OBJECTIVE: To determine the levels of CD4+ cells and micronutrients in HIV-infected and uninfected severely malnourished children. DESIGN: Cross-sectional study in two centres. SETTING: Children admitted to the malnutrition units in Kigali and Butare, Rwanda. PATIENTS: A total of 112 children aged 2 months to 5 years presenting with severe malnutrition (weight for height Z- score -3 SD +/- oedema). Fifty-two (46.4%) were HIV-infected. METHODS: CD4+ counts, selenium, zinc and copper levels were measured. The percentage of CD4 cells was calculated as a proportion of total lymphocyte count. RESULTS: The mean age of the 52 HIV-infected children (18 months) was lower than of the 60 uninfected children (26 months) (p=0.01). Six (11.5%) of the HIV-infected had oedematous malnutrition compared with 50% of the uninfected group. The mean (SD) CD4+ count was 1054 (780) in the HIV-infected and 1579 (721) in the uninfected group (p=0.001). The CD4+ count was also significantly lower in the HIV-infected group than in the uninfected group for the ages <12 mths (p=0.09), 12-24 mths (p=0.045) and >36 mths (p=0.001). In HIV-infected children, 17% had severe immunosuppression (<15% CD4+ cells), 33% moderate (15-24%) and 50% had none (>25%) compared with 9%, 12% and 80% in the HIV-uninfected group, respectively (p<0.001). Approximately one-third in both groups had low levels of selenium and zinc and 77% had raised levels of copper. In multivariate analysis there was significant correlation between selenium and CD4+ (r=0.36, p<0.001) in HIV-infected children and no correlation of zinc and copper to CD4+ %. In HIV uninfected children, CD4+ % was related to selenium (r=0.282, p=0.03) and to zinc (r=0.264, p=0.047) but not to copper. CONCLUSIONS: In severely malnourished children with HIV infection, low CD4+ levels are associated mainly with HIV infection. There was no significant difference in levels of selenium, zinc and copper between HIV-infected and uninfected children.
OBJECTIVE: To determine the levels of CD4+ cells and micronutrients in HIV-infected and uninfected severely malnourished children. DESIGN: Cross-sectional study in two centres. SETTING:Children admitted to the malnutrition units in Kigali and Butare, Rwanda. PATIENTS: A total of 112 children aged 2 months to 5 years presenting with severe malnutrition (weight for height Z- score -3 SD +/- oedema). Fifty-two (46.4%) were HIV-infected. METHODS:CD4+ counts, selenium, zinc and copper levels were measured. The percentage of CD4 cells was calculated as a proportion of total lymphocyte count. RESULTS: The mean age of the 52 HIV-infectedchildren (18 months) was lower than of the 60 uninfected children (26 months) (p=0.01). Six (11.5%) of the HIV-infected had oedematous malnutrition compared with 50% of the uninfected group. The mean (SD) CD4+ count was 1054 (780) in the HIV-infected and 1579 (721) in the uninfected group (p=0.001). The CD4+ count was also significantly lower in the HIV-infected group than in the uninfected group for the ages <12 mths (p=0.09), 12-24 mths (p=0.045) and >36 mths (p=0.001). In HIV-infectedchildren, 17% had severe immunosuppression (<15% CD4+ cells), 33% moderate (15-24%) and 50% had none (>25%) compared with 9%, 12% and 80% in the HIV-uninfected group, respectively (p<0.001). Approximately one-third in both groups had low levels of selenium and zinc and 77% had raised levels of copper. In multivariate analysis there was significant correlation between selenium and CD4+ (r=0.36, p<0.001) in HIV-infectedchildren and no correlation of zinc and copper to CD4+ %. In HIV uninfected children, CD4+ % was related to selenium (r=0.282, p=0.03) and to zinc (r=0.264, p=0.047) but not to copper. CONCLUSIONS: In severely malnourished children with HIV infection, low CD4+ levels are associated mainly with HIV infection. There was no significant difference in levels of selenium, zinc and copper between HIV-infected and uninfected children.
Authors: Julius Kamwesiga; Vincent Mutabazi; Josephine Kayumba; Jean-Claude K Tayari; Richard Smyth; Heather Fay; Alice Umurerwa; Marcel Baziruwiha; Christian Ntizimira; Antoinette Murebwayire; Jean Pierre Haguma; Julienne Nyiransabimana; Donatille Habarurema; Veneranda Mukarukundo; Jean Bosco Nzabandora; Pascal Nzamwita; Ernestine Mukazayire; Edward J Mills; Dugald Seely; Douglas J McCready; Don Warren Journal: Trials Date: 2011-08-13 Impact factor: 2.279