Weight Gain and Response to Treatment for Multidrug-Resistant Tuberculosis

Ma Tarcela Gler Tropical Disease Foundation, Makati City, Philippines; Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia; Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio

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Ruffy Guilatco Tropical Disease Foundation, Makati City, Philippines; Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia; Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio

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Janice C. Caoili Tropical Disease Foundation, Makati City, Philippines; Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia; Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio

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Julia Ershova Tropical Disease Foundation, Makati City, Philippines; Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia; Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio

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Peter Cegielski Tropical Disease Foundation, Makati City, Philippines; Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia; Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio

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John L. Johnson Tropical Disease Foundation, Makati City, Philippines; Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia; Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio

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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/m2) 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.

Author Notes

* Address correspondence to Maria Tarcela S. Gler, Makati Medical Center, Rm 336B, #2 Amorsolo St, Makati City, Philippines 1229. E-mail: tarcelasg@yahoo.com

Authors' addresses: Ma Tarcela Gler, Ruffy Guilatco, and Janice C. Caoili, Tropical Disease Foundation, PMDT, Makati City, Metro Manila, Philippines, E-mails: tarcelasg@yahoo.com, rsguilatco@gmail.com, and janice.caoili@gmail.com. Julia Ershova and Peter Cegielski, Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, GA, E-mails: jhe3@cdc.gov and gzc2@cdc.gov. John L. Johnson, Case Western Reserve University School of Medicine, Tuberculosis Research Unit, Department of Medicine, Cleveland, OH, E-mail: jlj@case.edu.

  • 1.

    Temple R, 1995. A regulatory authority's opinion about surrogate endpoints. Nimmo WS, Tucker GT, eds. Clinical Measurement in Drug Evaluation. New York: John Wiley, 3–22.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Harries AD, Nkhoma WA, Thompson PJ, Nyangulu DS, Wirima JJ, 1988. Nutritional status in Malawian patients with pulmonary tuberculosis and response to chemotherapy. Eur J Clin Nutr 42: 445–450.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Khan A, Sterling TR, Reves R, Vernon A, Horsburgh CR, 2006. Lack of weight gain and relapse risk in a large tuberculosis treatment trial. Am J Respir Crit Care Med 174: 344–348.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Krapp F, Veliz JC, Cornejo E, Gotuzzo E, Seas C, 2008. Bodyweight gain to predict treatment outcome in patients with pulmonary tuberculosis in Peru. Int J Tuberc Lung Dis 12: 1153–1159.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Onwubalili JK, 1988. Malnutrition among tuberculosis patients in Harrow, England. Eur J Clin Nutr 42: 363–366.

  • 6.

    Vasantha M, Gopi PG, Subramani R, 2009. Weight gain in patients with tuberculosis treated under directly observed treatment short-course (DOTS). Indian J Tuberc 56: 5–9.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Bark CM, Dietze R, Okwera A, Quelapio MI, Thiel BA, Johnson JL, 2011. Clinical symptoms and microbiological outcomes in tuberculosis treatment trials. Tuberculosis (Edinb) 91: 601–604.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Van Deun A, Maug A, Salim MA, Das PK, Sarker MR, Daru P, Reider HL, 2010. Short, highly effective, standardized treatment of multidrug-resistant tuberculosis. Am J Respir Crit Care Med 182: 684–692.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Franke MF, Appleton SC, Bayona J, Arteaga F, Palacios E, Llaro K, Shin SS, Becerra MC, Murray MB, Mitnick CD, 2008. Risk factors and mortality associated with default from multidrug-resistant tuberculosis treatment. Clin Infect Dis 46: 1844–1851.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Shin SS, Pasechnikov AD, Gelmanova IY, Peremitin GG, Strelis AK, Mishustin S, Barnashov A, Karpeichik Y, Andreev YG, Golubchikova VT, Tonkel TP, Yanova GV, Yedilbayev A, Rich ML, Mukherjee JS, Furin JJ, Atwood S, Farmer PE, Keshavjee S, 2007. Adverse reactions among patients being treated for MDR-TB in Tomsk, Russia. Int J Tuberc Lung Dis 11: 1314–1320.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Kim DH, Kim HJ, Park SK, Kong SJ, Kim YS, Kim TH, Kim EK, Lee KM, Lee SS, Park JS, Koh WJ, Lee CH, Kim JY, Shim TS, 2008. Treatment outcomes and long-term survival in patients with extensively drug-resistant tuberculosis. Am J Respir Crit Care Med 178: 1075–1082.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcantara F, Sanchez E, Sarria M, Becerra M, Fawzi MC, Kapiga S, Neuberg D, Maguire JH, Kim JY, Farmer P, 2003. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med 348: 119–128.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    World Health Organization, 2011. Global Tuberculosis Control. WHO Report 2011. Geneva: WHO/HTM/TB/2011.16.

