• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of bmjBMJ helping doctors make better decisionsSearch bmj.comLatest content
BMJ. Jun 11, 1994; 308(6943): 1531–1533.
PMCID: PMC2540503

Contribution of tuberculosis to slim disease in Africa.

Abstract

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.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (694K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Serwadda D, Mugerwa RD, Sewankambo NK, Lwegaba A, Carswell JW, Kirya GB, Bayley AC, Downing RG, Tedder RS, Clayden SA, et al. Slim disease: a new disease in Uganda and its association with HTLV-III infection. Lancet. 1985 Oct 19;2(8460):849–852. [PubMed]
  • Colebunders RL, Latif AS. Natural history and clinical presentation of HIV-1 infection in adults. AIDS. 1991;5 (Suppl 1):S103–S112. [PubMed]
  • De Cock KM, Lucas S, Coulibaly D, Coulibaly IM, Soro B. Expansion of surveillance case definition for AIDS in resource-poor countries. Lancet. 1993 Aug 14;342(8868):437–438. [PubMed]
  • Sewankambo N, Mugerwa RD, Goodgame R, Carswell JW, Moody A, Lloyd G, Lucas SB. Enteropathic AIDS in Uganda. An endoscopic, histological and microbiological study. AIDS. 1987 May;1(1):9–13. [PubMed]
  • Lucas SB, Papadaki L, Conlon C, Sewankambo N, Goodgame R, Serwadda D. Diagnosis of intestinal microsporidiosis in patients with AIDS. J Clin Pathol. 1989 Aug;42(8):885–887. [PMC free article] [PubMed]
  • Colebunders R, Lusakumuni K, Nelson AM, Gigase P, Lebughe I, van Marck E, Kapita B, Francis H, Salaun JJ, Quinn TC, et al. Persistent diarrhoea in Zairian AIDS patients: an endoscopic and histological study. Gut. 1988 Dec;29(12):1687–1691. [PMC free article] [PubMed]
  • Conlon CP, Pinching AJ, Perera CU, Moody A, Luo NP, Lucas SB. HIV-related enteropathy in Zambia: a clinical, microbiological, and histological study. Am J Trop Med Hyg. 1990 Jan;42(1):83–88. [PubMed]
  • Kapembwa MS, Fleming SC, Sewankambo N, Serwadda D, Lucas S, Moody A, Griffin GE. Altered small-intestinal permeability associated with diarrhoea in human-immunodeficiency-virus-infected Caucasian and African subjects. Clin Sci (Lond) 1991 Sep;81(3):327–334. [PubMed]
  • Nelson AM, Perriëns JH, Kapita B, Okonda L, Lusamuno N, Kalengayi MR, Angritt P, Quinn TC, Mullick FG. A clinical and pathological comparison of the WHO and CDC case definitions for AIDS in Kinshasa, Zaïre: is passive surveillance valid? AIDS. 1993 Sep;7(9):1241–1245. [PubMed]
  • Lucas SB, Hounnou A, Peacock C, Beaumel A, Djomand G, N'Gbichi JM, Yeboue K, Hondé M, Diomande M, Giordano C, et al. The mortality and pathology of HIV infection in a west African city. AIDS. 1993 Dec;7(12):1569–1579. [PubMed]
  • De Cock KM, Porter A, Kouadio J, Maran M, Gnaore E, Adjorlolo G, Lafontaine MF, Bretton G, Damet GM, Odehouri K, et al. Rapid and specific diagnosis of HIV-1 and HIV-2 infections: an evaluation of testing strategies. AIDS. 1990 Sep;4(9):875–878. [PubMed]
  • Kestens L, Brattegaard K, Adjorlolo G, Ekpini E, Sibailly T, Diallo K, Gigase PL, Gayle H, De Cock KM. Immunological comparison of HIV-1-, HIV-2- and dually-reactive women delivering in Abidjan, Côte d'Ivoire. AIDS. 1992 Aug;6(8):803–807. [PubMed]
  • Nambuya A, Sewankambo N, Mugerwa J, Goodgame R, Lucas S. Tuberculous lymphadenitis associated with human immunodeficiency virus (HIV) in Uganda. J Clin Pathol. 1988 Jan;41(1):93–96. [PMC free article] [PubMed]
  • Grunfeld C, Feingold KR. Metabolic disturbances and wasting in the acquired immunodeficiency syndrome. N Engl J Med. 1992 Jul 30;327(5):329–337. [PubMed]
  • Kotler DP, Tierney AR, Wang J, Pierson RN., Jr Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS. Am J Clin Nutr. 1989 Sep;50(3):444–447. [PubMed]
  • Nahlen BL, Chu SY, Nwanyanwu OC, Berkelman RL, Martinez SA, Rullan JV. HIV wasting syndrome in the United States. AIDS. 1993 Feb;7(2):183–188. [PubMed]
  • Keusch GT, Farthing MJ. Nutritional aspects of AIDS. Annu Rev Nutr. 1990;10:475–501. [PubMed]
  • De Cock KM, Lucas SB, Lucas S, Agness J, Kadio A, Gayle HD. Clinical research, prophylaxis, therapy, and care for HIV disease in Africa. Am J Public Health. 1993 Oct;83(10):1385–1389. [PMC free article] [PubMed]
  • Smith PD, Quinn TC, Strober W, Janoff EN, Masur H. NIH conference. Gastrointestinal infections in AIDS. Ann Intern Med. 1992 Jan 1;116(1):63–77. [PubMed]
  • De Cock KM, Soro B, Coulibaly IM, Lucas SB. Tuberculosis and HIV infection in sub-Saharan Africa. JAMA. 1992 Sep 23;268(12):1581–1587. [PubMed]
  • Scalcini M, Occenac R, Manfreda J, Long R. Pulmonary tuberculosis, human immunodeficiency virus type-1 and malnutrition. Bull Int Union Tuberc Lung Dis. 1991 Mar;66(1):37–41. [PubMed]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...