Nutritional factors associated with oral lesions in HIV disease and TB infection

[摘要] ENGLISH ABSTRACT:Problem Definition: In the context of HIV/AIDS malnutrition is almost universal amongchildren, and of the adverse effects of Protein Energy Malnutrition, the most frequent seems to bethe occurrence of opportunistic infections with micro-organisms such as oral Candida.Objective: The aim of this study was to determine the nutritional status of children with oralcomplications in relation to HIV/AIDS as well as the effects of the oral lesions on nutritionalstatus.Subjects/setting: The subjects of study were 24 children co-infected with TB and HIV who wereadmitted consecutively to the paediatric ward of Brooklyn Chest Hospital in Cape Town, SouthAfrica. The nutritional status of the children was assessed over a maximum period of six monthsby nutrient intake, anthropometric status, and by biochemical parameters and clinical and oralexamination on admission and at discharge from hospital.Results: Children with HIVand TB infection presenting with or without oral lesions weresimilarly malnourished throughout the period of hospitalization. There was no improvement in thenutritional status as indicated by height and weight measurements. Throughout the time ofhospitalization, 7% of the children had a combination of stunting, underweight and wasting.Average nutrient intake was not found to be higher than the Recommended Dietary Allowance(RDA) in any of the children. At the time of admission to hospital and at discharge, carbohydrateintake provided most of the daily energy (36% and 42%, the difference not being statisticallysignificant). There was a significant increase in the intake of energy (p=O.04) and a decrease intotal fat intake (p=O.03) at discharge. Although not significant, mean protein intake at admissionwas higher than at time of discharge.Selected sub-optimal biochemical values were prevalent among the children studied, with 45%and 41% showing low serum albumin values «2.9g/dL) at the time of admission and at dischargerespectively. Both on admission and at discharge, 38% of the children had Haemoglobin levelsbelow normal values. Serum ferritin levels below normal values were present in almost all thechildren and the trend was similar for the prevalence of low zinc values. Sub-normal plasmaretinol was present in 79% of the children at time of admission, while only 21% had deficientvalues at time of discharge (p=O.03). On admission, 29% of the children had vitamin evaluesbelow the normal range whereas at time of discharge 17% of the children had values belownormal (p=O.04).A total of 29% children presented with oral complications on admission. These included oralherpes, oral thrush, reflux, bleeding gums and stomatitis/angular cheilosis. Two children wereasymptomatically colonized with Candida of the oral cavity. Mean total protein intake was higher(p=O.057) among the children who were not diagnosed with oral complications.Conclusions: This study confirmed that malnutrition is not only a common and serious problemassociated with HIVand AIDS, but also that nutritional problems cannot be dealt with in isolationwhere Opportunistic Infections are present. The severity of malnutrition depends on variousfactors including oral complications. Additionally, appropriate management and treatment oftuberculosis did not appear to affect the nutritional status significantly.Recommendations: On the basis of these findings, and because of the increased risk of growthfailure and developmental delays, children should be referred for full nutritional evaluation assoon as possible after diagnosis of HIV -infection. In addition, there is a need for interventionprogrammes to identify the immediate underlying causes of malnutrition and the ways in whichsuch causes interact, in order to ensure that such interventions increase the resistance of HIVinfected infants and children to the disease.

[发布机构] Stellenbosch University