label>
<citation xlink:type="simple">McKinney RE Jr, Robertson JW. Effect of human immunodeficiency
virus infection on the growth of young children. Duke Pediatric AIDS Clinical
Trials Unit. <source>J Pediatr</source>
.<year>1993</year>
;<volume>123</volume>
(<issue>4</issue>
):<fpage>579</fpage>
-582.</citation>
</ref>
<ref id="REF10"><label>10</label>
<citation xlink:type="simple">Miller TL, Easley KA, Zhang W, et al. Maternal and infant factors
associated with failure to thrive in children with vertically transmitted
human immunodeficiency virus-1 infection: the prospective, P2C2 human
immunodeficiency virus multicenter study. <source>Pediatrics</source>
.<year>2001</year>
;<volume>108</volume>
(<issue>6</issue>
):<fpage>1287</fpage>
-1296.</citation>
</ref>
<ref id="REF11"><label>11</label>
<citation xlink:type="simple">CDC. 1994 Revised classification system for human immunodeficiency
infection in children less than 13 years of age. In: MMWR, ed. <source>Vol. 43:
Centers for Disease Control Surveillance Summary</source>
; <year>1994</year>
:<fpage>1</fpage>
-9.</citation>
</ref>
<ref id="REF12"><label>12</label>
<citation xlink:type="simple">Berhane R, Bagenda D, Marum L, et al. Growth failure as a
prognostic indicator of mortality in pediatric HIV infection.<source>Pediatrics</source>
.<year>1997</year>
;<volume>100</volume>
(<issue>1</issue>
):<fpage>E7</fpage>
.</citation>
</ref>
<ref id="REF13"><label>13</label>
<citation xlink:type="simple">Lepage P, Msellati P, Hitimana DG, et al. Growth of human
immunodeficiency type 1-infected and uninfected children: a prospective cohort
study in Kigali, Rwanda, 1988 to 1993. <source>Pediatr Infect Dis J</source>
.<year>1996</year>
;<volume>15</volume>
(<issue>6</issue>
):<fpage>479</fpage>
-485.</citation>
</ref>
<ref id="REF14"><label>14</label>
<citation xlink:type="simple">Villamor E, Misegades L, Fataki MR, Mbise RL, Fawzi WW. Child
mortality in relation to HIV infection, nutritional status, and socioeconomic
background. <source>Int J Epidemiol</source>
.<year>2005</year>
;<volume>34</volume>
(<issue>1</issue>
):<fpage>61</fpage>
-68.</citation>
</ref>
<ref id="REF15"><label>15</label>
<citation xlink:type="simple">Newell ML, Borja MC, Peckham C. Height, weight, and growth in
children born to mothers with HIV-1 infection in Europe.<source>Pediatrics</source>
.<year>2003</year>
;<volume>111</volume>
(<issue>1</issue>
):<fpage>e52</fpage>
-e60.</citation>
</ref>
<ref id="REF16"><label>16</label>
<citation xlink:type="simple">Verweel G, van Rossum AM, Hartwig NG, Wolfs TF, Scherpbier HJ, de
Groot R. Treatment with highly active antiretroviral therapy in human
immunodeficiency virus type 1-infected children is associated with a sustained
effect on growth. <source>Pediatrics</source>
.<year>2002</year>
;<volume>109</volume>
(<issue>2</issue>
):<fpage>E25</fpage>
.</citation>
</ref>
<ref id="REF17"><label>17</label>
<citation xlink:type="simple">Miller TL, Mawn BE, Orav EJ, et al. The effect of protease
inhibitor therapy on growth and body composition in human immunodeficiency
virus type 1-infected children. <source>Pediatrics</source>
.<year>2001</year>
;<volume>107</volume>
(<issue>5</issue>
):<fpage>E77</fpage>
.</citation>
</ref>
<ref id="REF18"><label>18</label>
<citation xlink:type="simple">Miller TL, Evans SJ, Orav EJ, Morris V, McIntosh K, Winter HS.
Growth and body composition in children infected with the human
immunodeficiency virus-1. <source>Am J Clin Nutr</source>
.<year>1993</year>
;<volume>57</volume>
(<issue>4</issue>
):<fpage>588</fpage>
-592.</citation>
</ref>
<ref id="REF19"><label>19</label>
<citation xlink:type="simple">Taylor P, Worrell C, Steinberg SM, et al. Natural history of lipid
abnormalities and fat redistribution among human immunodeficiency
virus-infected children receiving long-term, protease inhibitor-containing,
highly active antiretroviral therapy regimens. <source>Pediatrics</source>
