Effect of BMI on Mortality in Patients With Tuberculosis and HIV Coinfection in Asia and Africa: Systematic Review and Meta-Analysis

Abstract

Background: Tuberculosis (TB) continues to pose a major global health threat, particularly in low- and middle-income countries. An estimated 10.8 million people developed TB in 2023, corresponding to 134 cases per 100,000 population. The Southeast Asia region accounted for 45% of global TB incidence, while the African region contributed 24%. Nutritional status, particularly low BMI, is a key modifiable determinant of adverse clinical outcomes. However, its overall impact on mortality among TB-HIV coinfected populations in Asia and Africa remains poorly quantified. Objective: This study aimed to systematically assess the association between BMI and mortality among patients with TB-HIV coinfection in Asia and Africa. Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Cohort studies published between 2000 and 2024 were identified through PubMed, Scopus, and ProQuest. Data extraction and risk of bias assessment were performed independently by 3 reviewers using the Risk of Bias in Non-Randomized Studies – of Exposure tool. A random effects model with the DerSimonian-Laird method was applied using RevMan 7.2 (Cochrane) to estimate pooled risk ratios with 95% CI. Heterogeneity was quantified using the I2 statistic, and subgroup analyses were conducted by geographic region. Results: Seven cohort studies met the inclusion criteria. The pooled estimate indicated that patients with BMI less than 18.5 kg/m2 had approximately twofold higher mortality risk compared to those with normal or higher BMI (risk ratio=2.01; 95% CI 1.63‐2.48; P