Association of BMI Category Change with TB Treatment Mortality in HIV-Positive Smear-Negative and Extrapulmonary TB Patients in Myanmar and Zimbabwe 英文参考文献.docVIP
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Association of BMI Category Change with TB Treatment Mortality in HIV-Positive Smear-Negative and Extrapulmonary TB Patients in Myanmar and Zimbabwe 英文参考文献
AssociationofBMICategoryChangewithTBTreatment
MortalityinHIV-PositiveSmear-Negativeand
ExtrapulmonaryTBPatientsinMyanmarandZimbabwe
LenkaBenova1*,KatherineFielding1,JaneGreig2,Bern-ThomasNyang’wa2,EstherCarrilloCasas3,
MarcioSilveiradaFonseca3,PhilippduCros2
1London School of Hygiene and Tropical Medicine, London, United Kingdom, 2Me′decins Sans Frontie`res, London, United Kingdom, 3Me′decins Sans Frontie`res,
Amsterdam,Holland
Abstract
Objective:TheHIVepidemichasincreasedtheproportionofpatientswithsmear-negativeandextrapulmonarytuberculosis
(TB)diagnoses,withrelatedhigherratesofpoorTBtreatmentoutcomes.Unlikeinsmear-positivepulmonaryTB,nointerim
markersofTBtreatmentprogressaresystematicallyusedtoidentifyindividualsmostatriskofmortality.Theobjectiveof
thisstudywastoassesstheassociationofbodymassindex(BMI)changeat1month(615days)fromTBtreatmentstart
withmortalityamongHIV-positiveindividualswithsmear-negativeandextrapulmonaryTB.
Methods and Findings: A retrospective cohort study of adult HIV-positive new TB patients in Me′decins Sans Frontie`res
(MSF) treatment programmes in Myanmar and Zimbabwe was conducted using Cox proportional hazards regression to
estimatetheassociationbetweenBMIcategorychangeandmortality.Acohortof1090TBpatients(605smear-negativeand
485extrapulmonary)wasfollowedduringTBtreatmentwithmortalityrateof28.9per100person-years.Inmultivariable
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.BMIcategorychangecouldbeusedtoidentifyindividualsmostatriskofmortalityduringTBtreatmentamong
smear-negativeandextrapulmonarypatients.
Citation:BenovaL,FieldingK,GreigJ,Nyang’waB-T,CasasEC,etal.(2012)AssociationofBMICategoryChangewithTBTreatmentMortalityinHIV
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