Article
Lack of weight gain during the first two months of treatment and HIV independently predict unsuccessful treatment outcomes in tuberculosis
Registro en:
PEETLUK, Lauren S. et al. Lack of weight gain during the first two months of treatment and HIV independently predict unsuccessful treatment outcomes in tuberculosis. Journal of Infectious Diseases, p. 1-9, 2019.
0022-1899
10.1093/infdis/jiz595
Autor
Peetluk, Lauren S.
Rebeiro, Peter F.
Santos, Marcelo Cordeiro
Kritski, Afranio
Andrade, Bruno de Bezerril
Durovni, Betina
Calvacante, Solange
Arriaga Gutiérrez, María Belen
Turner, Megan M.
Figueiredo, Marina C.
Rolla, Valeria C.
Sterling, Timothy R.
Regional Prospective Observational Research in Tuberculosis (RePORT)Brazil network
Resumen
Departamento de Ciência e Tecnologia, Secretaria de
Ciência e Tecnologia, Ministério da Saúde, Brazil (grant
25029.000507/2013-07 to V. C. R.), the National Institutes
of Allergy and Infectious Diseases (grants U01-AI069923
and K01-AI131895 to P. F. R), and the National Center for
Advancing Translational Sciences (Clinical and Translational
Science Award (CTSA) award TL1TR000447 to L. S. P.). Weight change may inform tuberculosis treatment response, but its predictive power may be confounded by human immunodeficiency virus (HIV). Methods. We prospectively followed up adults with culture-confirmed, drug-susceptible, pulmonary tuberculosis receiving standard 4-drug therapy (isoniazid, rifampin, pyrazinamide, and ethambutol) in Brazil. We examined median weight change 2 months after treatment initiation by HIV status, using quantile regression, and unsuccessful tuberculosis treatment outcome (treatment failure, tuberculosis recurrence, or death) by HIV and weight change status, using Cox regression. Results. Among 547 participants, 102 (19%) were HIV positive, and 35 (6%) had an unsuccessful outcome. After adjustment for confounders, persons living with HIV (PLWH) gained a median of 1.3 kg (95% confidence interval [CI], −2.8 to .1) less than HIVnegative individuals during the first 2 months of tuberculosis treatment. PLWH were at increased risk of an unsuccessful outcome (adjusted hazard ratio, 4.8; 95% CI, 2.1–10.9). Weight change was independently associated with outcome, with risk of unsuccessful outcome decreasing by 12% (95% CI, .81%–.95%) per 1-kg increase. Conclusions. PLWH gained less weight during the first 2 months of tuberculosis treatment, and lack of weight gain and HIV independently predicted unsuccessful tuberculosis treatment outcomes. Weight, an easily collected biomarker, may identify patients who would benefit from alternative treatment strategies.