The GI manifestations of AIDS are not well characterized in children. We reviewed 9 children with congenitally acquired HIV. Clinical symptoms began at a mean age of 7.5 months (3wks-22mos); HIV seropositivity was confirmed at a mean of 20 months (3.5 mos - 5.5 yrs). Seropositive status was present at the time of study or death for a mean of 11.8 months.

RESULTS: 6 of the 9 children had diarrhea and failure to thrive all within the first 9 mo. of life. Stool cultures contained possible pathogens in 6 (1 Candida; 1 enterovirus and Candida; 2 pseudomonas aeruginosa and Candida; 1 pseudomonas and enterovirus; 1 giardia and rotavirus). 3 patients had secretory diarrhea 1 responding to Loperamide. Rectal biopsy showed non-specific colitis in 1; 2 others were normal. 4 patients with diarrhea had small bowel biopsies; 2 were abnormal (1 invasive CMV; 1 non-specific inflammation) Viruslike particles, distinct from CMV, were seen in both by electron microscopy. Five patients had severe failure to thrive and responded to aggressive nutritional therapy, (2 enteral feeds; 3 requiring TPN).

CONCLUSIONS: Differences from experiences in adults with HIV infection include: 1) The spectrum of enteric infections; 2) The timing and severity of the diarrhea and growth failure; these may be related to the immaturity of infants' immune function 3) Aggressive nutritional therapy is important in the rehabilitation of these children.

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