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Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho.
- Source :
-
Global health action [Glob Health Action] 2024 Dec 31; Vol. 17 (1), pp. 2305930. Date of Electronic Publication: 2024 Feb 02. - Publication Year :
- 2024
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Abstract
- Background: A low body mass index (BMI) at the start of treatment for rifampicin- or multidrug-resistant tuberculosis (MDR/RR-TB) is associated with poor treatment outcomes and may contribute to delayed sputum culture conversion, thereby prolonging the period of potential transmission to others. Whether the relative importance of low BMI in predicting treatment outcomes differs by HIV status is unclear.<br />Objectives: We evaluated the association between low BMI and two dependent variables, sputum culture conversion and end-of-treatment outcome, among patients receiving treatment for MDR/RR-TB in Lesotho, a setting with a high prevalence of HIV infection.<br />Methods: Secondary data from a prospective cohort of patients initiating a longer (18-20 months) treatment containing bedaquiline and/or delamanid under routine programmatic conditions in Lesotho were analysed. Risk ratios and differences were adjusted for potential confounders using multivariable logistic regression, and estimates were stratified by HIV status.<br />Results: Of 264 patients, 105 and 250 were eligible for culture conversion and end-of-treatment analyses, respectively. Seventy-one per cent of patients (74/105) experienced culture conversion within six months, while 74% (184/250) experienced a favourable end-of-treatment outcome. Low BMI was associated with a lower frequency of culture conversion at six months among those who were not living with HIV (relative risk [RR]: 0.50 [95% CI: 0.21, 0.79]); this association was attenuated among those living with HIV (RR: 0.88 [95% CI: 0.68, 1.23]). A low BMI was moderately associated with a lower frequency of treatment success (RR = 0.89 [95% CI: 0.77, 1.03]), regardless of HIV status.<br />Conclusions: Low BMI was common and associated with the frequency of six-month culture conversion and end-of-treatment outcomes. The association with culture conversion was more pronounced among those not living with HIV. Addressing the myriad factors that drive low BMI in this setting could hasten culture conversion and improve end-of-treatment outcomes. This will require a multipronged approach focused on alleviating food insecurity and enabling prompt diagnosis and treatment of HIV and TB.
- Subjects :
- Humans
Antitubercular Agents therapeutic use
Body Mass Index
Prospective Studies
Lesotho epidemiology
Sputum
Treatment Outcome
HIV Infections drug therapy
HIV Infections epidemiology
Tuberculosis, Multidrug-Resistant drug therapy
Tuberculosis, Multidrug-Resistant epidemiology
Tuberculosis, Multidrug-Resistant diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1654-9880
- Volume :
- 17
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Global health action
- Publication Type :
- Academic Journal
- Accession number :
- 38305025
- Full Text :
- https://doi.org/10.1080/16549716.2024.2305930