Abstract
Background
The impact of low body-mass-index at treatment initiation on rifampicin-resistant tuberculosis treatment outcomes is uncertain. We evaluated the association between body-mass-index at rifampicin-resistant tuberculosis treatment initiation and end-of-treatment outcomes, and its modifying factors.
Methods
We did an individual participant data meta-analysis of adults ≥18 years with rifampicin-resistant tuberculosis whose body-mass-index was documented at treatment initiation. We compared odds of any unfavorable treatment outcome, mortality, or failure/recurrence between patients who were underweight (body-mass-index <18.5 kg/m
2) and not underweight. Adjusted odds ratios and 95%CI were estimated using logistic regression, with matching on demographic, clinical, and treatment-related factors. We evaluated effect modification by HIV-infection and other variables using likelihood ratio tests. In secondary an alysis, we estimated cumulative incidence of mortality during treatment, stratified by HIV-infection.
Results
Overall, 5148 patients were included; 1702 (33%) were underweight at treatment initiation. The median (IQR) age was 37 years (29 to 47) and 455 (9%) were living with HIV. Compared to non-underweight patients, the adjusted odds ratio 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 observed for WHO region where the participant was treated. Among patients without HIV, cumulative incidence of 24-month mortality 14.8% (95%CI 12.7%-17.3%) for underweight and 5.6% (4.5%-7.0%) for not underweight patients. Among patients living with HIV, corresponding values were 33.0% (25.6%-42.6%) and 20.9% (14.1%-27.6%).
Conclusions
Low body-mass-index at treatment initiation for rifampicin-resistant tuberculosis is associated with increased odds of unfavorable treatment outcome, particularly mortality.
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