.<year>2004</year>
;<volume>114</volume>
(<issue>2</issue>
):<fpage>e235</fpage>
-e242.</citation>
</ref>
<ref id="REF20"><label>20</label>
<citation xlink:type="simple">Jaquet D, Levine M, Ortega-Rodriguez E, et al. Clinical and
metabolic presentation of the lipodystrophic syndrome in HIV-infected
children. <source>AIDS</source>
.<year>2000</year>
;<volume>14</volume>
(<issue>14</issue>
):<fpage>2123</fpage>
-2128.</citation>
</ref>
<ref id="REF21"><label>21</label>
<citation xlink:type="simple">Arpadi SM, Horlick MN, Wang J, Cuff P, Bamji M, Kotler DP. Body
composition in prepubertal children with human immunodeficiency virus type 1
infection. <source>Arch Pediatr Adolesc Med</source>
.<year>1998</year>
;<volume>152</volume>
(<issue>7</issue>
):<fpage>688</fpage>
-693.</citation>
</ref>
<ref id="REF22"><label>22</label>
<citation xlink:type="simple">Rollins NC, van den Broeck J, Kindra G, Pent M, Kasambira T,
Bennish ML. The effect of nutritional support on weight gain of HIV-infected
children with prolonged diarrhoea. <source>Acta Paediatr</source>
.<year>2007</year>
;<volume>96</volume>
(<issue>1</issue>
):<fpage>62</fpage>
-68.</citation>
</ref>
<ref id="REF23"><label>23</label>
<citation xlink:type="simple">Miller TL, Awnetwant EL, Evans S, Morris VM, Vazquez IM, McIntosh
K. Gastrostomy tube supplementation for HIV infected children.<source>Pediatrics</source>
.<year>1995</year>
;<volume>96</volume>
(<issue>4 Pt 1</issue>
):<fpage>696</fpage>
-702.</citation>
</ref>
<ref id="REF24"><label>24</label>
<citation xlink:type="simple">Henderson RA, Saavedra JM, Perman JA, Hutton N, Livingston RA,
Yolken RH. Effect of enteral tube feeding on growth of children with
symptomatic human immunodeficiency virus infection. <source>J Pediatr
Gastroenterol Nutr</source>
.<year>1994</year>
;<volume>18</volume>
(<issue>4</issue>
):<fpage>429</fpage>
-434.</citation>
</ref>
<ref id="REF25"><label>25</label>
<citation xlink:type="simple">Amadi B, Mwiya M, Chomba E, et al. Improved nutritional recovery on
an elemental diet in Zambian children with persistent diarrhoea and
malnutrition. <source>J Trop Pediatr</source>
.<year>2005</year>
;<volume>51</volume>
(<issue>1</issue>
):<fpage>5</fpage>
-10.</citation>
</ref>
<ref id="REF26"><label>26</label>
<citation xlink:type="simple">Guillen S, Ramos JT, Resino R, Bellon JM, Munoz MA. Impact on
weight and height with the use of HAART in HIV+ children. <source>Pediatr
Infect Dis J</source>
.<year>2007</year>
;<volume>26</volume>
(<issue>4</issue>
):<fpage>334</fpage>
-338.</citation>
</ref>
<ref id="REF27"><label>27</label>
<citation xlink:type="simple">Scherpbier HJ, Bekker V, van Leth F, Jurriaans S, Lange JM,
Kuijpers TW. Long-term experience with combination antiretroviral therapy that
contains nelfinavir for up to 7 years in a pediatric cohort.<source>Pediatrics</source>
.<year>2006</year>
;<volume>117</volume>
(<issue>3</issue>
):<fpage>e528</fpage>
-e536.</citation>
</ref>
<ref id="REF28"><label>28</label>
<citation xlink:type="simple">Nachman SA, Lindsey JC, Moye J, et al. Growth of human
immunodeficiency virus-infected children receiving highly active
antiretroviral therapy. <source>Pediatr Infect Dis J</source>
.<year>2005</year>
;<volume>24</volume>
(<issue>4</issue>
):<fpage>352</fpage>
-357.</citation>
</ref>
<ref id="REF29"><label>29</label>
<citation xlink:type="simple">Arpadi SM. Growth failure in children with HIV infection. <source>J
Acquir Immune Defic Syndr</source>
.<year>2000</year>
;<volume>25</volume>
(<issue>suppl 1)</issue>
:<fpage>S37</fpage>
-S42.</citation>
</ref>
<ref id="REF30"><label>30</label>
<citation xlink:type="simple">Ene L, Goetghebuer T, Hainaut M, Peltier A, Toppet V, Levy J.
Prevalence of lipodystrophy in HIV+ children: a cross-sectional study.<source>Eur J Pediatr</source>
.<year>2007</year>
;<volume>166</volume>
(<issue>1</issue>
):<fpage>13</fpage>
-21.</citation>
</ref>
