Severity of Human Immunodeficiency Virus Infection Is Associated with Decreased Phase Angle, Fat Mass and Body Cell Mass in Adults with Pulmonary Tuberculosis Infection in Uganda

Abstract

Although coinfection with tuberculosis and human immunodeficiency virus (HIV) is emerging as a major problem in many developing countries, nutritional status has not been well characterized in adults with tuberculosis and HIV infection. We compared nutritional status between 261 HIV-positive and 278 HIV-negative adults with pulmonary tuberculosis in Kampala, Uganda, using anthropometry and bioelectrical impedance analysis. Among 163 HIV-positive and 199 HIV-negative men, intracellular water-to-extracellular water (ICW:ECW) ratio was 1.48 +/- 0.26 and 1.59 +/- 0.48 (P = 0.006) and phase angle was 5.42 +/- 1.05 and 5.76 +/- 1.30 (P = 0.009), respectively. Among 98 HIV-positive and 79 HIV-negative women, ICW:ECW was 1.19 +/- 0.16 and 1.23 +/- 0.15 (P = 0.11) and phase angle was 5.35 +/- 1.27 and 5.43 +/- 0.93 (P = 0.61), respectively. There were no significant differences in BMI, body cell mass, fat mass or fat-free mass between HIV-positive and HIV-negative adults. Among HIV-positive subjects, BMI, ICW:ECW, body cell mass, fat mass and phase angle were significantly lower among those with CD4(+) lymphocytes < or = 200 cells/microL compared with those who had > 200 cells/microL. In sub-Saharan Africa, coinfection with pulmonary tuberculosis and HIV is associated with smaller body cell mass and intracellular water, but not fat-free mass, and by large differences in ICW:ECW and phase angle alpha.

Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis

“…One major consideration is that TBinfected subjects are expected to have lower baseline BMI and FM than those who are TB uninfected. In studies of Wasting in adults with tuberculosis E Villamor et al TB þ /HIVÀ African adults with pulmonary TB (Shah et al, 2001;Van Lettow et al, 2004), including ours, the typical average BMI is around 18-19 kg/m 2 in both men and women. Also, fat percent is usually o8% in men and 20-24% in women, compared to E15 and E31% in TBuninfected men and women from other African settings (Kotler et al, 1999).…”

“…Results on the additional impact of HIV on wasting at these low levels of fat percent in TB-infected subjects are inconsistent. HIV infection was related to lower BMI in some (Niyongabo et al, 1994(Niyongabo et al, , 1999Kennedy et al, 1996) but not all (Shah et al, 2001;Madebo et al, 2003;Van Lettow et al, 2004) these previous studies. We did not find associations between HIV and anthropometric indicators of FM such as BMI or TSF; however, we found that HIV infection was associated with decreased indicators of lean mass such as the AMC, in both men and women.…”

“…BCM (BCM), fat-free mass (FFM), total body water (TBW), and intracellular water (ICW) were estimated from the values of resistance and reactance obtained through BIA, using sex-specific equations validated by Kotler et al (1996) in a sample of white, black, and Hispanic patients that included HIV-infected individuals. These formulas had been previously used in African adults with pulmonary TB (Shah et al, 2001;Van Lettow et al, 2004). FM was calculated as weight minus FFM, and extracellular water (ECW) as TBW minus ICW.…”

“…This question was addressed in anthropometric studies that yielded inconsistent results. While HIV infection was related to decreased BMI among TB-infected adults from Burundi (Niyongabo et al, 1994(Niyongabo et al, , 1999 and Tanzania (Kennedy et al, 1996), no association was found in Uganda (Shah et al, 2001), Ethiopia (Madebo et al, 2003) or Malawi (Van Lettow et al, 2004). The majority of these studies failed to adjust the association between HIV infection and wasting for the potential confounding effects of socioeconomic characteristics and the severity of TB infection.…”

“…In addition, lean mass of TB-infected adults may increase after nutritional supplementation (Paton et al, 2004). A few cross-sectional studies examined the impact of HIV infection on body composition of adults with TB and yielded divergent results; BCM was found to be lower in coinfected men from Malawi (Van Lettow et al, 2004), but not in patients from Uganda (Shah et al, 2001) or Burundi (Niyongabo et al, 1994(Niyongabo et al, , 1999. In Malawi and Uganda, HIV coinfection was related to decreased phase angle, an indicator of cell membrane integrity that has been reported to be predictive of mortality (Ott et al, 1995;Schwenk et al, 2000).…”