There are anecdotal reports of acute kwashiorkor (oedematous nutrition) developing soon after initiation of antiretroviral therapy (ART) in HIV-infected children in resource-limited settings; this was investigated in 1207 children participating in a trial of ART in Zimbabwe and Uganda. 38 children (3%) were admitted to hospital with acute malnutrition in the first 12 weeks of ART, 19 of them with oedematous malnutrition (their clinical features are summarized). The children who developed oedematous malnutrition had been significantly more immunocompromized at baseline than those with non-oedematous malnutrition or those not hospitalized. There was high mortality among the children hospitalized with either form of malnutrition, but those who survived recovered well both immunologically (the relative improvement being better in the kwashiorkor group) and nutritionally. It is suggested that immune reconstitution inflammatory syndrome may have a role in the aetiology of kwashiorkor in patients like these.
Bwakura-Dangarembizi, M.; Cook, A.; Mugyenyi, P.; Kanywa Barungi, J.; Lutaakome, J.; Nathoo, K.; Crawley, J.; Musiime, V.; Musoke, P.; Nahirya-Ntege, P.; Mhute, T.; Karungi, C.; Kekitiinwa, A.; Munderi, P.; Gibb, D.M. Acute kwashiorkor soon after initiating ART among HIV infected children in the ARROW (AntiRetroviral Research fOr Watoto) trial. Presented at The 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, 19-22 July 2009, and 1st International Workshop on HIV Pediatrics, 17-18 July 2009, Cape Town, South Africa. (2009)