Low Body Mass Index at Treatment Initiation and Rifampicin-Resistant Tuberculosis Treatment Outcomes: An Individual...

Area of Science:

• Tuberculosis Research
• Clinical Medicine
• Epidemiology

Background:

• The impact of low body mass index (BMI) on outcomes for patients starting rifampicin-resistant tuberculosis (RR-TB) treatment remains unclear.
• This study aimed to assess the association between BMI at the initiation of RR-TB treatment and treatment outcomes.

Approach:

• An individual participant data meta-analysis was conducted on adult patients (≥18 years) with RR-TB and documented BMI at treatment initiation.
• Outcomes compared included any unfavorable treatment outcome, mortality, and treatment failure/recurrence between underweight (BMI <18.5 kg/m2) and non-underweight patients.
• Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression, with adjustments for demographic, clinical, and treatment factors. Effect modification by human immunodeficiency virus (HIV) status and World Health Organization region was evaluated.

Key Points:

• The analysis included 5148 patients, with 33% being underweight at treatment initiation.
• Underweight patients had significantly higher odds of unfavorable outcomes (aOR 1.7), death (aOR 3.1), and failure/recurrence (aOR 1.6) compared to non-underweight patients.
• Mortality rates were substantially higher in underweight patients, particularly among those with HIV co-infection.

Conclusions:

• Low BMI at the initiation of RR-TB treatment is a significant predictor of unfavorable treatment outcomes.
• Mortality risk is particularly elevated in underweight patients receiving RR-TB treatment, underscoring the need for nutritional assessment and support.