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1994-08-09
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Document 0169
DOCN M9480169
TI Contribution of tuberculosis to slim disease in Africa.
DT 9410
AU Lucas SB; De Cock KM; Hounnou A; Peacock C; Diomande M; Honde M; Beaumel
A; Kestens L; Kadio A; Department of Histopathology, University College
London Medical; School.
SO BMJ. 1994 Jun 11;308(6943):1531-3. Unique Identifier : AIDSLINE
MED/94290200
AB OBJECTIVES--To assess the contribution of tuberculosis to the aetiology
of the HIV wasting syndrome (slim) in Africa, a condition usually
considered an enteropathy. METHODS--Clinical examination and
representative necropsy study of adult patients positive for HIV.
SETTING--Hospital medical wards in Abidjan, Ivory Coast.
SUBJECTS--Adults positive for HIV. MAIN OUTCOME MEASURES--CD4 T
lymphocyte counts before death, clinical and anthropometric data, and
gross and microscopic pathology. RESULTS--Necropsy was done on 212 HIV
positive adults. Tuberculosis was found in 41 of 93 with the clinical
HIV wasting syndrome and in 32 of 119 without (odds ratio 2.1, 95%
confidence interval 1.2 to 4.0). A significant association existed
between the prevalence of tuberculosis at necropsy and the degree of
cadaveric wasting (no wasting 25% (15/59); moderate wasting 40% (23/58);
skeletal wasting 44% (42/95); P = 0.02). Wasting was also associated
with a history of chronic diarrhoea, but no association existed between
diarrhoea and tuberculosis. Median CD4 T lymphocyte counts were lowest
in wasted patients irrespective of findings at necropsy and in those
with chronic diarrhoea (< 60 x 10(6)/l). CONCLUSION--Wasting and chronic
diarrhoea are late stage manifestations of HIV disease in Africa. The
importance of tuberculosis as a contributing factor in the pathogenesis
of the slim syndrome has been underestimated. In nearly half of patients
dying with severe wasting, tuberculosis was the dominant pathological
finding.
DE Adolescence Adult Autopsy Chronic Disease
Diarrhea/ETIOLOGY/IMMUNOLOGY Emaciation/ETIOLOGY/*IMMUNOLOGY Female
Human HIV Infections/COMPLICATIONS/*IMMUNOLOGY Leukocyte Count Male
Support, Non-U.S. Gov't Syndrome
Tuberculosis/COMPLICATIONS/*IMMUNOLOGY/PATHOLOGY T4
Lymphocytes/*IMMUNOLOGY JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).