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3166 Association between HIV and early weight loss and the impact on subsequent treatment outcomes among patients with tuberculosis

Published online by Cambridge University Press:  26 March 2019

Lauren A Saag
Affiliation:
Vanderbilt University Medical Center
Peter F. Rebeiro
Affiliation:
Vanderbilt University Medical Center
Marcelo Cordeiro-Santos
Affiliation:
Fundação Medicina Tropical Dr. Heitor Vieira Dourado
Afranio Kritski
Affiliation:
Universidade Federal do Rio de Janeiro
Bruno B. Andrade
Affiliation:
Instituto Brasileiro para Investigação da Tuberculose
Betina Durovni
Affiliation:
Instituto Nacional de Infectologia Evandro Chagas
Solange Calvacante
Affiliation:
Vanderbilt University Medical Center Fundação Medicina Tropical Dr. Heitor Vieira Dourado Universidade Federal do Rio de Janeiro Instituto Brasileiro para Investigação da Tuberculose Instituto Nacional de Infectologia Evandro Chagas Secretaria Municipal de Saúde do Rio de Janeiro
Megan Turner
Affiliation:
Vanderbilt University Medical Center
Marina C. Figueiredo
Affiliation:
Vanderbilt University Medical Center
Valeria C. Rolla
Affiliation:
Secretaria Municipal de Saúde do Rio de Janeiro
Timothy R. Sterling
Affiliation:
Vanderbilt University Medical Center
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Abstract

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OBJECTIVES/SPECIFIC AIMS: Previous research suggests that weight loss during early TB treatment (first two months of anti-TB therapy) is a predictor of poor tuberculosis (TB) treatment outcomes among HIV-negative populations, but the relationship has not been well studied in the context of HIV. We examined the association between HIV and weight change during the first two months of anti-tuberculosis treatment, and also assessed the effects of HIV and early weight change on tuberculosis (TB) treatment outcomes. METHODS/STUDY POPULATION: Adults with culture-confirmed, drug-susceptible, pulmonary TB, regardless of HIV status, were enrolled into the Regional Prospective Observational Research for Tuberculosis (RePORT)-Brazil cohort and followed on standard anti-TB therapy. For the primary analysis, we compared weight change in persons living with HIV (PLWH) and HIV-negative patients between baseline and two months using multivariable bootstrapped quantile regression and modified Poisson regression. For secondary analysis, we examined the separate effects of HIV and weight change on poor TB treatment outcome (treatment failure, TB recurrence, or death) using Cox proportional hazards regression. RESULTS/ANTICIPATED RESULTS: Among 323 participants, 45 (14%) were HIV-positive. On average, PLWH lost 0.7% (interquartile range (IQR): −5.1%, 4.4%) of their baseline body weight between baseline and two months; those without HIV gained 3.5% (IQR: 0.8%, 6.7%). After adjusting for age, sex, and baseline BMI, PLWH lost 4.1% (95% confidence interval (CI): −6.5%, −1.6%) more weight during the first two months of anti-TB treatment than HIV-negative individuals. HIV infection was associated with weight loss ≥5% (adjusted odds ratio = 9.3; 95% CI: 4.2-20.6). Regarding the secondary analysis, 14 patients had a poor TB treatment outcome: 2 treatment failures, 4 cases of recurrent TB, and 8 deaths. PLWH and patients who lost ≥5% weight had significantly increased risk of poor TB treatment outcome with hazard ratios of 8.77 (95% CI: 2.96-25.94) and 4.09 (95% CI: 1.11-15.14), respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: Our results suggest that HIV is associated with weight loss during early TB treatment, and both HIV and early weight loss were associated with poor treatment outcome. Future research should examine the potential etiologies of these findings and identify the types of interventions that would best promote weight gain during TB treatment, especially among PLWH, in order to prevent poor TB treatment outcomes.

Type
Clinical Epidemiology/Clinical Trial
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-ncnd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
© The Association for Clinical and Translational Science 2019