Nutritional issues and HIV/AIDS: assessment and treatment strategies.

Ongoing nutritional assessment is vital in the care of adults and children with HIV infection. Nutritional deficiency is a common manifestation of HIV disease and results from a variety of factors. Nurses caring for individuals with HIV infection in a variety of settings can be instrumental in identifying nutritional deficits, linking patients with appropriate medical/nutritional support services, and assuring that appropriate nutritional interventions are implemented. This article summarizes etiologies of HIV-associated nutritional deficiencies, reviews important components of nutrition assessment (including nutrition-related side effects of approved medications commonly used in HIV disease), provides an overview of common nutritional problems and interventions, and lists some available nutritional resources.

Lower respiratory tract infections in the pediatric patient.

Lower respiratory tract infections in children are common and vary from relatively self-limited courses to life-threatening presentations. Recognition of disease patterns as they relate to age, sex, race, season, geography, environmental, and socioeconomic conditions is crucial in determining appropriate differential diagnosis and treatment strategies. The majority of children with respiratory infections will present to the primary care provider in an office setting and less frequently may require immediate referral from home or the outpatient setting to an emergency department. For children with recurrent or chronic respiratory infections, referral to a subspecialist may also be necessary. Primary providers are key in determining the extent of diagnostic effort, interventions, referrals, repeat evaluations, and in reinforcing treatment plans with children and their families.

Preliminary evaluation of human immunodeficiency virus type 1 (HIV-1) immunogen in children with HIV-1 infection.

The safety and preliminary activity of human immunodeficiency virus type 1 (HIV-1) immunogen were evaluated in 10 HIV-1-infected children with disease stage N1,2 or A1,2. Multiple inoculations of 2. 5 or 10 units (U) of HIV-1 immunogen were safe and well tolerated without an acceleration of disease progression. When antiretroviral agents were coadministered, the 10 U dose appeared to be associated with more sustained reduction in plasma HIV-1 RNA than the 2.5 U dose (median log10 HIV-1 RNA at month 18, 3.07 vs. 4.01 copies/mL in 10 U [n=4] vs. 2.5 U [n=3], respectively; P=.034). Levels of regulated-on-activation, normal T cell-expressed and -secreted chemokine produced from HIV-1 immunogen-stimulated lymphocytes in vitro were increased in the children who had HIV-1 immunogen-specific antibody responses (P<.02) and appeared to be inversely correlated with levels of plasma HIV-1 RNA (P<.01). These preliminary data warrant larger studies to determine the effectiveness of adjunctive therapy with HIV-1 immunogen in children with HIV-1 infection.