CD4 Counts Decline Despite Nutritional Recovery in HIV-Infected Zambian Children With Severe Malnutrition

The researchers undertook the current study to establish the contribution that severe malnutrition makes to CD4 lymphopenia in HIV-infected and -uninfected children and to determine the changes in CD4 count during nutritional rehabilitation.

From a pediatric ward in Lusaka, 56 children with severe malnutrition and with or without HIV infection were recruited for measurement of CD4 counts on admission, on discharge, and at final nutritional recovery.

The children with severe malnutrition but without HIV were found to have normal CD4 counts. CD4 counts in HIV-infected children with severe malnutrition were reduced, more so in those without edema compared to those with edema. The mean CD4 count of HIV-infected severely malnourished children fell despite nutritional recovery. At the time of full nutritional recovery, more than 85 percent of the children with HIV required antiretroviral therapy.

"Severe malnutrition did not reduce the CD4 counts of children without HIV," the authors concluded. "HIV-infected children with severe malnutrition may respond well to nutritional rehabilitation, despite low CD4 counts, but nearly all require early antiretroviral therapy to prevent disease progression."