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Free Content Low BMI and falling BMI predict HIV-associated tuberculosis: a prospective study in Tanzania

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BACKGROUND: Low body mass index (BMI) is a known risk factor for tuberculosis (TB) in people without human immunodeficiency virus (HIV), but there are no prospective studies linking BMI to the risk of HIV-associated TB.

DESIGN: In HIV-infected adults with CD4 counts ≥ 200 cells/μl receiving placebo in a TB booster vaccine trial in Dar es Salaam, Tanzania, we measured BMI at baseline and Year 1, and related baseline BMI and change in BMI to the risk of developing TB.

RESULTS: We documented 92 cases of TB among 979 subjects followed for a mean of 3.2 years. Compared to subjects who did not develop TB, subjects who developed TB had a lower baseline BMI (23.2 vs. 24.6 kg/m2, P = 0.006), and a greater BMI decline from baseline to Year 1 (−0.4 vs. 0.6 kg/m2, P < 0.001). In multivariate analyses, baseline BMI was associated with the risk of developing TB (hazard ratio [HR] per kg/m2 0.94, 95%CI 0.90–0.99, P = 0.028), as was the change in BMI from baseline to Year 1 (HR per kg/m2 0.79, 95%CI 0.71–0.87, P < 0.001). Subjects with a baseline BMI < 17 kg/m2 were more likely to develop TB (HR 3.72, 95%CI 1.16–12.0, P = 0.028).

CONCLUSION: Low and falling BMI predict HIV-associated TB.

Keywords: HIV; body mass index; malnutrition; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA 2: Dartmouth Medical School, Lebanon, New Hampshire, USA 3: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Publication date: 2010-11-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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