Published online January 5, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. e347-e351 (doi:10.1542/peds.2008-1316)
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ARTICLE

CD4 Counts Decline Despite Nutritional Recovery in HIV-Infected Zambian Children With Severe Malnutrition

Stephen Miles Hughes, BSc, MBChBa,b,c, Beatrice Amadi, MD, MMedb, Mwiya Mwiya, BSc, MBChB, MMedb, Hope Nkamba, BScc, Georgina Mulundu, MScc, Andrew Tomkins, FMedScid and David Goldblatt, MD, PhDa

a Immunobiology Unit
d Centre for International Health and Development Institute of Child Health, London, United Kingdom
b Department of Paediatrics and Child Health
c Virology Laboratory, University Teaching Hospital, Lusaka, Zambia

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.

Key Words: CD4 count • HIV infection • severe malnutrition • Zambia

Abbreviations: SM—severe malnutrition • WHO—World Health Organization • WHZ—weight-for-height z score • ART—antiretroviral therapy

Accepted Sep 24, 2008.


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