Association between steatorrhea, growth, and immunologic status in children with perinatally acquired HIV infection.
OBJECTIVE
To examine the prevalence of steatorrhea and exocrine pancreatic insufficiency (EPI) and their association with growth and immune status variables in children with perinatally acquired human immunodeficiency virus (HIV) infection.


METHODS
Cross-sectional study.


METHODS
Tertiary care HIV subspecialty practice.


METHODS
Children with perinatally acquired HIV infection. Exclusion criteria included being younger than 1 year and receiving mineral oil as a medication.


METHODS
Weight, height, and upper arm anthropometric variables were measured. Spot stool samples were analyzed for steatorrhea using the Sudan III qualitative test and for EPI using fecal elastase-1 enzyme assay. Hormone-stimulated pancreatic function testing and 72-hour stool and dietary fat sample collection were performed when fecal elastase-1 enzyme was in the range of EPI, defined as less than 200 microgram/g. HIV RNA viral load, CD4 status, type of antiretroviral therapy, and biochemical evidence of hepatobiliary disease were measured within 3 months of stool sample collection. z Scores were computed for height, weight, triceps skinfold, and upper arm muscle area.


RESULTS
We enrolled 44 patients (23 girls [52%]) with a mean +/- SD age of 7.4 +/- 3.1 years. None had hepatobiliary disease. The prevalence of steatorrhea was 39% (95% confidence interval, 23%-56%). The prevalence of EPI was 0% (95% confidence interval, 0%-9%). There were no associations between steatorrhea and EPI, growth, HIV RNA viral load, CD4 status, or type of antiretroviral therapy. Older children had decreased z scores for height (r = -0.42; P =.006).


CONCLUSIONS
The clinical significance of steatorrhea in children with HIV infection is unclear. Furthermore, its evaluation should focus on nonpancreas-based conditions. Continual close monitoring of growth is essential in children with HIV infection.
Sentongo
T A
TA
Division of Gastroenterology, Hepatology, and Nutrition, Children's Memorial Medical Center, 2300 Children's Plaza No. 65, Chicago, IL 60614. TSentongo@childrensmemorial.org
Rutstein
R M
RM
Stettler
N
N
Stallings
V A
VA
Rudy
B
B
Mulberg
A E
AE
D002446:Celiac Disease / Q000150:complications* / Q000276:immunology; D002648:Child; D002657:Child Development / Q000502:physiology; D003430:Cross-Sectional Studies; D010188:Exocrine Pancreatic Insufficiency / Q000150:complications; D005260:Female; D006128:Growth / Q000276:immunology; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D008297:Male; D010179:Pancreas / Q000502:physiology; D010196:Pancreatic Elastase / Q000097:blood; D010500:Perinatology; D015995:Prevalence
D010196:Pancreatic Elastase