title: Association of BMI category change with TB treatment mortality in HIV-positive smear-negative and extrapulmonary TB patients in Myanmar and Zimbabwe.
abstract: OBJECTIVE
  The HIV epidemic has increased the proportion of patients with smear-negative and extrapulmonary tuberculosis (TB) diagnoses, with related higher rates of poor TB treatment outcomes. Unlike in smear-positive pulmonary TB, no interim markers of TB treatment progress are systematically used to identify individuals most at risk of mortality. The objective of this study was to assess the association of body mass index (BMI) change at 1 month (±15 days) from TB treatment start with mortality among HIV-positive individuals with smear-negative and extrapulmonary TB.
  
  
  RESULTS
  A retrospective cohort study of adult HIV-positive new TB patients in Médecins Sans Frontières (MSF) treatment programmes in Myanmar and Zimbabwe was conducted using Cox proportional hazards regression to estimate the association between BMI category change and mortality. A cohort of 1090 TB patients (605 smear-negative and 485 extrapulmonary) was followed during TB treatment with mortality rate of 28.9 per 100 person-years. In multivariable analyses, remaining severely underweight or moving to a lower BMI category increased mortality (adjusted hazard ratio 4.05, 95% confidence interval 2.77-5.91, p<0.001) compared with remaining in the same or moving to a higher BMI category.
  
  
  CONCLUSIONS
  We found a strong association between BMI category change during the first month of TB treatment and mortality. BMI category change could be used to identify individuals most at risk of mortality during TB treatment among smear-negative and extrapulmonary patients.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Lenka
authors.initials: L
authors.lastname: Benova
authors.forename: Katherine
authors.initials: K
authors.lastname: Fielding
authors.forename: Jane
authors.initials: J
authors.lastname: Greig
authors.forename: Bern-Thomas
authors.initials: BT
authors.lastname: Nyang'wa
authors.forename: Esther Carrillo
authors.initials: EC
authors.lastname: Casas
authors.forename: Marcio Silveira
authors.initials: MS
authors.lastname: da Fonseca
authors.forename: Philipp
authors.initials: P
authors.lastname: du Cros
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D002052:Myanmar; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D015030:Zimbabwe
chemical_list: D000995:Antitubercular Agents