Contribution of tuberculosis to slim disease in Africa.
OBJECTIVE
To assess the contribution of tuberculosis to the aetiology of the HIV wasting syndrome (slim) in Africa, a condition usually considered an enteropathy.


METHODS
Clinical examination and representative necropsy study of adult patients positive for HIV.


METHODS
Hospital medical wards in Abidjan, Ivory Coast.


METHODS
Adults positive for HIV.


METHODS
CD4 T lymphocyte counts before death, clinical and anthropometric data, and gross and microscopic pathology.


RESULTS
Necropsy was done on 212 HIV positive adults. Tuberculosis was found in 41 of 93 with the clinical HIV wasting syndrome and in 32 of 119 without (odds ratio 2.1, 95% confidence interval 1.2 to 4.0). A significant association existed between the prevalence of tuberculosis at necropsy and the degree of cadaveric wasting (no wasting 25% (15/59); moderate wasting 40% (23/58); skeletal wasting 44% (42/95); P = 0.02). Wasting was also associated with a history of chronic diarrhoea, but no association existed between diarrhoea and tuberculosis. Median CD4 T lymphocyte counts were lowest in wasted patients irrespective of findings at necropsy and in those with chronic diarrhoea (< 60 x 10(6)/l).


CONCLUSIONS
Wasting and chronic diarrhoea are late stage manifestations of HIV disease in Africa. The importance of tuberculosis as a contributing factor in the pathogenesis of the slim syndrome has been underestimated. In nearly half of patients dying with severe wasting, tuberculosis was the dominant pathological finding.
Lucas
S B
SB
Department of Histopathology, University College London Medical School.
De Cock
K M
KM
Hounnou
A
A
Peacock
C
C
Diomande
M
M
Hondé
M
M
Beaumel
A
A
Kestens
L
L
Kadio
A
A
D000293:Adolescent; D000328:Adult; D001344:Autopsy; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D002908:Chronic Disease; D003967:Diarrhea / Q000209:etiology / Q000276:immunology; D004614:Emaciation / Q000209:etiology / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D013577:Syndrome; D014376:Tuberculosis / Q000150:complications / Q000276:immunology* / Q000473:pathology