title: Nutritional status and its response to treatment of children, with and without HIV infection, hospitalized for the management of tuberculosis.
abstract: BACKGROUND
  The association of childhood tuberculosis (TB) and malnutrition is known, but treatment response, the influence of the acute-phase response (APR) and concomitant HIV infection are not well documented.
  
  
  OBJECTIVE
  To evaluate the nutritional response and APR in HIV-infected and uninfected children hospitalised for the treatment of TB and receiving standard anti-tuberculosis chemotherapy.
  
  
  METHODS
  During a study of the pharmacokinetics of standard anti-tuberculosis agents, anthropometric parameters were measured and blood concentrations of nutrients and C-reactive protein (CRP) determined at 1 and 4 months after initiation of chemotherapy.
  
  
  RESULTS
  24 HIV-infected and 34 HIV-uninfected children were studied. On enrollment, 31.6% of HIV-infected and 2.9% of HIV-uninfected children were underweight, and 31.6% and 14.7%, respectively, were stunted. Mean values of weight, height/length, head circumference and mid-upper-arm circumference on enrollment and at 4-month assessment in HIV-infected and uninfected children did not differ. Mean triceps skinfold (TSF) (8.17 and 9.73 cm) and subscapular skinfold (SSF) thicknesses (5.75 and 7.5 cm) on enrollment differed significantly (P = 0.03 and P = 0.003); by 4 months, TSF had declined to 5.97 cm (P<0.001) and 8.87 cm (P = 0.05), respectively, and SSF to 5.57 cm (P = 0.79) and 6.73 cm (P = 0.04); the arm muscle area (AMA) was low in a majority of children on enrollment and remained so at the second assessment. CRP was raised in 66.6% and 53.3% of HIV-infected and -uninfected children on enrollment, but at 4-month assessment was raised in 63.2% and 15.2%, respectively. Other micronutrient and haematological findings probably reflect an APR, but no children had sub-normal zinc or magnesium values; most selenium and vitamin C and E values were normal. An elevated platelet count (> 420 × 10(9)/L) was significantly more common in HIV-uninfected children, and was still raised in 39% at 4 months.
  
  
  CONCLUSIONS
  A majority of HIV-infected and uninfected children had an APR but it had resolved by 4 months in most HIV-uninfected children. In both groups, low and declining skinfolds and a persistently low AMA indicate a persistent disturbance of fat and protein metabolism, despite successful chemotherapy.
authors.affiliation: Department of Paediatrics & Child Health, Stellenbosch University, Cape Town, South Africa. hss@sun.ac.za
authors.forename: H Simon
authors.initials: HS
authors.lastname: Schaaf
authors.forename: Karien
authors.initials: K
authors.lastname: Cilliers
authors.forename: Marianne
authors.initials: M
authors.lastname: Willemse
authors.forename: Demetre
authors.initials: D
authors.lastname: Labadarios
authors.forename: Martin
authors.initials: M
authors.lastname: Kidd
authors.forename: Peter R
authors.initials: PR
authors.lastname: Donald
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology; D000210:Acute-Phase Reaction / Q000209:etiology; D000886:Anthropometry; D000995:Antitubercular Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000150:complications; D018977:Micronutrients / Q000097:blood; D009752:Nutritional Status; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents; D018977:Micronutrients; D002097:C-Reactive Protein