Low Body Mass Index at Treatment Initiation and Rifampicin-Resistant Tuberculosis Treatment Outcomes: An Individual Participant Data Meta-Analysis.

BACKGROUND

The impact of low body mass index (BMI) at initiation of rifampicin-resistant tuberculosis (RR-TB) treatment on outcomes is uncertain. We evaluated the association between BMI at RR-TB treatment initiation and end-of-treatment outcomes.

METHODS

We performed an individual participant data meta-analysis of adults aged ≥18 years with RR-TB whose BMI was documented at treatment initiation. We compared odds of any unfavorable treatment outcome, mortality, or failure/recurrence between patients who were underweight (BMI <18.5 kg/m2) and not underweight. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression, with matching on demographic, clinical, and treatment-related factors. We evaluated effect modification by human immunodeficiency virus (HIV) status and other variables using likelihood ratio tests. We also estimated cumulative incidence of mortality during treatment stratified by HIV.

RESULTS

Overall, 5148 patients were included; 1702 (33%) were underweight at treatment initiation. The median (interquartile range) age was 37 years (29 to 47), and 455 (9%) had HIV. Compared with nonunderweight patients, the aOR among underweight patients was 1.7 (95% CI, 1.4-1.9) for any unfavorable outcome, 3.1 (2.4-3.9) for death, and 1.6 (1.2-2.0) for failure/recurrence. Significant effect modification was found for World Health Organization region of treatment. Among HIV-negative patients, 24-month mortality was 14.8% (95% CI, 12.7%-17.3%) for underweight and 5.6% (4.5%-7.0%) for not underweight patients. Among patients with HIV, corresponding values were 33.0% (25.6%-42.6%) and 20.9% (14.1%-27.6%).

CONCLUSIONS

Low BMI at treatment initiation for RR-TB is associated with increased odds of unfavorable treatment outcome, particularly mortality.

Informations de copyright

© The Author(s) 2022. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: [e-mail].

Déclaration de conflit d'intérêts

Potential conflicts of interest. D. F. is a staff member of the World Health Organization (WHO). I. M. R. reports consulting fees from WHO, DR-TB, for the regional Green Light Committee (rGLC) mission in Pakistan, Yemen, Syria, Jordan, and Lebanon; WHO, drug-resistant tuberculosis(DR-TB) guideline writing for Eastern Mediterranean Regional Office; and WHO, situational analysis of the 10 DR-TB high burden countries after the United Nations High Level Meeting, all paid to self; payment or honoraria for international DR-TB trainings at The Union (on line), International tuberculosis (TB) infection training at The Union (on line), and DR-TB training for Middle East Response countries at international organization for migration, all paid to self; payment for expert testimony from Teladoc Health International (clinical cases, second medical opinion in complex infectious diseases management), paid to self; and participation on Novel triple-dose tuberculosis retreatment regimens (TriDoRe; NCT04260477) and received no payment. S. K. reports support for the present study from the Eli Lilly Foundation (grant to Brigham & Women’s Hospital to support multidrug-resistant tuberculosis (MDR-TB) program supports in Russia; The donor had no involvement in data collection, manuscript preparation, or interpretation.) and Advance Access & Delivery (nongovernmental organization) as a board member. D. M. reports support for the present manuscript through funding provided in 2018–2019 by WHO, ATS/ERS/CDC/IDSA, for establishment of the individual participant data dataset, no funding for this analysis, paid to their institution; participation in scientific advisory committee for 2 trials of MDRTB in South Africa (no honoraria); and served as chair of the Canadian Thoracic Society–TB Committee (unpaid). A. T. reports a grant from Brazilian Ministry of Science, Technology and Innovation, as a direct grant to self outside of the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.