title: CD4 counts decline despite nutritional recovery in HIV-infected Zambian children with severe malnutrition.
abstract: 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.
authors.affiliation: 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
authors.forename: Stephen Miles
authors.initials: SM
authors.lastname: Hughes
authors.forename: Beatrice
authors.initials: B
authors.lastname: Amadi
authors.forename: Mwiya
authors.initials: M
authors.lastname: Mwiya
authors.forename: Hope
authors.initials: H
authors.lastname: Nkamba
authors.forename: Georgina
authors.initials: G
authors.lastname: Mulundu
authors.forename: Andrew
authors.initials: A
authors.lastname: Tomkins
authors.forename: David
authors.initials: D
authors.lastname: Goldblatt
mesh_terms: 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