Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho
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. Whet...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Global Health Action |
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| Online Access: | http://dx.doi.org/10.1080/16549716.2024.2305930 |
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| author | Lawrence Oyewusi Chengbo Zeng KJ Seung Stephanie Mpinda Mikanda Kunda Carole D Mitnick Makelele Kanu Meseret Tamirat Joalane Makaka Mabatloung Mofolo Refiloe Maime Llang Maama Ninza Senyo Bamidele Oguntoyinbo Lwayi Mayombo Molly F Franke |
| author_facet | Lawrence Oyewusi Chengbo Zeng KJ Seung Stephanie Mpinda Mikanda Kunda Carole D Mitnick Makelele Kanu Meseret Tamirat Joalane Makaka Mabatloung Mofolo Refiloe Maime Llang Maama Ninza Senyo Bamidele Oguntoyinbo Lwayi Mayombo Molly F Franke |
| author_sort | Lawrence Oyewusi |
| collection | DOAJ |
| description | 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. 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. 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. 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. 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. |
| format | Article |
| id | doaj-art-36506c03c88b452eb9791903ec8d4cc3 |
| institution | Kabale University |
| issn | 1654-9880 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Global Health Action |
| spelling | doaj-art-36506c03c88b452eb9791903ec8d4cc32025-02-05T12:46:13ZengTaylor & Francis GroupGlobal Health Action1654-98802024-12-0117110.1080/16549716.2024.23059302305930Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in LesothoLawrence Oyewusi0Chengbo Zeng1KJ Seung2Stephanie Mpinda3Mikanda Kunda4Carole D Mitnick5Makelele Kanu6Meseret Tamirat7Joalane Makaka8Mabatloung Mofolo9Refiloe Maime10Llang Maama11Ninza Senyo12Bamidele Oguntoyinbo13Lwayi Mayombo14Molly F Franke15Partners In HealthHarvard Medical SchoolBrigham and Women’s HospitalPartners In HealthPartners In HealthHarvard Medical SchoolPartners In HealthPartners In HealthPartners In HealthPartners In HealthPartners In HealthLesotho Ministry of HealthPartners In HealthPartners In HealthPartners In HealthHarvard Medical SchoolBackground 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. 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. 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. 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. 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.http://dx.doi.org/10.1080/16549716.2024.2305930lesothomdrtbbminew drugsculture conversion |
| spellingShingle | Lawrence Oyewusi Chengbo Zeng KJ Seung Stephanie Mpinda Mikanda Kunda Carole D Mitnick Makelele Kanu Meseret Tamirat Joalane Makaka Mabatloung Mofolo Refiloe Maime Llang Maama Ninza Senyo Bamidele Oguntoyinbo Lwayi Mayombo Molly F Franke Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho Global Health Action lesotho mdrtb bmi new drugs culture conversion |
| title | Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho |
| title_full | Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho |
| title_fullStr | Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho |
| title_full_unstemmed | Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho |
| title_short | Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho |
| title_sort | low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug resistant tuberculosis in lesotho |
| topic | lesotho mdrtb bmi new drugs culture conversion |
| url | http://dx.doi.org/10.1080/16549716.2024.2305930 |
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