RESUMO
OBJECTIVE: Tuberculosis (TB) is the commonest HIV-related opportunistic infection in many developing countries and is thought to be a frequent underlying cause of HIV-associated wasting. We have used reference water dilution methods to examine the body composition changes associated with TB and to assess 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-infected controls without TB (HIVTB-) were studied. Total body water (TBW) and extracellular water (ECW) were measured by giving oral doses of deuterium oxide and sodium bromide, respectively, and determining enrichment in plasma after 4 hours. Intracellular water (ICW), body cell mass (BCM), lean body mass (LBM) and fat mass were calculated from these parameters using standard equations. RESULTS: HIVTB+ (n = 11) and HIVTB- (n = 12) groups were similar in age, height, CD4 count and HIV risk factors. HIVTB+ men had significantly lower mean 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 versus 14.4 kg; p = .51) compared with HIVTB- controls. BCM in the HIVTB+ group was similar to reference values for severe malnutrition. The relative depletion of BCM appeared excessive in comparison with reference values for uncomplicated starvation. CONCLUSION: The nutritional status of HIVTB+ patients was significantly worse than HIVTB- patients. Body weight and LBM underestimated the nutritional deficit, and measurement of BCM is therefore necessary to appreciate the extent 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 HIV and TB.
PIP: This paper examines the impact of tuberculosis (TB) on the body composition of HIV-positive men with treatment for active TB (HIV/TB+) and HIV-infected men without TB (HIV/TB-) in Brazil. Total body water (TBW) and extracellular water (ECW) were measured by giving oral doses of deuterium oxide and sodium bromide, respectively, and determining the enrichment in plasma after 4 hours. Calculated from these parameters are the intracellular water (ICW), body cell mass (BCM), lean body mass (LBM) and fat mass. Age, height, CD4 count and HIV risk factors were similar among HIV/TB+ (n = 11) and HIV/TB- (n = 12). HIV/TB+ patients had significantly lower mean ICW (13.2 vs. 16.6 kg) and BCM (18.4 vs. 23 kg), a relative expansion of ECW (35 vs. 30 l/kg body weight, nonsignificant reductions in TBW (58 vs. 62.1 kg), LBM (45.5 vs. 47.7 kg) and fat mass (12.5 vs. 14.4 kg) compared with HIV/TB- men. Nutritional status was found to be significantly worse among HIV+ patients. Malnutrition was also severe in HIV/TB+ patients, which contributed to a decreased life span. Hypermetabolism appears to play a role in the wasting process of patients with HIV and TB. To improve physical function, quality of life, and survival among HIV-infected patients with TB, optimization of nutritional status should be at the core of treatment.