<ref id="REF31"><label>31</label>
<citation xlink:type="simple">Sanchez Torres AM, Munoz Muniz R, Madero R, Borque C, Garcia-Miguel
MJ, De Jose Gomez MI. Prevalence of fat redistribution and metabolic disorders
in human immunodeficiency virus-infected children. <source>Eur J
Pediatr</source>
.<year>2005</year>
;<volume>164</volume>
(<issue>5</issue>
):<fpage>271</fpage>
-276.</citation>
</ref>
<ref id="REF32"><label>32</label>
<citation xlink:type="simple">Carter RJ, Wiener J, Abrams EJ, et al. Dyslipidemia among
perinatally HIV+ children enrolled in the PACTS-HOPE cohort, 1999-2004: a
longitudinal analysis. <source>J Acquir Immune Defic Syndr</source>
.<year>2006</year>
;<volume>41</volume>
(<issue>4</issue>
):<fpage>453</fpage>
-460.</citation>
</ref>
<ref id="REF33"><label>33</label>
<citation xlink:type="simple">Beregszaszi M, Dollfus C, Levine M, et al. Longitudinal evaluation
and risk factors of lipodystrophy and associated metabolic changes in HIV+
children. <source>J Acquir Immune Defic Syndr</source>
.<year>2005</year>
;<volume>40</volume>
(<issue>2</issue>
):<fpage>161</fpage>
-168.</citation>
</ref>
<ref id="REF34"><label>34</label>
<citation xlink:type="simple">Farley J, Gona P, Crain M, et al. Prevalence of elevated
cholesterol and associated risk factors among perinatally HIV+ children (4-19
years old) in Pediatric AIDS Clinical Trials Group 219C. <source>J Acquir
Immune Defic Syndr</source>
.<year>2005</year>
;<volume>38</volume>
(<issue>4</issue>
):<fpage>480</fpage>
-487.</citation>
</ref>
<ref id="REF35"><label>35</label>
<citation xlink:type="simple">Arpadi SM, Cuff PA, Kotler DP, et al. Growth velocity, fat-free
mass and energy intake are inversely related to viral load in HIV+ children.<source>J Nutr</source>
.<year>2000</year>
;<volume>130</volume>
(<issue>10</issue>
):<fpage>2498</fpage>
-2502.</citation>
</ref>
<ref id="REF36"><label>36</label>
<citation xlink:type="simple">Amaya RA, Kozinetz CA, McMeans A, Schwarzwald H, Kline MW.
Lipodystrophy syndrome in human immunodeficiency virus-infected children.<source>Pediatr Infect Dis J</source>
.<year>2002</year>
;<volume>21</volume>
(<issue>5</issue>
):<fpage>405</fpage>
-410.</citation>
</ref>
<ref id="REF37"><label>37</label>
<citation xlink:type="simple">Hartman K, Verweel G, de Groot R, Hartwig NG. Detection of
lipoatrophy in human immunodeficiency virus-1-infected children treated with
highly active antiretroviral therapy. <source>Pediatr Infect Dis J</source>
.<year>2006</year>
;<volume>25</volume>
(<issue>5</issue>
):<fpage>427</fpage>
-431.</citation>
</ref>
<ref id="REF38"><label>38</label>
<citation xlink:type="simple">Antiretroviral therapy, fat redistribution and hyperlipidaemia in
HIV+ children in Europe. <source>Aids</source>
.<year>2004</year>
;<volume>18</volume>
(<issue>10</issue>
):<fpage>1443</fpage>
-1451.</citation>
</ref>
<ref id="REF39"><label>39</label>
<citation xlink:type="simple">Fawzi WW, Hunter DJ. Vitamins in HIV disease progression and
vertical transmission. <source>Epidemiology</source>
.<year>1998</year>
;<volume>9</volume>
(<issue>4</issue>
):<fpage>457</fpage>
-466.</citation>
</ref>
<ref id="REF40"><label>40</label>
<citation xlink:type="simple">Fawzi WW, Msamanga GI, Spiegelman D, et al. Randomised trial of
effects of vitamin supplements on pregnancy outcomes and T cell counts in
HIV-1-infected women in Tanzania. <source>Lancet</source>
.<year>1998</year>
;<volume>351</volume>
(<issue>9114</issue>
):<fpage>1477</fpage>
-1482.</citation>
</ref>
<ref><label>41</label>
<citation xlink:type="simple">McGrath N, Bellinger D, Robins J, Msamanga GI, Tronick E, Fawzi WW.
Effect of maternal multivitamin supplementation on the mental and psychomotor
development of children who are born to HIV-1-infected mothers in Tanzania.<source>Pediatrics</source>
.<year>2006</year>
;<volume>117</volume>
(<issue>2</issue>
):<fpage>e216</fpage>
-e225.</citation>
</ref>
