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Association between steatorrhea, growth, and immunologic status in children with perinatally acquired HIV infection.

AbstractOBJECTIVE:
To examine the prevalence of steatorrhea and exocrine pancreatic insufficiency (EPI) and their association with growth and immune status variables in children with perinatally acquired human immunodeficiency virus (HIV) infection.
DESIGN:
Cross-sectional study.
SETTING:
Tertiary care HIV subspecialty practice.
PARTICIPANTS:
Children with perinatally acquired HIV infection. Exclusion criteria included being younger than 1 year and receiving mineral oil as a medication.
METHODS:
Weight, height, and upper arm anthropometric variables were measured. Spot stool samples were analyzed for steatorrhea using the Sudan III qualitative test and for EPI using fecal elastase-1 enzyme assay. Hormone-stimulated pancreatic function testing and 72-hour stool and dietary fat sample collection were performed when fecal elastase-1 enzyme was in the range of EPI, defined as less than 200 microgram/g. HIV RNA viral load, CD4 status, type of antiretroviral therapy, and biochemical evidence of hepatobiliary disease were measured within 3 months of stool sample collection. z Scores were computed for height, weight, triceps skinfold, and upper arm muscle area.
RESULTS:
We enrolled 44 patients (23 girls [52%]) with a mean +/- SD age of 7.4 +/- 3.1 years. None had hepatobiliary disease. The prevalence of steatorrhea was 39% (95% confidence interval, 23%-56%). The prevalence of EPI was 0% (95% confidence interval, 0%-9%). There were no associations between steatorrhea and EPI, growth, HIV RNA viral load, CD4 status, or type of antiretroviral therapy. Older children had decreased z scores for height (r = -0.42; P =.006).
CONCLUSIONS:
The clinical significance of steatorrhea in children with HIV infection is unclear. Furthermore, its evaluation should focus on nonpancreas-based conditions. Continual close monitoring of growth is essential in children with HIV infection.
AuthorsT A Sentongo, R M Rutstein, N Stettler, V A Stallings, B Rudy, A E Mulberg
JournalArchives of pediatrics & adolescent medicine (Arch Pediatr Adolesc Med) Vol. 155 Issue 2 Pg. 149-53 (Feb 2001) ISSN: 1072-4710 [Print] United States
PMID11177089 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
Chemical References
  • Pancreatic Elastase
Topics
  • Celiac Disease (complications, immunology)
  • Child
  • Child Development (physiology)
  • Cross-Sectional Studies
  • Exocrine Pancreatic Insufficiency (complications)
  • Female
  • Growth (immunology)
  • HIV Infections (complications, immunology, physiopathology)
  • Humans
  • Male
  • Pancreas (physiology)
  • Pancreatic Elastase (blood)
  • Perinatology
  • Prevalence

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