Nutritional status and its response to treatment of children, with and without HIV infection, hospitalized for the management of tuberculosis

被引:13
作者
Schaaf, H. Simon [1 ,3 ]
Cilliers, Karien [2 ]
Willemse, Marianne [1 ,3 ]
Labadarios, Demetre [5 ]
Kidd, Martin [4 ]
Donald, Peter R. [1 ,3 ]
机构
[1] Univ Stellenbosch, Dept Paediat & Child Hlth, Fac Hlth Sci, ZA-7505 Tygerberg, South Africa
[2] Univ Stellenbosch, Dept Human Nutr, Fac Hlth Sci, ZA-7505 Tygerberg, South Africa
[3] Univ Stellenbosch, Tygerberg Childrens Hosp, ZA-7505 Tygerberg, South Africa
[4] Univ Stellenbosch, Ctr Stat Consultat, ZA-7505 Tygerberg, South Africa
[5] Human Sci Res Council, Cape Town, South Africa
关键词
Children; Tuberculosis; Nutritional status; Acute-phase response; HIV; Treatment response; ACUTE-PHASE RESPONSE; C-REACTIVE PROTEIN; PULMONARY TUBERCULOSIS; BODY-COMPOSITION; PLASMA-CONCENTRATIONS; AFRICAN PATIENTS; ENDEMIC AREA; IRON STATUS; SERUM; MALNUTRITION;
D O I
10.1179/2046905512Y.0000000008
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
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. Aim: 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 enrolment, 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 enrolment 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 enrolment 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 enrolment and remained so at the second assessment. CRP was raised in 66.6% and 53.3% of HIV-infected and -uninfected children on enrolment, 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 (>420x10(9)/L) was significantly more common in HIV-uninfected children, and was still raised in 39% at 4 months. Conclusion: 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.
引用
收藏
页码:74 / 81
页数:8
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