<ref id="REF42"><label>42</label>
<citation xlink:type="simple">Villamor E, Saathoff E, Bosch RJ, et al. Vitamin supplementation of
HIV+ women improves postnatal child growth. <source>Am J Clin Nutr</source>
.<year>2005</year>
;<volume>81</volume>
(<issue>4</issue>
):<fpage>880</fpage>
-888.</citation>
</ref>
<ref id="REF43"><label>43</label>
<citation xlink:type="simple">Fawzi WW, Villamor E, Msamanga GI, et al. Trial of zinc supplements
in relation to pregnancy outcomes, hematologic indicators, and T cell counts
among HIV-1-infected women in Tanzania. <source>Am J Clin Nutr</source>
.<year>2005</year>
;<volume>81</volume>
(<issue>1</issue>
):<fpage>161</fpage>
-167.</citation>
</ref>
<ref id="REF44"><label>44</label>
<citation xlink:type="simple">Humphrey JH, Iliff PJ, Marinda ET, et al. Effects of a single large
dose of vitamin A, given during the postpartum period to HIV-positive women
and their infants, on child HIV infection, HIV-free survival, and mortality.<source>J Infect Dis</source>
.<year>2006</year>
;<volume>193</volume>
(<issue>6</issue>
):<fpage>860</fpage>
-871.</citation>
</ref>
<ref id="REF45"><label>45</label>
<citation xlink:type="simple">Humphrey JH, Hargrove JW, Malaba LC, et al. HIV incidence among
post-partum women in Zimbabwe: risk factors and the effect of vitamin A
supplementation. <source>AIDS</source>
.<year>2006</year>
;<volume>20</volume>
(<issue>10</issue>
):<fpage>1437</fpage>
-1446.</citation>
</ref>
<ref id="REF46"><label>46</label>
<citation xlink:type="simple">Kumwenda N, Miotti PG, Taha TE, et al. Antenatal vitamin A
supplementation increases birth weight and decreases anemia among infants born
to human immunodeficiency virus-infected women in Malawi. <source>Clin Infect
Dis</source>
. <year>2002</year>
;<volume>35</volume>
(<issue>5</issue>
):<fpage>618</fpage>
-624.</citation>
</ref>
<ref id="REF47"><label>47</label>
<citation xlink:type="simple">Coutsoudis A, Pillay K, Spooner E, Kuhn L, Coovadia HM. Randomized
trial testing the effect of vitamin A supplementation on pregnancy outcomes
and early mother-to-child HIV-1 transmission in Durban, South Africa. South
African Vitamin A Study Group. <source>AIDS</source>
.<year>1999</year>
;<volume>13</volume>
(<issue>12</issue>
):<fpage>1517</fpage>
-1524.</citation>
</ref>
<ref><label>48</label>
<citation xlink:type="simple">Fawzi WW, Msamanga GI, Hunter D, et al. Randomized trial of vitamin
supplements in relation to transmission of HIV-1 through breastfeeding and
early child mortality. <source>AIDS</source>
.<year>2002</year>
;<volume>16</volume>
(<issue>14</issue>
):<fpage>1935</fpage>
-1944.</citation>
</ref>
<ref id="REF49"><label>49</label>
<citation xlink:type="simple">Wiysonge CS, Shey MS, Sterne JA, Brocklehurst P. Vitamin A
supplementation for reducing the risk of mother-to-child transmission of HIV
infection. <source>Cochrane Database Syst Rev</source>
.<year>2005</year>
;(<issue>4</issue>
):<fpage>CD003648</fpage>
.</citation>
</ref>
<ref id="REF50"><label>50</label>
<citation xlink:type="simple">Fawzi WW, Msamanga GI, Wei R, et al. Effect of providing vitamin
supplements to human immunodeficiency virus-infected, lactating mothers on the
child's morbidity and CD4+ cell counts. <source>Clin Infect Dis</source>
.<year>2003</year>
;<volume>36</volume>
(<issue>8</issue>
):<fpage>1053</fpage>
-1062.</citation>
</ref>
<ref id="REF51"><label>51</label>
<citation xlink:type="simple">Kruzich LA, Marquis GS, Carriquiry AL, Wilson CM, Stephensen CB. US
youths in the early stages of HIV disease have low intakes of some
micronutrients important for optimal immune function. <source>J Am Diet
Assoc</source>
. <year>2004</year>
;<volume>104</volume>
(<issue>7</issue>
):<fpage>1095</fpage>
-1101.</citation>
</ref>
<ref id="REF52"><label>52</label>
<citation xlink:type="simple">Jacobson DL, Spiegelman D, Duggan C, et al. Predictors of bone
mineral density in human immunodeficiency virus-1 infected children. <source>J
