1. Study Purpose and Rationale Background

Severe acute malnutrition (SAM) leads to greater than 1 million preventable deaths per year in the developing world among children under 5 years old [1]. Greater than 60 percent of such fatal cases are reported to be associated with HIV infection [1]. Amongst those who survive, morbidity remains high. SAM puts children at risk for severe infections, electrolyte disorders, micronutrient deficiencies, and increased metabolic complications associated with HAART [2], [7]. Limiting these complications is of additional importance in children because of their tendency to stunt both physical and cognitive development. Several mechanisms that work either independently or synergistically have been proposed to explain why SAM occurs so commonly in HIV-infected children [3]. One theory highlights malabsorption secondary to an excessive inflammation of the gut epithelium as the primary factor [3]. Damage to the gut mucosa may lead to a protein-losing enteropathy and a malabsorptive state. This may lead to macro and micronutrient malabsorption, as well as malabsorption of ARVs [4]. Such mucosal changes are believed to be due to local HIV infection of the gut or to secondary enteric co-infections, or