Malnutrition among HIV- infected Children by Anthropometric Measures in Poor Outreach Area of a Developing Country and its Relationship with CD4 Counts

Background: Diagnosis and management of malnutrition in HIV- infected children is important as it is both a manifestation as well as an independent risk factor for death. Extent in hilly poor outreach areas of North India has been poorly studied.  Aim: to study the prevalence of malnutrition among children with HIV/AIDS using WHO z- score and Indian Academy of Pediatrics (IAP) method and effect of malnutrition on immune status. Material and Methods: Setting-Antiretroviral (ART) Centre of a teaching medical college in Uttarakhand-India. Anthropometric measurements (weight, height) and CD4 counts were taken on registration and follow up and duly recorded. Data analysis was done using SPSS -18 and WHO z- score value was calculated using WHO AntroPlus software. Result: A total of 107 children ( 67 male and 40 female) were studied with mean age of 7.15years.Valid z- score could be calculated only for 46 children  and it showed stunting in 69.8%(30/43), wasting in 22.4%(10/46), underweight in 58.9%(27/46). Using IAP method 75% (81/107) had PEM, 85.5% (93/107) stunting. There was no difference between male and female (P>0.05) and no relation between CD4 count and nutritional status (P>0.05). Single dose nevirapine used earlier for Prevention of Parent to Child Transmission (PPTCT) used in 10 newborns resulted in 3/10 HIV negative, 3/10 positive, 4/10 deaths at 18 months. Conclusion: Malnutrition is rampant in children with HIV/AIDS in hilly poor Outreach areas of India. Chronic malnutrition or stunting was the most common abnormality seen in three fourth of all the children. Hence sensitizing health care workers for timely recognition and prompt remedial measures (ART, nutritional interventions) are need of the hour to reduce mortality and prevent growth failure. It also provides baseline data of efficacy of single dose nevirapine to compare efficacy of newer regimes in prevention of PPTCT.