Pediatr Gastroenterol Nutr</source>
.<year>2005</year>
;<volume>41</volume>
(<issue>3</issue>
):<fpage>339</fpage>
-346.</citation>
</ref>
<ref id="REF53"><label>53</label>
<citation xlink:type="simple">Campa A, Shor-Posner G, Indacochea F, et al. Mortality risk in
selenium-deficient HIV-positive children. <source>J Acquir Immune Defic Syndr
Hum Retrovirol</source>
.<year>1999</year>
;<volume>20</volume>
(<issue>5</issue>
):<fpage>508</fpage>
-513.</citation>
</ref>
<ref id="REF54"><label>54</label>
<citation xlink:type="simple">Fawzi WW, Mbise RL, Hertzmark E, et al. A randomized trial of
vitamin A supplements in relation to mortality among human immunodeficiency
virus-infected and uninfected children in Tanzania. <source>Pediatr Infect Dis
J</source>
. <year>1999</year>
;<volume>18</volume>
(<issue>2</issue>
):<fpage>127</fpage>
-133.</citation>
</ref>
<ref id="REF55"><label>55</label>
<citation xlink:type="simple">Coutsoudis A, Bobat RA, Coovadia HM, Kuhn L, Tsai WY, Stein ZA. The
effects of vitamin A supplementation on the morbidity of children born to HIV+
women. <source>Am J Public Health</source>
.<year>1995</year>
;<volume>85</volume>
(<issue>8 pt 1</issue>
):<fpage>1076</fpage>
-1081.</citation>
</ref>
<ref id="REF56"><label>56</label>
<citation xlink:type="simple">Bobat R, Coovadia H, Stephen C, et al. Safety and efficacy of zinc
supplementation for children with HIV-1 infection in South Africa: a
randomised double-blind placebo-controlled trial. <source>Lancet</source>
.<year>2005</year>
;<volume>366</volume>
(<issue>9500</issue>
):<fpage>1862</fpage>
-1867.</citation>
</ref>
<ref id="REF57"><label>57</label>
<citation xlink:type="simple">Tremeschin MH, Cervi MC, Camelo Júnior JS, et al. Niacin
nutritional status in HIV type 1-positive children: preliminary data. <source>J
Pediatr Gastroenterol Nutr</source>
.<year>2007</year>
;<volume>44</volume>
(<issue>5</issue>
):<fpage>629</fpage>
-633.</citation>
</ref>
<ref id="REF58"><label>58</label>
<citation xlink:type="simple">Semba RD, Ndugwa C, Perry RT, et al. Effect of periodic vitamin A
supplementation on mortality and morbidity of human immunodeficiency
virus-infected children in Uganda: a controlled clinical trial.<source>Nutrition</source>
.<year>2005</year>
;<volume>21</volume>
(<issue>1</issue>
):<fpage>25</fpage>
-31.</citation>
</ref>
<ref id="REF59"><label>59</label>
<citation xlink:type="simple">Nduati R, John G, Mbori-Ngacha D, et al. Effect of breastfeeding
and formula feeding on transmission of HIV-1: a randomized clinical trial.<source>JAMA</source>
.<year>2000</year>
;<volume>283</volume>
(<issue>9</issue>
):<fpage>1167</fpage>
-1174.</citation>
</ref>
<ref id="REF60"><label>60</label>
<citation xlink:type="simple">Iliff PJ, Piwoz EG, Tavengwa NV, et al. Early exclusive
breastfeeding reduces the risk of postnatal HIV-1 transmission and increases
HIV-free survival. <source>AIDS</source>
.<year>2005</year>
;<volume>19</volume>
(<issue>7</issue>
):<fpage>699</fpage>
-708.</citation>
</ref>
<ref id="REF61"><label>61</label>
<citation xlink:type="simple">Dunn DT, Newell ML, Ades AE, Peckham CS. Risk of human
immunodeficiency virus type 1 transmission through breastfeeding.<source>Lancet</source>
.<year>1992</year>
;<volume>340</volume>
(<issue>8819</issue>
):<fpage>585</fpage>
-588.</citation>
</ref>
<ref id="REF62"><label>62</label>
<citation xlink:type="simple">Kourtis AP, Jamieson DJ, de Vincenzi I, et al. Prevention of human
immunodeficiency virus-1 transmission to the infant through breastfeeding: new
developments. <source>Am J Obstet Gynecol</source>
.<year>2007</year>
;<volume>197</volume>
(<issue>3 suppl</issue>
):<fpage>S113</fpage>
-S122.</citation>
</ref>
<ref id="REF63"><label>63</label>
<citation xlink:type="simple">WHO UUU. <source>Report of a technical consultation held on behalf
of the Inter-agency Task Team (IATT) on Prevention of HIV infections in
