Management of HIV-infected children under 5 years of age with severe acute malnutrition
In children who are under 5 years of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length or clinical signs of bilateral pitting oedema. A very low mid-upper arm circumference also indicates severe acute malnutrition in children who are 6–59 months of age. Severe acute malnutrition affects an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child deaths each year.
HIV infection and undernutrition often affect the same populations, particularly in resource-limited settings, and moderate or severe acute malnutrition commonly affects HIV-infected children. HIV-infection increases susceptibility to persistent diarrhoea and opportunistic infections which can greatly impact the health of severely malnourished children and HIV-infected children with severe acute malnutrition are nearly three times more likely to die during treatment (for severe acute malnutrition), compared to their HIV-negative counterparts.
WHO recommends that children under 5 years of age with severe acute malnutrition who are HIV-infected and who qualify for lifelong antiretroviral therapy should be started on antiretroviral drug treatment as soon as possible after stabilization of metabolic complications and sepsis.
WHO further recommends that children under 5 years of age with severe acute malnutrition who are HIV-infected should be managed with the same therapeutic feeding approaches as children with severe acute malnutrition who are not HIV-infected.
Additional recommendations are provided within the guideline documents referenced below.
Updates on the management of severe acute malnutrition in infants and children
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection
Antiretroviral therapy for HIV infection in infants and children: Towards universal access Recommendations for a public health approach: 2010 revision
Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings
Other guidance documents
Pocket book of hospital care for children: second edition. Guidelines for the management of common illnesses with limited resources
Guidelines for an integrated approach to nutritional care of HIV-infected children (6 month-14 years)
Diarrhoea treatment guidelines including new recommendations for the use of ORS and zinc supplementation for clinic-based healthcare workers
Management of severe malnutrition: a manual for physicians and other senior health workers