Lack of Weight Gain During the First 2 Months of Treatment and Human Immunodeficiency Virus Independently Predict Unsuccessful Treatment Outcomes in Tuberculosis

• Published in: The Journal of infectious diseases 2020-04, Vol.221 (9), p.1416-1424
• Main Authors: Peetluk, Lauren S, Rebeiro, Peter F, Cordeiro-Santos, Marcelo, Kritski, Afranio, Andrade, Bruno B, Durovni, Betina, Calvacante, Solange, Arriaga, María B, Turner, Megan M, Figueiredo, Marina C, Rolla, Valeria C, Sterling, Timothy R
• Format: Article
• Language: English
• Subjects: Adult; Antitubercular Agents - therapeutic use; Brazil; Clinical outcomes; Drug therapy; Ethambutol; Ethambutol - therapeutic use; Female; HIV; HIV Seropositivity - complications; Human immunodeficiency virus; Humans; Isoniazid; Isoniazid - therapeutic use; Major and Brief Reports; Male; Middle Aged; Observational studies; Proportional Hazards Models; Prospective Studies; Pyrazinamide; Pyrazinamide - therapeutic use; Rifampin; Rifampin - therapeutic use; Time Factors; Treatment Outcome; Tuberculosis; Tuberculosis, Pulmonary - complications; Tuberculosis, Pulmonary - drug therapy; Weight Gain
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiz595

Abstract Background 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 HIV-negative 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. We evaluated the impact of human immunodeficiency virus (HIV) on weight gain and tuberculosis treatment outcomes. Persons living with HIV gained less weight and were more likely to have unsuccessful tuberculosis treatment outcomes (death, failure, relapse) than persons without HIV.