pregnant women, mother and their infants</source>. Paper presented at: HIV and
infant feeding: new evidence and programmatic experience;<month>October</month>
<year>2006</year>
; Geneva, Switzerland.</citation>
</ref>
<ref id="REF64"><label>64</label>
<citation xlink:type="simple">Bulteel N, Henderson P. Evidence behind the WHO guidelines:
hospital care for children: what are the risks of formula feeding in children
of HIV+ mothers? <source>J Trop Pediatr</source>
.<year>2007</year>
;<volume>53</volume>
(<issue>6</issue>
):<fpage>370</fpage>
-373.</citation>
</ref>
<ref id="REF65"><label>65</label>
<citation xlink:type="simple">Bulteel N, Henderson P. Evidence behind the WHO guidelines:
hospital care for children: what are the risks of HIV transmission through
breastfeeding? <source>J Trop Pediatr</source>
.<year>2007</year>
;<volume>53</volume>
(<issue>5</issue>
):<fpage>298</fpage>
-302.</citation>
</ref>
<ref id="REF66"><label>66</label>
<citation xlink:type="simple">Newell ML, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P,
Dabis F. Mortality of infected and uninfected infants born to HIV+ mothers in
Africa: a pooled analysis. <source>Lancet</source>
.<year>2004</year>
;<volume>364</volume>
(<issue>9441</issue>
):<fpage>1236</fpage>
-1243.</citation>
</ref>
<ref id="REF67"><label>67</label>
<citation xlink:type="simple">Coovadia HM, Rollins NC, Bland RM, et al. Mother-to-child
transmission of HIV-1 infection during exclusive breastfeeding in the first 6
months of life: an intervention cohort study. <source>Lancet</source>
.<year>2007</year>
;<volume>369</volume>
(<issue>9567</issue>
):<fpage>1107</fpage>
-1116.</citation>
</ref>
<ref id="REF68"><label>68</label>
<citation xlink:type="simple">Becquet R, Ekouevi DK, Menan H, et al. Early mixed feeding and
breastfeeding beyond 6 months increase the risk of postnatal HIV transmission:
ANRS 1201/1202 Ditrame Plus, Abidjan, Cote d'Ivoire. <source>Prev Med</source>
.<year>2008</year>
;<volume>47</volume>
(<issue>1</issue>
):<fpage>27</fpage>
-33.</citation>
</ref>
<ref id="REF69"><label>69</label>
<citation xlink:type="simple">Rollins NC, Becquet R, Bland RM, Coutsoudis A, Coovadia HM, Newell
ML. Infant feeding, HIV transmission and mortality at 18 months: the need for
appropriate choices by mothers and prioritization within programmes.<source>AIDS</source>
.<year>2008</year>
;<volume>22</volume>
(<issue>17</issue>
):<fpage>2349</fpage>
-2357.</citation>
</ref>
<ref id="REF70"><label>70</label>
<citation xlink:type="simple">Kuhn L, Aldrovandi GM, Sinkala M, et al. Effects of early, abrupt
weaning on HIV-free survival of children in Zambia. <source>N Engl J
Med</source>
. <year>2008</year>
;<volume>359</volume>
(<issue>2</issue>
):<fpage>130</fpage>
-141.</citation>
</ref>
<ref id="REF71"><label>71</label>
<citation xlink:type="simple">Palombi L, Marazzi MC, Voetberg A, Magid NA. Treatment acceleration
program and the experience of the DREAM program in prevention of
mother-to-child transmission of HIV. <source>AIDS</source>
.<year>2007</year>
;<volume>21</volume>
(<issue>suppl 4</issue>
):<fpage>S65</fpage>
-S71.</citation>
</ref>
<ref id="REF72"><label>72</label>
<citation xlink:type="simple">Taha TE, Hoover DR, Kumwenda NI, et al. Late postnatal transmission
of HIV-1 and associated factors. <source>J Infect Dis</source>
.<year>2007</year>
;<volume>196</volume>
(<issue>1</issue>
):<fpage>10</fpage>
-14.</citation>
</ref>
<ref id="REF73"><label>73</label>
<citation xlink:type="simple">Thior I, Lockman S, Smeaton LM, et al. Breastfeeding plus infant
zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine
for 1 month to reduce mother-to-child HIV transmission in Botswana: a
randomized trial: the Mashi Study. <source>JAMA</source>
.<year>2006</year>
;<volume>296</volume>
(<issue>7</issue>
):<fpage>794</fpage>
-805.</citation>
</ref>
<ref id="REF74"><label>74</label>
