Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Adv Nutr. 2021 Jul 30;12(4):1424-1437. doi: 10.1093/advances/nmaa163.
HIV infection and undernutrition remain significant public health concerns for infants and children. In infants and children under these conditions, undernutrition is one of the leading causes of death. Proper management of nutrition and related nutrition complications in these groups with increased nutrition needs are prominent challenges, particularly in HIV-prevalent poor-resource environments. Several studies support the complexity of the relation between HIV infection, nutrition, and the immune system. These elements interact and create a vicious circle of poor health outcomes. Recent studies on the use of probiotics as a novel approach to manage microbiome imbalance and gut-mucosal impairment in HIV infection are gaining attention. This new strategy could help to manage dysbiosis and gut-mucosal impairment by reducing immune activation, thereby potentially forestalling unwanted health outcomes in children with HIV. However, existing trials on HIV-infected children are still insufficient. There are also conflicting reports on the dosage and effectiveness of single or multiple micronutrient supplementation in the survival of HIV-infected children with severe acute malnutrition. The WHO has published guidelines that include time of initiation of antiretroviral therapy for HIV-pregnant mothers and their HIV-exposed or HIV-infected children, micronutrient supplementation, dietary formulations, prevention, and management of HIV therapy. However, such guidelines need to be reviewed owing to recent advances in the field of nutrition. There is a need for new intervention studies, practical strategies, and evidence-based guidelines to reduce the disease burden, improve adherence to treatment regimen, and enhance the nutrition, health, and well-being of HIV-infected infants and children. This review provides up-to-date scientific information on current knowledge and existing challenges for nutrition therapy in HIV-infected infants and children. Moreover, it presents new research findings that could be incorporated into current guidelines.
HIV 感染和营养不良仍然是婴儿和儿童面临的重大公共卫生问题。在这些情况下的婴儿和儿童中，营养不良是导致死亡的主要原因之一。在这些营养需求增加的人群中，对营养及相关营养并发症进行适当管理是一个突出的挑战，尤其是在 HIV 流行的资源匮乏环境中。多项研究支持 HIV 感染、营养和免疫系统之间关系的复杂性。这些因素相互作用，形成了不良健康结局的恶性循环。最近的研究关注益生菌作为一种管理 HIV 感染中微生物组失衡和肠道黏膜损伤的新方法。这种新策略可以通过减少免疫激活来帮助管理肠道菌群失调和肠道黏膜损伤，从而有可能预防 HIV 儿童出现不良健康结局。然而，针对 HIV 感染儿童的现有试验仍然不足。关于单一或多种微量营养素补充对严重急性营养不良的 HIV 感染儿童的生存的剂量和效果，也存在相互矛盾的报告。世卫组织发布了指南，其中包括为 HIV 感染孕妇及其 HIV 暴露或感染儿童启动抗逆转录病毒治疗的时间、微量营养素补充、饮食配方、预防和管理 HIV 治疗。然而，由于营养领域的最新进展，这些指南需要进行审查。需要开展新的干预研究、制定实用策略和循证指南，以减轻疾病负担，提高对治疗方案的依从性，并增强 HIV 感染婴儿和儿童的营养、健康和幸福感。本综述提供了关于 HIV 感染婴儿和儿童营养治疗的最新科学信息，包括现有知识和挑战。此外，它还介绍了可能被纳入现有指南的新研究结果。
