Management of HIV-infected children under 5 years of age with severe acute malnutrition

In children who are under 5 years of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length or clinical signs of bilateral pitting oedema. A very low mid-upper arm circumference also indicates severe acute malnutrition in children who are 6–59 months of age. Severe acute malnutrition affects an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child deaths each year.

HIV infection and undernutrition often affect the same populations, particularly in resource-limited settings, and moderate or severe acute malnutrition commonly affects HIV-infected children. HIV-infection increases susceptibility to persistent diarrhoea and opportunistic infections which can greatly impact the health of severely malnourished children and HIV-infected children with severe acute malnutrition are nearly three times more likely to die during treatment (for severe acute malnutrition), compared to their HIV-negative counterparts.