Background:
Tuberculosis (TB) is frequently associated with malnutrition and wasting, a relationship further complicated by HIV infection. While weight change during treatment can inform the host’s response to therapy, its predictive value for overall treatment success remains unclear when potentially confounded by HIV status. Understanding how these factors interact is critical for identifying patients at high risk for unsuccessful outcomes.
Abstract:
Methods: This prospective cohort study followed 547 adults with culture-confirmed, drug-susceptible pulmonary TB in Brazil. Median weight change was examined two months after treatment initiation by HIV status, and unsuccessful outcomes (failure, recurrence, or death) were evaluated using Cox and mediation analyses.
Results: Overall, 19% of participants were HIV-positive, and 6% experienced an unsuccessful treatment outcome. After adjusting for confounders, persons living with HIV (PLWH) gained a median of 1.3 kg less than HIV-negative individuals during the first two months. PLWH were significantly more likely to have an unsuccessful outcome (aHR = 4.8). Each 1 kg increase in weight during the first two months was associated with a 12% decrease in the risk of failure, recurrence, or death.
Conclusion: HIV infection and a lack of early weight gain are independent and powerful predictors of poor TB treatment outcomes. Weight monitoring serves as a simple, low-cost biomarker to identify patients who may require alternative or intensified treatment strategies.
Keywords: Tuberculosis, HIV, body weight changes, treatment outcome, observational study.
Clique aqui
- Data de Publicação: 28/11/2019
- Autores: Lauren S. Peetluk, MPH,1 Peter F. Rebeiro, PhD, MHS, 1,2 Marcelo Cordeiro-Santos, MD, PhD,3,4 Afranio Kritski, MD, PhD,4,5 Bruno B. Andrade, MD, PhD,2,6,7,8,9,10 Betina Durovni, MD, MBA, MPH,11 Solange Calvacante, MD, PhD,11,12 María B. Arriaga6,7, Megan M. Turner, MA,2 Marina C. Figueiredo, DVM, MS,2 Valeria C. Rolla, MD, PhD,12 Timothy R. Sterling, MD,2 and the Regional Prospective Observational Research in Tuberculosis (RePORT)-Brazil network
