title: Effects of HIV infection on the metabolic and hormonal status of children with severe acute malnutrition.
abstract: BACKGROUND
  HIV infection occurs in 30% of children with severe acute malnutrition in sub-Saharan Africa. Effects of HIV on the pathophysiology and recovery from malnutrition are poorly understood.
  
  
  METHODS
  We conducted a prospective cohort study of 75 severely malnourished Ugandan children. HIV status/CD4 counts were assessed at baseline; auxologic data and blood samples were obtained at admission and after 14 days of inpatient treatment. We utilized metabolomic profiling to characterize effects of HIV infection on metabolic status and subsequent responses to nutritional therapy.
  
  
  RESULTS
  At admission, patients (mean age 16.3 mo) had growth failure (mean W/H z-score -4.27 in non-edematous patients) that improved with formula feeding (mean increase 1.00). 24% (18/75) were HIV-infected. Nine children died within the first 14 days of hospitalization; mortality was higher for HIV-infected patients (33% v. 5%, OR = 8.83). HIV-infected and HIV-negative children presented with elevated NEFA, ketones, and even-numbered acylcarnitines and reductions in albumin and amino acids. Leptin, adiponectin, insulin, and IGF-1 levels were low while growth hormone, cortisol, and ghrelin levels were high. At baseline, HIV-infected patients had higher triglycerides, ketones, and even-chain acylcarnitines and lower leptin and adiponectin levels than HIV-negative patients. Leptin levels rose in all patients following nutritional intervention, but adiponectin levels remained depressed in HIV-infected children. Baseline hypoleptinemia and hypoadiponectinemia were associated with increased mortality.
  
  
  CONCLUSIONS
  Our findings suggest a critical interplay between HIV infection and adipose tissue storage and function in the adaptation to malnutrition. Hypoleptinemia and hypoadiponectinemia may contribute to high mortality rates among malnourished, HIV-infected children.
authors: Division of Pediatric Endocrinology and Diabetes, Pediatric Division of Quantitative Sciences, Duke University Medical Center, Durham, North Carolina, United States of America.
authors: Aaloke
authors: A
authors: Mody
authors: Division of Pediatric Endocrinology and Diabetes, Pediatric Division of Quantitative Sciences, Duke University Medical Center, Durham, North Carolina, United States of America.
authors: Sarah
authors: S
authors: Bartz
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, United States of America.
authors: Christoph P
authors: CP
authors: Hornik
authors: Mwanamugimu Nutrition Unit, Mulago Hospital Complex, Kampala, Uganda.
authors: Tonny
authors: T
authors: Kiyimba
authors: Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, United States of America.
authors: James
authors: J
authors: Bain
authors: Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, United States of America.
authors: Michael
authors: M
authors: Muehlbauer
authors: Mwanamugimu Nutrition Unit, Mulago Hospital Complex, Kampala, Uganda.
authors: Elizabeth
authors: E
authors: Kiboneka
authors: Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, United States of America.
authors: Robert
authors: R
authors: Stevens
authors: Global Research & Development, Long Term Research, PepsiCo, Inc., Purchase, New York, United States of America.
authors: John V
authors: JV
authors: St Peter
authors: Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, United States of America.
authors: Christopher B
authors: CB
authors: Newgard
authors: Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina, United States of America.
authors: John
authors: J
authors: Bartlett
authors: Division of Pediatric Endocrinology and Diabetes, Pediatric Division of Quantitative Sciences, Duke University Medical Center, Durham, North Carolina, United States of America; Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, United States of America; Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina, United States of America.
authors: Michael
authors: M
authors: Freemark
mesh_terms: D000208:Acute Disease; D052242:Adiponectin / Q000097:blood; D000596:Amino Acids / Q000097:blood; D015362:Child Nutrition Disorders / Q000097:blood* / Q000401:mortality / Q000628:therapy / Q000821:virology; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000401:mortality; D006801:Humans; D007223:Infant; D020738:Leptin / Q000097:blood; D008297:Male; D016896:Treatment Outcome
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D000596:Amino Acids; D020738:Leptin