NUTRITIONAL EVALUATION AND INTERVENTION OF HIV INFECTED INFANTS AND CHILDREN

在过去的五年里，我们成功地前瞻性地收集了100多名感染艾滋病毒的儿童的生长和营养数据，并控制了这些儿童。我们已经确定了这些儿童在生长、身体成分、能量利用、细胞因子产生和有效营养干预计划方面的变化。在这一竞争中，更新将继续收集关于这一独特的艾滋病毒感染儿童队列的生长、身体成分、饮食摄入量和能量利用的数据。由于儿科艾滋病毒的面貌每一次都在发生变化，因此在出现新的治疗方案之前很早就对这些儿童进行持续的评估和跟踪是非常宝贵的。我们将通过在儿童HIV临床谱(CDC A、B、C级和对照组)中使用13C亮氨酸进行全身蛋白质周转研究来量化蛋白质代谢，因为我们知道这些儿童的瘦体重随着时间的推移有显著的下降。我们将确定蛋白质周转、病毒活性和其他感染结果之间是否存在关联。此外，随着蛋白酶抑制剂(PI)和其他高效抗逆转录病毒疗法(HAART)的出现，身体成分的变化和临床结果的改善是显而易见的。我们将通过身体成分研究来量化和描述这些变化，这些研究将研究脂肪分布的区域化，并通过新的治疗方法纵向跟踪变化。我们还将确定这些儿童是否存在明显的糖代谢异常，并可能导致脂肪再分配综合征。最后提出了通过锻炼计划增加瘦体重和功能的实用干预措施，这对艾滋病毒和一般儿科来说都是独一无二的。我们将确定12周的锻炼方案，并加强户外活动，是否在改善HIV感染儿童的瘦体重、力量、耐力、灵活性和功能状态方面有效，同时将他们与“注意”对照组进行比较。

Over the past five years, we have been successfully able to prospectively collect growth and nutrition data on over 100 HIV-infected and control children. We have determined changes in growth, body composition, energy utilization, cytokine production, and effective nutritional intervention programs for these children. In this competing renewal will continue to collect data on growth, body composition, dietary intake, and energy utilization on this unique cohort of HIV-infected children. As the face of pediatric HIV is every changing, capture and continued assessment and follow-up of these children with very early preceding the advent of newer therapeutic regimens is invaluable. We will quantitate protein metabolism through whole body protein turnover studies using 13C leucine in the clinical spectrum of HIV in children (CDC class A,B,C, and controls), knowing that there are significant declines in lean body mass in these children over time. We will determine if there are associations between protein turnover, viral activity, and other infectious outcomes. As well, with the advent of protease inhibitors (PIs) and other highly active anti-retroviral therapies (HAART), changes in body composition and improved clinical outcomes are apparent. We will quantitate and characterize these changes through body composition studies that study regionalization of fat distribution and follow changes longitudinally and with new therapies. We will also determine if abnormal glucose metabolism is apparent in these children and may potentially led to the fat redistribution syndrome. Lastly practical interventions to increase lean body mass and function through exercise programs are proposed and are unique both to HIV, as well as pediatrics in general. We will determine if a 12 week exercise regimen, with reinforcement of outside activities are effective in improving lean body mass, strength, endurance, flexibility, and functional status in HIV-infected children while comparing them to an "attention" control group.