Impact of tuberculosis on the body composition of HIV-infected men in Brazil

Objective: Tuberculosis (TB) is the commonest HIV-related opportunistic inf ection in many developing countries and is thought to be a frequent underly ing cause of HIV-associated wasting. We have used reference water dilution methods to examine the body composition changes associated with TB and to a ssess the severity and pattern of wasting. Methods: The study was conducted at a charitable support house for poor and homeless HIV-infected people in Rio de Janeiro, Brazil. Male patients who were HIV-positive and receiving treatment for active TB (HIVTB+) and HIV-in fected controls without TB (HIVTB-) were studied. Total body water (TBW) an d extracellular water (ECW) were measured by giving oral doses of deuterium oxide and sodium bromide, respectively, and determining enrichment in plas ma after 4 hours. Intracellular water (ICW), body cell mass (BCM), lean bod y mass (LBM) and fat mass were calculated from these parameters using stand ard equations. Results: HIVTB+ (n = 11) and HIVTB- (n = 12) groups were similar in age, he ight, CD4 count and HIV risk factors. HIVTB+ men had significantly lower me an ICW (13.2 Versus 16.6 kg; p = .02) and BCM (18.4 versus 23.0 kg; p = .02 ), a relative expansion of ECW (35.0 versus 30.0 L/kg body weight; p = .04) , and small and nonsignificant reductions in total body weight (58.0 versus 62.1 kg; p = .26), LBM (45.5 versus 47.7 kg; p = .33) and fat mass (12.5 v ersus 14.4 kg; p = .51) compared with HIVTB- controls. BCM in the HIVTB+ gr oup was similar to reference values for severe malnutrition. The relative d epletion of BCM appeared excessive in comparison with reference values for uncomplicated starvation. Conclusion: The nutritional status of HIVTB+ patients was significantly wor se than HIVTB- patients. Body weight and LBM underestimated the nutritional deficit, and measurement of BCM is therefore necessary to appreciate the e xtent of malnutrition in such patients. Malnutrition in HIVTB+ patients is severe and may therefore contribute to decreased survival. Hypermetabolism appears to play a role in the wasting process in patients coinfected with H IV and TB.