CONTRIBUTION OF TUBERCULOSIS TO SLIM DISEASE IN AFRICA

Objectives-To assess the contribution of tuberculosis to the aetiology of the HIV wasting syndrome (slim) in Africa, a condition usually con sidered an enteropathy. Methods-Clinical examination and representativ e necropsy study of adult patients positive for HIV. Setting-Hospital medical wards in Abidjan, Ivory Coast. Subjects-Adults positive for HI V. Main outcome measures-CD4 T lymphocyte counts before death, clinica l and anthropometric data, and gross and microscopic pathology. Result s-Necropsy was done on 212 HIV positive adults. Tuberculosis was found in 41 of 93 with the clinical HIV wasting syndrome and in 32 of 119 w ithout (odds ratio 2.1, 95% confidence interval 1.2 to 4.0). A signifi cant association existed between the prevalence of tuberculosis at nec ropsy and the degree of cadaveric wasting (no wasting 25% (15/59); mod erate wasting 40% (23/58); skeletal wasting 44% (42/95); P=0.02). Wast ing was also associated with a history of chronic diarrhoea, but no as sociation existed between diarrhoea and tuberculosis. Median CD4 T lym phocyte counts were lowest in wasted patients irrespective of findings at necropsy and in those with chronic diarrhoea (<60x10(6)/l). Conclu sion-Wasting and chronic diarrhoea are late stage manifestations of HI V disease in Africa. The importance of tuberculosis as a contributing factor in the pathogenesis of the slim syndrome has been underestimate d. In nearly half of patients dying with severe wasting, tuberculosis was the dominant pathological finding.