<citation xlink:type="simple">Coutsoudis A, Pillay K, Spooner E, Coovadia HM, Pembrey L, Newell
ML. Morbidity in children born to women infected with human immunodeficiency
virus in South Africa: does mode of feeding matter? <source>Acta
Paediatr</source>
.<year>2003</year>
;<volume>92</volume>
(<issue>8</issue>
):<fpage>890</fpage>
-895.</citation>
</ref>
</ref-list>
</back>
</article>
</istex:document>
</istex:metadataXml>
<mods version="3.6"><titleInfo lang="en"><title>A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With HumanImmunodeficiency Virus Infection</title>
</titleInfo>
<titleInfo type="alternative" lang="en" contentType="CDATA"><title>A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With Human Immunodeficiency Virus Infection</title>
</titleInfo>
<name type="corporate"><namePart>the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors</namePart>
<affiliation>Address correspondence to: Charlene W. Compher, PhD, RD, FADA, LDN, CNSC, University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217; e-mail: compherc@nursing.upenn.edu.</affiliation>
<affiliation>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</affiliation>
</name>
<name type="personal"><namePart type="given">Nasim</namePart>
<namePart type="family">Sabery</namePart>
<affiliation>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Christopher</namePart>
<namePart type="family">Duggan</namePart>
<affiliation>From 1Pediatric Gastroenterology and Nutrition, Children's Hospital Boston, Harvard School of Public Health, Boston, Massachusetts; and 2Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts.</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<typeOfResource>text</typeOfResource>
<genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre>
<originInfo><publisher>SAGE Publications</publisher>
<dateIssued encoding="w3cdtf">2009-NaN</dateIssued>
<copyrightDate encoding="w3cdtf">2009</copyrightDate>
</originInfo>
<language><languageTerm type="code" authority="iso639-2b">eng</languageTerm>
<languageTerm type="code" authority="rfc3066">en</languageTerm>
</language>
<note type="author-notes">Address correspondence to: Charlene W. Compher, PhD, RD, FADA, LDN, CNSC, University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217; e-mail: compherc@nursing.upenn.edu.</note>
<relatedItem type="host"><titleInfo><title></title>
</titleInfo>
<titleInfo type="abbreviated"><title>JPEN J Parenter Enteral Nutr</title>
</titleInfo>
<genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre>
<identifier type="ISSN">0148-6071</identifier>
<identifier type="eISSN">1941-2444</identifier>
<identifier type="PublisherID-hwp">sppen</identifier>
<identifier type="PublisherID-nlm-ta">JPEN J Parenter Enteral Nutr</identifier>
<part><date>2009</date>
<detail type="volume"><caption>vol.</caption>
<number>33</number>
</detail>
<detail type="issue"><caption>no.</caption>
<number>6</number>
</detail>
<extent unit="pages"><start>588</start>
<end>606</end>
</extent>
</part>
</relatedItem>
<identifier type="istex">C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0</identifier>
<identifier type="ark">ark:/67375/M70-GBJXX17D-8</identifier>
<identifier type="DOI">10.1177/0148607109346276</identifier>
<identifier type="href">11JPEN09_588-606</identifier>
<identifier type="local">10.1177_0148607109346276</identifier>
<accessCondition type="use and reproduction" contentType="copyright">American Society for Parenteral and Enteral Nutrition</accessCondition>
<recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-0J1N7DQT-B">sage</recordContentSource>
<recordOrigin>American Society for Parenteral and Enteral
Nutrition</recordOrigin>
</recordInfo>
</mods>
<json:item><extension>json</extension>
<original>false</original>
<mimetype>application/json</mimetype>
<uri>https://api.istex.fr/document/C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0/metadata/json</uri>
</json:item>
</metadata>
<serie></serie>
</istex>
</record>

