Management of SAM in Hivexposed/Hivinfected and TB infected children

  • SAM may occur in children who are HIV exposed/HIV infected. Basic principles & steps of management is same as described earlier.
  • Treatment of malnutrition should be started at a minimum two weeks before the introduction of antiretroviral drugs and other long term treatment to diminish the risk of serious side effects. Preferably antiretroviral treatment should be delayed until the recovery phase is well established.
  • Children with HIV should be given co-trimoxazole prophylaxis against pneumocystis pneumonia. This is inadequate antibiotic cover for the severely malnourished patient; amoxicillin should be given in addition to prophylactic doses of co-trimoxazole.
  • Once SAM is being treated satisfactorily, treatment for HIV and/or TB (as indicated) should be started; national guidelines are to be followed.
  • Cotrimoxazole prophylaxis is to be continued as per NACO guidelines.
  • For severe pneumonia in HIV infected children give adequate anti-staphylococcal and gram-negative antibiotic coverage (e.g. ampicillin and gentamicin). For pneumonia with severe hypoxia, consider Pneumocystis pneumonia. Add high-dose cotrimoxazole (trimethoprim 5 mg/kg/dose, sulfamethoxazole 25 mg/kg/dose) 6-hrly for 3 weeks.