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Association Between Steatorrhea, Growth, and Immunologic Status in Children With Perinatally Acquired HIV Infection
Timothy A. Sentongo, MD;
Richard M. Rutstein, MD;
Nicolas Stettler, MD;
Virginia A. Stallings, MD;
Bret Rudy, MD;
Andrew E. Mulberg, MD
Arch Pediatr Adolesc Med. 2001;155:149-153.
Objective To examine the prevalence of steatorrhea and exocrine pancreatic insufficiency
(EPI) and their association with growth and immune status variables in children
with perinatally acquired human immunodeficiency virus (HIV) infection.
Design Cross-sectional study.
Setting Tertiary care HIV subspecialty practice.
Participants Children with perinatally acquired HIV infection. Exclusion criteria
included being younger than 1 year and receiving mineral oil as a medication.
Methods Weight, height, and upper arm anthropometric variables were measured.
Spot stool samples were analyzed for steatorrhea using the Sudan III qualitative
test and for EPI using fecal elastase-1 enzyme assay. Hormone-stimulated pancreatic
function testing and 72-hour stool and dietary fat sample collection were
performed when fecal elastase-1 enzyme was in the range of EPI, defined as
less than 200 µg/g. HIV RNA viral load, CD4 status, type of antiretroviral
therapy, and biochemical evidence of hepatobiliary disease were measured within
3 months of stool sample collection. z Scores were
computed for height, weight, triceps skinfold, and upper arm muscle area.
Results We enrolled 44 patients (23 girls [52%]) with a mean ± SD age
of 7.4 ± 3.1 years. None had hepatobiliary disease. The prevalence
of steatorrhea was 39% (95% confidence interval, 23%-56%). The prevalence
of EPI was 0% (95% confidence interval, 0%-9%). There were no associations
between steatorrhea and EPI, growth, HIV RNA viral load, CD4 status, or type
of antiretroviral therapy. Older children had decreased z scores for height (r = -0.42; P = .006).
Conclusions The clinical significance of steatorrhea in children with HIV infection
is unclear. Furthermore, its evaluation should focus on nonpancreas-based
conditions. Continual close monitoring of growth is essential in children
with HIV infection.
From the Divisions of Gastroenterology and Nutrition (Drs Sentongo,
Stettler, Stallings, and Mulberg) and General Pediatrics (Drs Rutstein and
Rudy), The Children's Hospital of Philadelphia, University of Pennsylvania
School of Medicine, Philadelphia. Dr Sentongo is now with the Division of
Gastroenterology, Hepatology, and Nutrition, Children's Memorial Medical Center,
Northwestern University School of Medicine, Chicago, Ill.
Corresponding author and reprints: Timothy A. Sentongo, MD, Division
of Gastroenterology, Hepatology, and Nutrition, Children's Memorial Medical
Center, 2300 Children's Plaza No. 65, Chicago, IL 60614 (e-mail: TSentongo{at}childrensmemorial.org).
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