Duration of Pneumonia and Diarrheal Episodes in HIV-Infected Children

Short-Term Micronutrient Supplementation Reduces the Duration of Pneumonia and Diarrheal Episodes in HIV-Infected Children

The duration of pneumonia and of diarrhoea is reported to be longer in HIV-infected than in uninfected children. The authors assessed the effect of a multi-micronutrient supplement on the duration of hospitalization in HIV-infected children. In a double-blind, randomized trial, HIV-infected children (4-24 mo) who were hospitalized with diarrhoea or pneumonia were enrolled (n = 118) and given a daily dose of a multi-micronutrient supplement (containing vitamins A, B complex, C, D, E, and folic acid, as well as copper, iron, and zinc at levels based on recommended daily allowances) or a placebo until discharge from the hospital. Children's weights and heights were measured after enrolment and micronutrient concentrations were measured before discharge. On recovery from diarrhoea or pneumonia, the children were discharged and the duration of hospitalization was noted. Anthropometric indices and micronutrient concentrations did not differ between children who received supplements and those who received placebos. Overall, the duration of hospitalization was shorter (P <> (7.3 +/- 3.9 days) (mean +/- SD) than in children who were receiving placebos (9.0 +/- 4.9); this was independent of admission diagnosis. In children admitted with diarrhoea, the duration of hospitalization was 1.6 days (19%) shorter among children receiving supplements than in those receiving placebos, and hospitalization for pneumonia was 1.9 days (20%) shorter among children receiving supplements. Short-term multi-micronutrient supplementation significantly reduced the duration of pneumonia or diarrhoea in HIV-infected children who were not yet receiving antiretroviral therapy and who remained alive during hospitalization.

Editors’ note: The role of micronutrient deficiency in HIV infection is not well understood and micronutrient supplementation remains controversial. Further, both pneumonia and diarrhoea can cause micronutrient deficiencies. This study of 118 children with HIV infection admitted to hospital for pneumonia or diarrhoea and randomised to receive a micronutrient supplement or placebo found a significantly shorter duration of hospitalisation for those children receiving the supplement. This both decreased their chance of a hospital-acquired infection and freed up a hospital bed earlier for another child. Unfortunately, no baseline micronutrient levels were established before the supplements began so it is impossible to know to what extent the children were micronutrient deficient in the first place. This area clearly deserves further study to confirm these findings. Even more so, it would be useful to determine whether supplementation might reduce the incidence of diarrhoea and pneumonia, both of which are more common in children with HIV infection.