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Journal of Tropical Pediatrics 1993 39(2):93-96; doi:10.1093/tropej/39.2.93
© 1993 by Oxford University Press
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HIV-1 Infection Among Malnourished Children in Butare, Rwanda

Jean-Baptiste Kurawige*,**,, Thèophile Gatsinzi*, Vera Kleinfeldt***, Thomas Rehle{dagger} and Marc Bulterys**,{dagger}{dagger}

*Department of Pediatrics, School of Medicine, National University of Rwanda Butare, Rwanda
**National University of Rwanda-Johns Hopkins University Perinatal AIDS Research Project Butare, Rwanda
***Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ), Ministry of Health AIDS Laboratory Butare, Rwanda
{dagger}Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) Eschborn, Germany
{dagger}{dagger}Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health Baltimore, USA

Correspondence: Dr Jean-Baptiste Kurawige B.P. 399, Butare, Rwanda

In order to investigate the relationship between human immunodeficiency virus (HIV-1) infection and protein-energy malnutrition (PEM), all 101 malnourished children who were admitted to the Department of Pediatrics of the National University Hospital between February and July of 1989 (median age = 2.5 years), and who were accompanied by their mother were screened for HIV-1 antibody. Mothers were also screened and interviewed. Mother-child pairs were followed-up 2 years later to determine mortality and clinical status.

Fourteen per cent of malnourished children were HIV-1 seropositive. Only one seropositive child had a seronegative mother. This child had a history of multiple blood transfusions and injections. Among children above 15 months of age, HIV-1 seropositivity was more common among marasmic children than among malnourished children presenting with oedema at admission to the hospital. Also, HIV-1 infection was found more frequently among chronically malnourished children (low height for age and weight for age) than among acutely malnourished children (low weight for height). Mortality during the 2-year follow-up was 75 per cent among HIV-1 seropositive children and 23 per cent among HIV-1 seronegatives (mortality density ratio = 6.2; 95 per cent confidence interval = 2.2–17.4). Severe, chronic PEM should always alert health workers to the possible diagnosis of pediatric AIDS, and its implications for treatment and prognosis.


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