The Tuberculosis Research Centre has been following a cohort of HIV-infected children from 2001 in Chennai and Madurai cities of Tamil selleck bio Nadu, south India. Data from this study of HIV-infected children provided us with a unique opportunity to describe the prevalence of stunting, underweight, and wasting at presentation and also examine any relationship with age, sex, and stage of the disease. We investigated whether any of these indices of nutritional status could predict the immune status of the child or serve as surrogate markers of disease severity. If so, they could be potentially used in peripheral health care settings, where facilities for sophisticated laboratory monitoring may not be available. 2.

Materials and Methods This was a cross-sectional study of children infected with HIV, between the ages of 0 and 15 years, who were referred to the outpatient clinics of Tuberculosis research Centre (TRC) in the cities of Chennai and Madurai, south India between May 2001 and December 2007. Children already on antiretroviral therapy (ART), in a moribund state, not willing for regular hospital visits or blood draw as per the study protocol were excluded. Children were assessed clinically, examined for physical and mental development, nutritional status, and any evidence of opportunistic infections including tuberculosis. Staging was done using the WHO clinical staging chart [8] and CD4 count and CD4 percentage measured by standard flow cytometric methods using the Beckman Coulter Epics XL. Children were referred for ART initiation if eligible, as per WHO and national guidelines [8].

However, provision of free ART was launched by the government of India in April 2004 and a special pediatric initiative in November 2006. Prior to this, access to ART was limited as very few patients could afford to buy these drugs. The study was approved by the Institutional Ethics committee of TRC and written informed consent was obtained from the parent or legal guardian. Children were included in this analysis if measurements for height and weight were obtained upon enrollment. The Z-scores for weight, height and BMI were computed based on the child’s age and gender using the EPI-NUT component of the EPI-INFO 2002 software package (version 3.4.3) from CDC (based on NCHS reference median values). The WHO Global Database on Child Growth and Malnutrition recommends a cutoff z score of < ?2 to classify low weight-for-age (underweight), low height-for-age (stunting), and low weight-for-height (wasting) as moderate and a z score of GSK-3 < ?3 standard deviations (SD) to define severe undernutrition [6].