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The effect of lactose-free formula feeds on growth responses among severely malnourished HIV-infected children in Durban, South Africa

Edem Binka, Diana Montoya-Fontalvo, Michael Healy, Magdalena Sobieszczyk, Philip LaRussa, Raziya Bobat, Moherndran Archary

Abstract


Background. The co-occurrence of HIV infection and severe malnutrition contributes to high rates of morbidity and mortality among children in resource-limited settings. Lactose-free, ready-to-use therapeutic feeds (RUTFs) may be most appropriate in this population because of underlying mucosal damage secondary to inflammation and infection. 

Objectives. To describe the effect of lactose-free RUTFs on the growth parameters of severely malnourished HIV-infected children in Durban, South Africa (SA).

Methods. This was a prospective, observational study of nutritional recovery in HIV-infected, severely malnourished children, aged 6 months to 5 years, who received lactose-free RUTFs following admission to King Edward VIII Hospital in Durban, SA. The primary outcome was nutritional recovery, defined as 15% weight gain from enrolment to end of study. Secondary outcomes included z-scores for weight-for-height, weight-for-age, height-for-age, triceps skinfold thickness (SFT) and subscapular SFT calculated at baseline and 7, 14, 30 and 45 days after admission. Univariate analysis was done to compare outcomes among antiretroviral therapy (ART)-naive and ART-experienced children; the effect of ART on nutritional recovery was evaluated in a logistic regression model. 

Results. A significant improvement in most nutritional parameters was found at 45 days; 59% of children attained nutritional recovery. There was no significant difference in the proportion of children reaching recovery based on ART status at admission (p=0.08).

Conclusion. Lactose-free formula feeds may be an effective strategy for nutritional rehabilitation of severely malnourished and HIV-infected children in resource-limited settings. It remains to be determined how ART initiation affects nutritional recovery in these children.


Authors' affiliations

Edem Binka, Department of Medicine, Columbia University College of Physicians and Surgeons, Columbia University, New York

Diana Montoya-Fontalvo, Department of Medicine, Columbia University College of Physicians and Surgeons, Columbia University, New York

Michael Healy, Department of Medicine, Columbia University College of Physicians and Surgeons, Columbia University, New York

Magdalena Sobieszczyk, Department of Medicine, Columbia University College of Physicians and Surgeons, Columbia University, New York

Philip LaRussa, Department of Medicine, Columbia University College of Physicians and Surgeons, Columbia University, New York

Raziya Bobat, Paediatric Infectious diseases unit Department of Paediatrics and child health University of KwaZulu Natal

Moherndran Archary, Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban

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Keywords

HIV; severe acute malnutrition; lactose-free; ready-to-use-therapeutic feeds; growth responses

Cite this article

South African Journal of Child Health 2015;9(4):130-132. DOI:10.7196/SAJCH.2015.v9i4.814

Article History

Date submitted: 2014-07-22
Date published: 2015-11-06

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