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Human Nutrition and Metabolism

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 Uganda¹

Snehal Shah^*, Christopher Whalen, Donald P. Kotler^**, Harriet Mayanja, Alice Namale, George Melikian, Roy Mugerwa and Richard D. Semba

The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA; Tuberculosis Research Unit, Department of Epidemiology, Case Western Reserve University, Cleveland, OH; Division of Gastroenterology, Department of Medicine, St. Luke’s-Roosevelt Hospital Center, New York, NY; Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD; and Department of Medicine, Makerere University, Kampala, Uganda ^{** *}

²To whom correspondence should be addressed. E-mail: rdsemba{at}jhmi.edu

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 200 cells/µL compared with those who had >200 cells/µL. 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 .

KEY WORDS: • acquired immune deficiency syndrome • AIDS • human immunodeficiency virus infection • HIV • malnutrition • body composition • bioelectrical impedance • tuberculosis

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