Weight Gain and Response to Treatment for Multidrug-Resistant Tuberculosis

Abstract

Abstract. Alternatives to culture are needed in high burden countries to assess whether response to treatment of multidrug-resistant-tuberculosis (MDR-TB) is satisfactory. The objective was to assess the association of weight gain and treatment outcome. The methods included analysis of clinical, bacteriologic, and weight from 439 MDR-TB patients in the Philippines. Odds ratios (ORs) were calculated to determine whether 5% weight gain during the first 6 months of treatment was associated with outcome. Three hundred and ten (71%) patients were cured and 129 (29%) had poor outcomes (death, defaulted, or failed treatment). Fifty-three percent were underweight (body mass index [BMI] 18.5 kg/m 2 ) before treatment. Five percent weight gain after completing 3 months of treatment was associated with good outcome among patients who were underweight before treatment (OR 2.1; 95% confidence interval [CI], 1.05 to 4.4). Baseline weight and degree of weight change during the first 6 months of treatment can help identify persons who are more likely to have poor outcomes and require other interventions.

Macronutrient intake and body composition changes during anti-tuberculosis therapy in adults

“…One prior study showed that weight gain was associated with an improved clinical better response to MDR-TB drug treatment, which is consistent with our data in drug-sensitive subjects. (7) Despite a trend toward increased mean energy intake, individuals with MDR-TB gained significantly less body weight and fat-free mass. These data suggest that MDR-TB patients were more catabolic/less anabolic than the drug-sensitive TB patients, likely due to ineffective anti-TB drug treatment until second-line drugs were initiated approximately 8 weeks after diagnosis.…”

“…(1, 3, 5, 6) Body weight changes during treatment have been explored as a simple biomarker for both disease severity and treatment outcomes. (4, 7) Further, it has been shown that TB patients with low BMI (<18.5 kg/m 2 ) are at increased risk for TB-related mortality and treatment failure. (4, 7, 8) Despite the abundance of cross-sectional data on the relationship between drug-sensitive TB and body composition, there are few serial studies of body composition in TB(9, 10) or that combine dietary intake and body composition during anti-TB drug treatment.…”

“…(4, 7) Further, it has been shown that TB patients with low BMI (<18.5 kg/m 2 ) are at increased risk for TB-related mortality and treatment failure. (4, 7, 8) Despite the abundance of cross-sectional data on the relationship between drug-sensitive TB and body composition, there are few serial studies of body composition in TB(9, 10) or that combine dietary intake and body composition during anti-TB drug treatment. Also, the relationship between nutrient intake and body composition in individuals with multidrug resistant TB (MDR-TB) compared to those with drug-sensitive TB has not been reported.…”

Treatment Outcomes for Patients with Multidrug-Resistant Tuberculosis in Post-Earthquake Port-au-Prince, Haiti

“…[29][30][31] Interestingly, patients with isolates resistant to pyrazinamide were found to be less likely to achieve culture conversion by 60 days. The introduction of the Xpert MTB/ RIF assay allowed for rapid diagnosis of MDR-TB treatment, particularly in patients with no overt signs of failure.…”

Follow-up examinations: Are multidrug-resistant tuberculosis patients in Uttar Pradesh, India, on track?

“…Weight monitoring during the first 6 months of treatment is also an important predictor of unfavourable outcome. 5 Poor adherence to monthly weight measurement, as reported in this study, thus fails to identify poor treatment outcome.…”