Tuberculosis, human immunodeficiency virus infection, and malnutrition in Burundi

In order to compare the nutritional status of tuberculosis (TB) patients wh o were human immunodeficiency virus (HIV)seropositive with those who were s eronegative, we carried out a cross-sectional anthropometric and biochemica l assessment, together with bioelectrical impedance analysis (BIA) of the n utritional status of TB patients hospitalized in the Department of Internal Medicine, Bujumbura University Hospital, Burundi, East Africa. Of the 65 T B patients (33 pulmonary, 6 extrapulmonary, and 26 disseminated TB), 50 (76 .9%) were HIV-seropositive (HIV+). When assessed according to anthropometri c, BIA, and biochemical variables, HIV+ TB patients had more pronounced mal nutrition than HIV- patients. Similar results were obtained when the compar ison was restricted td patients with only pulmonary TB: HIV+ patients were more malnourished than HIV- patients. The results according to anthropometr ic measurements were: weight loss (13.5% of HIV- patients versus 26.4% of H IVS patients, P = 0.005), body mass index (18.6 versus 15.1, P = 0.003), fa t free mass (FFM) (13.9 versus 11.9, P < 0.01), and body fat (BF) (4.55 ver sus 3.71, P = 0.03) expressed per unit height(2). BIA showed that the diffe rence in FFM between HIV- and HIV+ TB pulmonary patients was mostly due to a decrease in body cellular mass. Measurements of albumin, prealbumin, and transferrin showed a marked decrease in all three markers in HIV+ TB pulmon ary patients. The nutritional status of HIV+ patients with disseminated ver sus pulmonary TB was similar. The nutritional status of HIV+ TB patients is far worse than that of HIV- TB patients. In such patients, anthropometry u nderestimates the degree of malnutrition because it does not account for th e water component of FFM. Nutritional status should be assessed and nutriti onal intervention should be provided in an attempt to improve the prognosis of TB patients, especially those who are infected by HIV. Nutrition 1999; 15:289-293. (C) Elsevier Science Inc. 1999.