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. 2024 Dec 31;17(1):2305930.
doi: 10.1080/16549716.2024.2305930. Epub 2024 Feb 2.

Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho

Lawrence Oyewusi  1 , Chengbo Zeng  2 , K J Seung  3 , Stephanie Mpinda  1 , Mikanda Kunda  1 , Carole D Mitnick  2 , Makelele Kanu  1 , Meseret Tamirat  1 , Joalane Makaka  1 , Mabatloung Mofolo  1 , Refiloe Maime  1 , Llang Maama  4 , Ninza Senyo  1 , Bamidele Oguntoyinbo  1 , Lwayi Mayombo  1 , Molly F Franke  2
Affiliations

Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho

Lawrence Oyewusi et al. Glob Health Action. .

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.

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.

Keywords: BMI; Lesotho; MDRTB; culture conversion; new drugs.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Forest plot of the adjusted relative risk of low BMI on culture conversion within six months or favourable EOT outcomes, stratified by HIV status.
See this image and copyright information in PMC

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