Micronutrients and T-cell subsets: a comparison between HIV-infected and uninfected, severely malnourished Rwandan children

Objective: To determine the levels of CD4+ cells and micronutrients in HIV-infected and uninfected severely malnourished children.

Design: Cross-sectional study in two centres.

Setting: Children admitted to the malnutrition units in Kigali and Butare, Rwanda.

Patients: A total of 112 children aged 2 months to 5 years presenting with severe malnutrition (weight for height Z-score -3 SD +/- oedema). Fifty-two (46.4%) were HIV-infected.

Methods: CD4+ counts, selenium, zinc and copper levels were measured. The percentage of CD4 cells was calculated as a proportion of total lymphocyte count.

Results: The mean age of the 52 HIV-infected children (18 months) was lower than of the 60 uninfected children (26 months) (p=0.01). Six (11.5%) of the HIV-infected had oedematous malnutrition compared with 50% of the uninfected group. The mean (SD) CD4+ count was 1054 (780) in the HIV-infected and 1579 (721) in the uninfected group (p=0.001). The CD4+ count was also significantly lower in the HIV-infected group than in the uninfected group for the ages <12 mths (p=0.09), 12-24 mths (p=0.045) and >36 mths (p=0.001). In HIV-infected children, 17% had severe immunosuppression (<15% CD4+ cells), 33% moderate (15-24%) and 50% had none (>25%) compared with 9%, 12% and 80% in the HIV-uninfected group, respectively (p<0.001). Approximately one-third in both groups had low levels of selenium and zinc and 77% had raised levels of copper. In multivariate analysis there was significant correlation between selenium and CD4+ (r=0.36, p<0.001) in HIV-infected children and no correlation of zinc and copper to CD4+%. In HIV uninfected children, CD4+% was related to selenium (r=0.282, p=0.03) and to zinc (r=0.264, p=0.047) but not to copper.

Conclusions: In severely malnourished children with HIV infection, low CD4+ levels are associated mainly with HIV infection. There was no significant difference in levels of selenium, zinc and copper between HIV-infected and uninfected children.