Lauren S Peetluk1, Peter F Rebeiro1,2, Marcelo Cordeiro-Santos3,4, Afranio Kritski4,5, Bruno B Andrade2,6,7,8,9,10, Betina Durovni11, Solange Calvacante11,12, María B Arriaga6,7, Megan M Turner2, Marina C Figueiredo2, Valeria C Rolla12, Timothy R Sterling2. 1. Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 2. Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 3. Fundação Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil. 4. Universidade do Estado do Amazonas, Manaus, Brazil. 5. Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, Brazil. 6. Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Bahia, Brazil. 7. Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil. 8. Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil. 9. Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil. 10. Faculdade de Tecnologia e Ciências, Salvador, Bahia, Brazil. 11. Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil. 12. Secretaria Municipal de Saúde do Rio de Janeiro (Clínica da Familia Rinaldo Delamare)-Rocinha, Rio de Janeiro, Brazil.
Abstract
BACKGROUND: Weight change may inform tuberculosis treatment response, but its predictive power may be confounded by human immunodeficiency virus (HIV). METHODS: We prospectively followed up adults with culture-confirmed, drug-susceptible, pulmonary tuberculosis receiving standard 4-drug therapy (isoniazid, rifampin, pyrazinamide, and ethambutol) in Brazil. We examined median weight change 2 months after treatment initiation by HIV status, using quantile regression, and unsuccessful tuberculosis treatment outcome (treatment failure, tuberculosis recurrence, or death) by HIV and weight change status, using Cox regression. RESULTS: Among 547 participants, 102 (19%) were HIV positive, and 35 (6%) had an unsuccessful outcome. After adjustment for confounders, persons living with HIV (PLWH) gained a median of 1.3 kg (95% confidence interval [CI], -2.8 to .1) less than HIV-negative individuals during the first 2 months of tuberculosis treatment. PLWH were at increased risk of an unsuccessful outcome (adjusted hazard ratio, 4.8; 95% CI, 2.1-10.9). Weight change was independently associated with outcome, with risk of unsuccessful outcome decreasing by 12% (95% CI, .81%-.95%) per 1-kg increase. CONCLUSIONS: PLWH gained less weight during the first 2 months of tuberculosis treatment, and lack of weight gain and HIV independently predicted unsuccessful tuberculosis treatment outcomes. Weight, an easily collected biomarker, may identify patients who would benefit from alternative treatment strategies.
BACKGROUND: Weight change may inform tuberculosis treatment response, but its predictive power may be confounded by human immunodeficiency virus (HIV). METHODS: We prospectively followed up adults with culture-confirmed, drug-susceptible, pulmonary tuberculosis receiving standard 4-drug therapy (isoniazid, rifampin, pyrazinamide, and ethambutol) in Brazil. We examined median weight change 2 months after treatment initiation by HIV status, using quantile regression, and unsuccessful tuberculosis treatment outcome (treatment failure, tuberculosis recurrence, or death) by HIV and weight change status, using Cox regression. RESULTS: Among 547 participants, 102 (19%) were HIV positive, and 35 (6%) had an unsuccessful outcome. After adjustment for confounders, persons living with HIV (PLWH) gained a median of 1.3 kg (95% confidence interval [CI], -2.8 to .1) less than HIV-negative individuals during the first 2 months of tuberculosis treatment. PLWH were at increased risk of an unsuccessful outcome (adjusted hazard ratio, 4.8; 95% CI, 2.1-10.9). Weight change was independently associated with outcome, with risk of unsuccessful outcome decreasing by 12% (95% CI, .81%-.95%) per 1-kg increase. CONCLUSIONS: PLWH gained less weight during the first 2 months of tuberculosis treatment, and lack of weight gain and HIV independently predicted unsuccessful tuberculosis treatment outcomes. Weight, an easily collected biomarker, may identify patients who would benefit from alternative treatment strategies.
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