Nang T T Kyaw1,2, Ajay M V Kumar3,4,5, Anthony D Harries5,6, Srinath Satyanarayana3, Nay L Oo1, Matthew J Hayat2, Kenneth G Castro7,8,9, Matthew J Magee8. 1. International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar. 2. Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA. 3. Department of Research, International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Office, New Delhi. 4. Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India. 5. Department of Research, International Union Against Tuberculosis and Lung Disease, Paris, France. 6. London School of Hygiene and Tropical Medicine, London, UK. 7. Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University. 8. Hubert Department of Global Health. 9. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Abstract
OBJECTIVES: Low BMI and hyperglycemia are each important risk factors for tuberculosis (TB). However, the contribution of synergy between low BMI and hyperglycemia to risk of TB among people living with HIV (PWH) is unexplored. We compared TB incidence among PWH with different exposure profiles to low BMI (BMI < 18.5 kg/m2) and hyperglycemia (random blood glucose ≥140 mg/dl). DESIGN AND METHODS: We conducted a cohort study using data of PWH (≥15 years) who enrolled in Myanmar's Integrated HIV Care Program between 2011 and 2017. We used their follow-up data until 2018 to determine TB incidence. RESULTS: Among 20 865 PWH included in this study, 7610 (36%) had low BMI only, 1324 (6%) had hyperglycemia only, and 465 (2%) patients had concurrent low BMI and hyperglycemia (joint exposure) at baseline. During a median follow-up of 2.2 years (interquartile range: 0.5, 4.2), 3628 (17%) developed TB [6.7, 95% confidence interval (CI): 6.5,7.0 cases per 100 person-years (PY)]. TB incidence among PWH with joint exposure was 21.0 (95% CI: 18.0, 24.7), with low BMI only was 10.9 (95% CI: 10.4, 11.4), with hyperglycemia only was 5.2 (95% CI: 4.4, 6.3) and with no exposure was 4.6 (95% CI: 4.4, 4.9) cases per 100 PY. The attributable proportion of incident TB due to synergy between low BMI and hyperglycemia was 0.23 (95% CI: 0.06, 0.36). CONCLUSION: Synergy between low BMI and hyperglycemia was associated with increased excess TB incidence in PWH. TB preventive treatment, nutritional support, and hyperglycemia management should be evaluated as interventions to reduce TB risk in PWH with joint exposure.
OBJECTIVES: Low BMI and hyperglycemia are each important risk factors for tuberculosis (TB). However, the contribution of synergy between low BMI and hyperglycemia to risk of TB among people living with HIV (PWH) is unexplored. We compared TB incidence among PWH with different exposure profiles to low BMI (BMI < 18.5 kg/m2) and hyperglycemia (random blood glucose ≥140 mg/dl). DESIGN AND METHODS: We conducted a cohort study using data of PWH (≥15 years) who enrolled in Myanmar's Integrated HIV Care Program between 2011 and 2017. We used their follow-up data until 2018 to determine TB incidence. RESULTS: Among 20 865 PWH included in this study, 7610 (36%) had low BMI only, 1324 (6%) had hyperglycemia only, and 465 (2%) patients had concurrent low BMI and hyperglycemia (joint exposure) at baseline. During a median follow-up of 2.2 years (interquartile range: 0.5, 4.2), 3628 (17%) developed TB [6.7, 95% confidence interval (CI): 6.5,7.0 cases per 100 person-years (PY)]. TB incidence among PWH with joint exposure was 21.0 (95% CI: 18.0, 24.7), with low BMI only was 10.9 (95% CI: 10.4, 11.4), with hyperglycemia only was 5.2 (95% CI: 4.4, 6.3) and with no exposure was 4.6 (95% CI: 4.4, 4.9) cases per 100 PY. The attributable proportion of incident TB due to synergy between low BMI and hyperglycemia was 0.23 (95% CI: 0.06, 0.36). CONCLUSION: Synergy between low BMI and hyperglycemia was associated with increased excess TB incidence in PWH. TB preventive treatment, nutritional support, and hyperglycemia management should be evaluated as interventions to reduce TB risk in PWH with joint exposure.
Authors: Amit C Achhra; Sanjay Pujari; Jun Yong Choi; Suwimol Khusuwan; Nguyen Van Kinh; Praphan Phanuphak; Romanee Chaiwarith; Man Po Lee; Vonthanak Saphonn; Sasisopin Kiertiburanakul; Pham Thanh Thuy; Matthew G Law Journal: J Acquir Immune Defic Syndr Date: 2014-08-15 Impact factor: 3.731
Authors: Nang Thu Thu Kyaw; Anthony D Harries; Ajay M V Kumar; Myo Minn Oo; Khine Wut Yee Kyaw; Than Win; Thet Ko Aung; Aung Chan Min; Htun Nyunt Oo Journal: PLoS One Date: 2017-02-09 Impact factor: 3.240