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In this prospective cohort of 2006 individuals with drug-susceptible tuberculosis in India, 18% had unfavorable treatment outcomes (4.7% treatment failure, 2.5% recurrent infection, 4.1% death, 6.8% loss to follow-up) over a median 12-month follow-up period. Age, male sex, low education, nutritional status, and alcohol use were predictors of unfavorable outcomes. [ABSTRACT FROM AUTHOR]

Background Undernutrition is the leading risk factor for tuberculosis (TB) globally. Its impact on treatment outcomes is poorly defined. Methods We conducted a prospective cohort analysis of adults with drug-sensitive pulmonary TB at 5 sites from 2015–2019. Using multivariable Poisson regression, we assessed associations between unfavorable outcomes and nutritional status based on body mass index (BMI) nutritional status at treatment initiation, BMI prior to TB disease, stunting, and stagnant or declining BMI after 2 months of TB treatment. Unfavorable outcome was defined as a composite of treatment failure, death, or relapse within 6 months of treatment completion. Results Severe undernutrition (BMI <16 kg/m2) at treatment initiation and severe undernutrition before the onset of TB disease were both associated with unfavorable outcomes (adjusted incidence rate ratio [aIRR], 2.05; 95% confidence interval [CI], 1.42–2.91 and aIRR, 2.20; 95% CI, 1.16–3.94, respectively). Additionally, lack of BMI increase after treatment initiation was associated with increased unfavorable outcomes (aIRR, 1.81; 95% CI, 1.27–2.61). Severe stunting (height-for-age z score <−3) was associated with unfavorable outcomes (aIRR, 1.52; 95% CI, 1.00–2.24). Severe undernutrition at treatment initiation and lack of BMI increase during treatment were associated with a 4- and 5-fold higher rate of death, respectively. Conclusions Premorbid undernutrition, undernutrition at treatment initiation, lack of BMI increase after intensive therapy, and severe stunting are associated with unfavorable TB treatment outcomes. These data highlight the need to address this widely prevalent TB comorbidity. Nutritional assessment should be integrated into standard TB care. [ABSTRACT FROM AUTHOR]

Aim: Coexistence of DM and TB influences TB treatment outcomes. TB increases hyperglycaemia due to inflammatory response. Effect of prediabetes (PDM) on TB treatment outcomes is unknown. The aim was to assess the effect of PDM on treatment outcomes after TB treatment. Methods: This is a prospective observational cohort study (EDOTS - part of RePORT India Consortium) of 569 eligible New smear positive cases screened for DM between 2014 to 2018 in TB units in North Chennai, South India. Out of 569 subjects, 179 with a known history of DM were excluded.The remaining 390 screened TB subjects, 120 were excluded based on culture results and unwillingness to participate in the study. HbA1c was assessed at baseline and categorised into two groups (Gp): normoglycaemia (Gp1) (<5.7%) and PDM (Gp 2) (5.7 to 6.4%) and followed them at 3rd and 6th month and treatment outcomes were assessed at the end of the TB treatment. Results: Prevalence of Prediabetes was 41.1%. There was no significant difference in the treatment outcomes between the groups(p=0.54). Total cure rate was 72.7% with no significant difference between the groups. There was a higher proportion of treatment failures (7.9%) amongGp1 as compared to Gp 2 (4.5%) (p = 0.33). There were 15.8 vs. 17.1% treatment defaulters. Higher proportion of deaths occurred during the course of DOTS in Gp 2 (7.2%) compared to Gp 1 (1.3%) (p = 0.06). At the end of intensive phase of DOTS treatment, about 23.8 % were observed to have positive sputum smear in Gp 2 compared to 8.6% in Gp 1 (p=0.019). The estimated relative risk to remain as sputum smear positive among prediabetes at the end of intensive phase was 3.0 (95% CI: 1.2-7.6). Conclusion: Higher prevalence of prediabetes was evident among TB patients. Among those who had prediabetes, death rate was higher during the course of the treatment and higher proportion remained sputum smear positive at the end of the intensive phase of TB treatment. Disclosure: V. Viswanathan: None. A. Devarajan: None. S. Kumpatla: None. M. Dhanasekaran: None. S. Babu: None. H. Kornfeld: None. Funding: Government of India (BT/MB/INDO-US/REPORT/03/2013-140) [ABSTRACT FROM AUTHOR]

In this prospective cohort of 2006 individuals with drug-susceptible tuberculosis in India, 18% had unfavorable treatment outcomes (4.7% treatment failure, 2.5% recurrent infection, 4.1% death, 6.8% loss to follow-up) over a median 12-month follow-up period. Age, male sex, low education, nutritional status, and alcohol use were predictors of unfavorable outcomes., Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest. 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., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)