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Weight Loss
 A mother tells you her HIV-infected child has been losing weight. What advice would you give her?
 HIV infection itself, as well as complicating infections and febrile illnesses, can cause an increase in metabolic rate, which can lead to weight loss. Highly active antiretroviral therapy (HAART) helps control HIV infection, promoting normal growth and weight gain. However, certain medications, including some antiretroviral drugs, potentially can cause a decrease in appetite, nausea, vomiting, and diarrhea.
Children with HIV and weight loss often need to increase their calorie intake to 150% to 200% of their normal intake to prevent further weight loss and promote growth and adequate weight gain. It is important to obtain a thorough history from the mother regarding the patient's eating habits. A well balanced diet is very important, one that includes adequate protein, carbohydrate and fat. Good protein sources are eggs, pasteurized (and powdered) milk, yogurt and cheeses, meat, fish, poultry, nuts, and beans. Carbohydrates such as fruits and vegetables are not high in calories but provide important vitamins and minerals. Carbohydrates such as cereals, grains, bread, rice, potatoes and noodles are good sources of calories. Fats such as oil, butter, margarine, and meat gravies are very concentrated sources of calories and are good to add to food to increase calories. Foods need to be well cooked to avoid any potential food borne illnesses.
Small frequent meals sometimes are tolerated better than are larger meals if a patient is not feeling well. If the patient has a sore throat or has trouble swallowing, softer foods can be easier to eat. It is important for the caregiver to be aware of how much the child is eating and if possible, to keep a record of intake in case the child continues to lose weight. Follow up visits are important to monitor the child's weight and growth.
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