Effect of Body Mass Index on Mortality in Patients with Tuberculosis and HIV Co-Infection within the Scope of Asia Africa: A Systematic Review and Meta-Analysis (Preprint)

BACKGROUND In 2022, an estimated 10.6 million people developed tuberculosis (TB) globally, with 6.3% co-infected with HIV. The Southeast Asia region accounted for 46% of global TB cases, while Africa contributed 23%. TB-HIV co-infection remains a major cause of death, with 167,000 deaths recorded among co-infected individuals in 2022. Nutritional status, particularly Body Mass Index (BMI), may influence mortality in this population. However, no comprehensive synthesis of the evidence currently exists. OBJECTIVE To assess the association between BMI and mortality among TB-HIV co-infected patients in Asia and Africa. METHODS A systematic review and meta-analysis of cohort studies published between 2000 and 2024 were conducted using PubMed, Scopus, and ProQuest. A random-effects model was applied to calculate pooled Risk Ratio (RR) and 95% confidence intervals. RESULTS Eleven cohort studies met the inclusion criteria. Patients with low BMI (<18.5 kg/m²) had a 10% higher risk of mortality compared to those with normal or higher BMI (RR = 0.90; 95% CI: 0.86–0.94; p < 0.05). Heterogeneity was substantial (I² = 78%), but the association remained statistically significant and robust. CONCLUSIONS Low BMI is significantly associated with increased mortality among TB-HIV co-infected patients in Asia and Africa. Routine nutritional screening and targeted support should be prioritized in TB-HIV clinical management strategies. CLINICALTRIAL This systematic review and meta-analysis has been registered with the Open Science Framework (doi: 10.17605/OSF.IO/74QWH).