Pour manipuler ce document sous Unix (Dilib)

EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Istex/Corpus

HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 004105 | SxmlIndent | more

HfdSelect -h $EXPLOR_AREA/Data/Istex/Corpus/biblio.hfd -nk 004105 | SxmlIndent | more

Pour mettre un lien sur cette page dans le réseau Wicri

{{Explor lien
   |wiki=    Wicri/Sante
   |area=    SidaSubSaharaV1
   |flux=    Istex
   |étape=   Corpus
   |type=    RBID
   |clé=     ISTEX:C78875B103CC49CF8B5E01CDE55A2FA8A03AF1B0
   |texte=   A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With HumanImmunodeficiency Virus Infection
}}

This area was generated with Dilib version V0.6.32.
Data generation: Mon Nov 13 19:31:10 2017. Site generation: Wed Mar 6 19:14:32 2024

	Le SIDA en Afrique subsaharienne (serveur d'exploration)
	Attention, ce site est en cours de développement ! Attention, site généré par des moyens informatiques à partir de corpus bruts. Les informations ne sont donc pas validées.

Le SIDA en Afrique subsaharienne (serveur d'exploration)

A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With HumanImmunodeficiency Virus Infection

A.S.P.E.N. Clinical Guidelines: Nutrition Support of Children With HumanImmunodeficiency Virus Infection

Source :

English descriptors

Links to Exploration step

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri