The nutritional needs of children with human immunodeficiency virus
infection are poorly understood. Twenty-eight children with vertically transmitted human immunodeficiency virus
infection were evaluated for
carbohydrate malabsorption using
lactose hydrogen breath tests and
d-xylose absorption studies.
Lactose malabsorption was a common finding in human immunodeficiency virus-infected children and occurred in 8 of 20 patients who had no identifiable enteric pathogen.
Lactose malabsorption occurred at an earlier age in human immunodeficiency virus-infected children than in an age-matched group of 45 symptomatic control children (P = 0.02). However,
lactose malabsorption was not associated with higher rates of
diarrhea or growth failure. Abnormalities in
d-xylose absorption were not significantly associated with either
diarrhea or growth failure. However, 39% of
d-xylose studies (9 of 23) showed abnormal results and were significantly associated with enteric
infections (P = 0.004). Abnormalities in small-bowel morphology were found in 4 of 9 children with growth failure, 3 of whom had an enteric
infection and low
d-xylose absorption.
Lactose hydrogen breath testing and
d-xylose testing showed
carbohydrate malabsorption in 61% of children (17 of 28). This study demonstrates that human immunodeficiency virus-infected children are at risk for malabsorptive disorders, which are not always related to clinical symptoms. We speculate that human immunodeficiency virus may be directly involved in the development of
lactose malabsorption.
Carbohydrate malabsorption in human immunodeficiency virus-infected children may not be the only factor responsible for growth failure.