Historical perspectives on the evolution in understanding the importance of nutritional care in pediatric HIV infection

Women, perinatally-infected infants, and sexually exposed and exploited youths and adolescents have become a major focus of the worldwide HIV/AIDS pandemic. Increased perinatal screening, improvement in early infant diagnosis, and the benefits of primary HIV therapies have increased the numbers identified and longevity of infants and children living with HIV. This increase in survival is associated with HIV/AIDS becoming a chronic multiorgan system disease that requires a multidiscipline comprehensive care approach. The combination of poor oral intake, increased loss, and increased metabolic needs of long-term surviving HIV-infected children are obstacles to both survival and quality of life. HIV-infected children and their families need supportive care services including nutritional as well as primary therapy. Clinical guidelines for effective nutrition interventions must be developed to prevent and treat failure to thrive and wasting syndrome. Gains in survival duration must be linked to enhanced quality of life through supportive care, including comprehensive nutritional services that have their efficacy documented by appropriate clinical trials.