CD4 counts decline despite nutritional recovery in HIV-infected Zambian children with severe malnutrition.
OBJECTIVE
The objective of this study was to establish the contribution that severe malnutrition makes to CD4 lymphopenia in HIV-infected and uninfected children and to determine the changes in CD4 count during nutritional rehabilitation.


METHODS
Fifty-six children with severe malnutrition and with and without HIV infection were recruited from a pediatric ward in Lusaka for measurement of CD4 counts on admission, on discharge, and at final nutritional recovery.


RESULTS
HIV-uninfected children with severe malnutrition had normal CD4 counts. In contrast, CD4 counts in HIV-infected children with severe malnutrition were reduced, more so in those without edema compared with those with edema. Mean CD4 count of HIV-infected SM children fell despite nutritional recovery so that at the time of full nutritional recovery, >85% of HIV-infected children required antiretroviral therapy.


CONCLUSIONS
Severe malnutrition did not reduce the CD4 counts of children without HIV. HIV-infected children with severe malnutrition may respond well to nutritional rehabilitation, despite low CD4 counts, but nearly all require early antiretroviral therapy to prevent disease progression.
Hughes
Stephen Miles
SM
Immunobiology Unit, and Centre for International Health and Development, Institute of Child Health, 30 Guilford St, London, United Kingdom, WC1N 1EH. s.hughes@ich.ucl.ac.uk
Amadi
Beatrice
B
Mwiya
Mwiya
M
Nkamba
Hope
H
Mulundu
Georgina
G
Tomkins
Andrew
A
Goldblatt
David
D
D018791:CD4 Lymphocyte Count; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology*; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000209:etiology* / Q000534:rehabilitation*; D012720:Severity of Illness Index; D015024:Zambia