  • 14.

    Dalton T, Cegielski P, Aaksilp S, Asencios L, Caoili JC, Cho SN, Erokhin VV, Ershova J, Gler MT, Kazennyy BY, Kim HJ, Kliiman K, Kurbatova E, Kvasnovsky C, Leimane V, van der Walt M, Via LE, Volchenkov GV, Yagui MA, Kang H; Global PETTS Investigators, Akksilp R, Sitti W, Wattanaamornkiet W, Andreevskaya SN, Chernousova LN, Demikhova OV, Larionova EE, Smirnova TG, Vasilieva IA, Vorobyeva AV, Barry CE 3rd, Cai Y, Shamputa IC, Bayona J, Contreras C, Bonilla C, Jave O, Brand J, Lancaster J, Odendaal R, Chen MP, Diem L, Metchock B, Tan K, Taylor A, Wolfgang M, Cho E, Eum SY, Kwak HK, Lee J, Lee J, Min S, Degtyareva I, Nemtsova ES, Khorosheva T, Kyryanova EV, Egos G, Perez MT, Tupasi T, Hwang SH, Kim CK, Kim SY, Lee HJ, Kuksa L, Norvaisha I, Skenders G, Sture I, Kummik T, Kuznetsova T, Somova T, Levina K, Pariona G, Yale G, Suarez C, Valencia E, Viiklepp P, 2012. Prevalence of and risk factors for resistance to second-line drugs in people with multidrug-resistant tuberculosis in eight countries: a prospective cohort study. Lancet 380: 1406–1417.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Gler MT, Macalintal LE, Raymond L, Guilatco R, Quelapio MI, Tupasi TE, 2011. Multi-drug resistant TB among previously treated patients in the Philippines. Int J Tuberc Lung Dis 15: 652–656.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Rich ML, 2003. The PIH Guide to the Medical Management of Multidrug-Resistant Tuberculosis. International edition. Boston, MA: Partners in Health, 1–146.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    ExpertPanel on the Identification, Evaluation, and Treatment of Over- weight in Adults, 1998. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Am J Clin Nutr 68: 899–917.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    World Health Organization, 2008. Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis: Emergency Update 2008. Geneva: WHO/HTM/TB/2008.

  • 19.

    Laserson KF, Thorpe LE, Leimane V, Weyer K, Mitnick CD, Riekstina V, Zarovska E, Rich ML, Fraser HS, Alarcón E, Cegielski JP, Grzemska M, Gupta R, Espinal M, 2005. Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 9: 640–645.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    U.S. Centers for Disease Control and Prevention, 2005. Epi Info. Available at: http://wwwn.cdc.gov/epiinfo/html/downloads.htm. Accessed December 4, 2011.

  • 21.

    Buyse M, 2007. Towards validation of statistically reliable biomarkers. Eur J Cancer, Suppl 5: 89–95.

  • 22.

    Hoa NB, Lauritsen JM, Reider HL, 2012. Changes in bodyweight and tuberculosis outcome in Vietnam. Int J Tuberc Lung Dis 17: 61–66.

  • 23.

    Bailey KV, Ferro-Luzzi A, 1995. Use of body mass index of adults in assessing individual and community nutritional status. Bull World Health Organ 73: 673–680.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Dhingra VK, Rajpal S, Mittal A, Hanif M, 2008. Outcome of multi-drug resistant tuberculosis cases treated by individualized regimens at a tertiary level clinic. Indian J Tuberc 55: 15–21.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Diacon A, Pym A, Grobusch M, Patientia R, Rustomjee R, Page-Shipp L, Pistorius C, Krause R, Bogoshi M, Churchyard G, Venter A, Allen J, Palomino JC, De Marez T, van Heeswijk RP, Lounis N, Meyvisch P, Verbeeck J, Parys W, de Beule K, Andries K, McNeeley DF, 2009. The diarylquinoline TMC 207 for multidrug-resistant tuberculosis. N Engl J Med 360: 2397–2405.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Joint United Nations Programme on HIV/AIDS (UNAIDS), 2010. Global Report: UNAIDS Report on the Global AIDS Epidemic. Geneva: UNAIDS/10.11E/JC1058E.

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