Anthropometry and HIV-Infected Children in Africa
The epicentre of the HIV/AIDS epidemic is in sub-Saharan Africa. There are few data on the growth and anthropometric indices of HIV-infected children in Africa. HIV-infected children are at risk for malnutrition and have unique nutritional needs due to the physiological demands of growth and the infection. Anthropometry is an affordable and noninvasive method of assessment of body composition and can be used to monitor changes in body composition and nutritional risk of HIV-infected children. Measurements in children should include serial measurements of height/length and weight, mid-upperarm circumference, waist circumference and skinfolds in children older than 1 y to reflect fat and lean body mass. These measurements are often the only option in African countries, because more sophisticated methods of body composition assessment are expensive and seldom available. HIV-infected children not receiving HAART had significantly smaller weight-for-age z-score (WAZ) and height/length-for-age z-score (HAZ) than control children. After HAART became more generally available around 2004, studies indicated significantly improved WAZ, but not HAZ, in children from the initiation of HAART to 6–24 months of treatment. Before HAART became available, more than 50% of infants died before attaining the age of 2 y in Uganda, whereas 8–9% of children died in equally resource-limited African countries within the first 12–24 months of receiving HAART. There are indications that HAART improves lean body mass in HIV-infected children, with a delayed effect on linear growth and a trend to an increase in fat mass. Such increase in lean body mass is remarkable, because maintenance and increases in lean body mass can be problematic in HIV-infected children. However, HAART has side effects, such as the lipodystrophy syndrome, characterized by peripheral fat wasting, central fat accumulation and metabolic changes. HIV-infected children in the USA and Europe have been shown to develop lipodystrophy syndrome. No published data of lipodystrophy in HIV-infected children receiving HAART in Africa are currently available, probably due to limited availability of HAART in Africa. It is difficult to use anthropometry to measure lipodystrophy in HIV-infected children due to the changes of normal growth and development that occur during childhood and adolescence. The challenge remains to improve height and reduce protein catabolism in HIV-infected children concomitant to a decrease in viral load to undetectable levels. Anthropometry can detect stunted growth, underweight and excessive fat deposition on the trunk. Appropriate interventions can prevent detrimental effects of both undernutrition and overweight in HIV-infected children in Africa.
KeywordsHuman Immunodeficiency Virus Human Immunodeficiency Virus Infection Lean Body Mass Skinfold Thickness Lipodystrophy Syndrome
Acquired immunodeficiency syndrome
Body mass index
Body mass index-for-age z-score
Dual energy X-ray absorptiometry
Highly active antiretroviral therapy
Human immunodeficiency virus
National Health and Nutrition Examination Survey
World Health Organization
All work for this review was undertaken as part of the academic work of the author at the North-West University, Potchefstroom campus, South Africa.
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