One in Five HIV Patients Develop TB Soon After Preventive Therapy

Tuberculosis remains a leading cause of illness and death among people living with HIV (PLHIV). The abstract for this study, with corresponding author Brian Atubu Esele, begins by noting that PLHIV face a 12-fold higher risk of active TB reactivation than people without HIV, and that TB/HIV co-infection remains high at 40–45%. Although TB preventive therapy (TPT) is an effective intervention, that troubling persistence of co-infection raises questions about how long protection lasts after a single course of TPT. To investigate, researchers carried out a retrospective case-only cohort study using routine clinical data from 2022–2024. They pulled information from Uganda’s electronic medical record system, TB registers, and patient files at three TASO Centres of Excellence: Soroti, Mbale, and Tororo. The project focused on PLHIV who were on antiretroviral therapy (ART) and who were diagnosed with TB after completing TPT. The study set out to measure the time between completing TPT and being diagnosed with TB, and to identify which factors predicted an earlier return of active disease.

The study included 670 people. Most participants were female (464, 69.3%) and the average age was 51.6 years (SD 14.5). Nearly all of the TB cases were newly diagnosed (638, 95.2%), with detailed breakdowns: bacteriologically confirmed pulmonary TB made up 535 cases (79.9%), clinically diagnosed TB accounted for 123 cases (18.4%), and extrapulmonary TB was recorded in 12 cases (1.8%). Overall, 548 participants (82.8%) were virally suppressed and most were on Dolutegravir-based regimens (641, 95.7%). Early TB—defined by the study as disease occurring soon after TPT completion—happened in 144 people, or 21.5%, and the average time to diagnosis after finishing TPT was 2.6 years. The team used logistic regression to look for predictors of early TB. In multivariable analysis, care at TASO Soroti was strongly protective (adjusted odds ratio aOR = 0.104, p < 0.001). Factors that increased the odds of early TB included clinically diagnosed TB (aOR = 1.91, p = 0.007), shorter ART duration (<5 years: aOR = 3.07, p = 0.001; 5–10 years: aOR = 1.74, p = 0.018), and viral suppression (aOR = 1.87, p = 0.014).

The findings suggest that TB can return relatively soon after a course of TPT: about one in five people in this group developed TB early, with an average of 2.6 years until diagnosis. Crucially, the pattern shows that people with shorter time on ART were at higher risk of early TB even when they were virally suppressed and taking modern regimens like Dolutegravir-based regimens. The protective effect seen at one centre, TASO Soroti, points to possible differences in care delivery or follow-up that merit further attention. From a public-health perspective the study reinforces the idea that a single round of TPT may not be durable for everyone and that follow-up practices matter. The authors conclude that strengthening routine TB screening, continuous monitoring among PLHIV, and considering repeat TPT for groups at higher risk could help prevent more cases. These conclusions come directly from the data reviewed in Uganda’s clinics between 2022 and 2024 and highlight where clinical programs might focus to reduce TB reactivation among people living with HIV.