Page 260 - AIDSBK23C

Page 260

systemic candidiasis. Systemic, recurrent bacterial infections are seen with frequency and may
satisfy definitional criteria for diagnosis of AIDS.[391]
Diarrhea can be a serious problem in HIV-infected infants and appears more frequently,
tends to be more persistent, and has an onset earlier in life than in infants who are not HIV-
infected. Fever, vomiting, anorexia, and dehydration often accompany the diarrheal illness. In
many cases, a pathogen cannot be found. The most common pathogens identified are
cytomegalovirus (particularly involving the cecum), rotavirus and Salmonella species.[1063]
Metabolic complications associated with antiretroviral therapy (ART) are seen in
children. The HIV-associated lipoatrophy (lipodystrophy) described in adults, with dyslipidemia,
fat redistribution, and insulin resistance, also occurs in children. Up to a third of children
receiving ART may be affected.[1064] In addition, there can be growth retardation and
decreased bone mineral density. Mitochondrial toxicity can produce neurologic complications
with hyperlactatemia.[1065]
Granulomas are seen less frequently in children and fewer organisms are present with
either mycobacterial or fungal infections than in adult AIDS patients. The large macrophages
containing Mycobacterium avium-complex (MAC) found throughout the reticuloendothelial
system in some cases may mimic the cells observed with some storage diseases such as Gaucher
disease and Niemann-Pick disease.[1066]