Nutritional status and its response to treatment of children, with and without HIV infection, hospitalized for the management of tuberculosis

Abstract

Background: The association of childhood tuberculosis (TB) and malnutrition is known, but treatment response, the influence of the acute-phase response (APR) and concomitant HIV infection are not well documented.Aim: To evaluate the nutritional response and APR in HIV-infected and uninfected children hospitalised for the treatment of TB and receiving standard anti-tuberculosis chemotherapy.Methods: During a study of the pharmacokinetics of standard anti-tuberculosis agents, anthropometric parameters were measured and blood concentrations of nutrients and C-reactive protein (CRP) determined at 1 and 4 months after initiation of chemotherapy.Results: 24 HIV-infected and 34 HIV-uninfected children were studied. On enrolment, 31·6% of HIV-infected and 2·9% of HIV-uninfected children were underweight, and 31·6% and 14·7%, respectively, were stunted. Mean values of weight, height/length, head circumference and mid-upper-arm circumference on enrolment and at 4-month assessment in HIV-infected and uninfected children did not differ. Mean triceps skinfold (TSF) (8·17 and 9·73 cm) and subscapular skinfold (SSF) thicknesses (5·75 and 7·5 cm) on enrolment differed significantly (P = 0·03 and P = 0·003); by 4 months, TSF had declined to 5·97 cm (P<0·001) and 8·87 cm (P = 0·05), respectively, and SSF to 5·57 cm (P = 0·79) and 6·73 cm (P = 0·04); the arm muscle area (AMA) was low in a majority of children on enrolment and remained so at the second assessment. CRP was raised in 66·6% and 53·3% of HIV-infected and -uninfected children on enrolment, but at 4-month assessment was raised in 63·2% and 15·2%, respectively. Other micronutrient and haematological findings probably reflect an APR, but no children had sub-normal zinc or magnesium values; most selenium and vitamin C and E values were normal. An elevated platelet count (>420×109/L) was significantly more common in HIV-uninfected children, and was still raised in 39% at 4 months.Conclusion: A majority of HIV-infected and uninfected children had an APR but it had resolved by 4 months in most HIV-uninfected children. In both groups, low and declining skinfolds and a persistently low AMA indicate a persistent disturbance of fat and protein metabolism, despite successful chemotherapy.