Severe acute malnutrition and HIV in African children.

HIV is a significant cause of severe acute malnutrition (SAM) in Africa, which radically alters its epidemiology and clinical presentation. Clinical diagnosis of HIV is difficult: marasmus, oral candidiasis and persistent diarrhea are associated with HIV, but are also commonly observed in SAM. The same pathogens have been identified in HIV-infected and -uninfected children with SAM, but the former respond less well to treatment. HIV also affects children’s nutrition through food insecurity and infant feeding practice. A threefold greater mortality (30%) occurs in children living with HIV during nutrition program admission and continues after discharge. Nutrition interventions alone are able to achieve a nutritional cure in most HIV-infected children, including those with severe immunodeficiency, although weight gain is slower. Nonresponse to nutritional therapy is a defining WHO clinical criteria for initiating antiretroviral treatment, and malnutrition is the strongest predictor of death after starting a...