title: Morbidity and nutritional impairment in relation to CD4 count in a Zambian population with high HIV prevalence.
abstract: The HIV epidemic has greatly increased morbidity in many African cities and severe undernutrition is a prominent feature of the clinical presentation. However, there is little information about the relationship of morbidity or nutritional status to immune damage at a population level. We report a cross-sectional study of morbidity and nutritional status in relation to CD4 count in an impoverished urban community in Lusaka, Zambia, at enrollment into a longitudinal study. Over a 2 month period in 1999, 261 (52%) of 506 adults resident in one area were interviewed and examined. Of 186 adults who consented to testing, 33 (51%) of 65 who were HIV seropositive reported symptoms of disease compared to 39 (32%) of 121 who were HIV seronegative (OR 2.2, 95%CI 1.1-4.2; P=0.02). Peripheral blood CD4 counts in HIV seronegative individuals were broadly similar to norms in developed countries, but 8 (7%) had CD4 counts below 500 cells/microl. Morbidity in HIV seropositive adults was dominated by tuberculosis (n=11), other respiratory infections (5) or persistent diarrhoea (4), and affected individuals had a wide range of CD4 counts. Nutritional impairment was evident in HIV seropositive adults with clinical evidence of opportunistic infection (OI), not those with asymptomatic HIV infection. Unexpectedly, we also noted that systolic blood pressure was reduced progressively in HIV infection and in those with OI. In conclusion, HIV-related morbidity was dominated by a small number of treatable infectious diseases occurring over a wide range of CD4 count. Nutritional impairment was associated with OI.
authors.affiliation: Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia. m.p.kelly@qmul.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
authors.forename: Isaac
authors.initials: I
authors.lastname: Zulu
authors.forename: Beatrice
authors.initials: B
authors.lastname: Amadi
authors.forename: Mwansa
authors.initials: M
authors.lastname: Munkanta
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Banda
authors.forename: Laura C
authors.initials: LC
authors.lastname: Rodrigues
authors.forename: David
authors.initials: D
authors.lastname: Mabey
authors.forename: Roger
authors.initials: R
authors.lastname: Feldman
authors.forename: Michael J G
authors.initials: MJ
authors.lastname: Farthing
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000914:Antibodies, Viral / Q000302:isolation & purification*; D001794:Blood Pressure; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D006678:HIV / Q000276:immunology*; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D015995:Prevalence; D014505:Urban Population; D015024:Zambia / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral