Table 2: Selected examples of open research questions in the care of HIV-infected children with severe malnutrition.

ART in malnourished children
 Appropriate medication regimen?
  Changes based on maternal nevirapine exposure?
 Appropriate dosing?
 Optimal timing of initiating ART?
 Adverse effects of ART in malnourished children?
  Clinical or laboratory markers of adverse effects?
  Risk factors or preventive measures for IRIS?
 Interactions with TB medications?

Diarrhea in HIV-infected malnourished children
 Optimal rehydration regimen?
  Modified rehydration solutions (both oral and parenteral)?
 Role for antibiotics or antiparasitics?
 Role for zinc, glutamine, or probiotics?

Nutritional therapy in HIV-infected malnourished children
 Need to modify screening criteria for enrollment into  nutritional care?
  Need to modify criteria for younger (<6 mos) and older   (>5 yrs) children?
 Optimal initial choice of therapeutic food?
 Optimal choice of therapeutic food during transition phase?
 Need to modify criteria for graduation from nutritional care?

Adjuncts to nutritional therapy in HIV-infected malnourished children
 Vitamin A?
 Empiric choice of antibiotics and antiparasitics?

TB diagnosis in HIV-infected malnourished children
 Accuracy of traditional methods for diagnosis (e.g., chest X-ray,  TST)?
 Accuracy of newer methods for diagnosis (e.g., Xpert  MTB/RIF)?

Operational challenges
 How to implement the above findings and guidelines at each  level of care?
  Prenatal and perinatal care?
  Rural health center?
  District hospital?
  Central referral hospital?