Micronutrients and T-cell subsets: a comparison between HIV-infected and uninfected, severely malnourished Rwandan children.
OBJECTIVE
To determine the levels of CD4+ cells and micronutrients in HIV-infected and uninfected severely malnourished children.


METHODS
Cross-sectional study in two centres.


METHODS
Children admitted to the malnutrition units in Kigali and Butare, Rwanda.


METHODS
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.
Ndagije
F
F
Liverpool School of Tropical Medicine, Liverpool, UK.
Baribwira
C
C
Coulter
J B S
JB
D000886:Anthropometry; D018791:CD4 Lymphocyte Count; D002675:Child, Preschool; D003300:Copper / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000097:blood* / Q000150:complications / Q000276:immunology; D018977:Micronutrients / Q000097:blood*; D012643:Selenium / Q000097:blood; D016176:T-Lymphocyte Subsets / Q000276:immunology; D015032:Zinc / Q000097:blood
D018977:Micronutrients; D003300:Copper; D012643:Selenium; D015032:Zinc