Past TB Tied to Hypertension and Different Inflammation in People with HIV

People living with HIV (PWH) face higher rates of heart and blood vessel disease even when the virus is controlled with antiretroviral therapy (ART). Chronic immune activation appears to be one driver of that increased cardiovascular burden. Tuberculosis (TB) is a common co-infection in many parts of the world, and researchers have wondered whether having TB in the past might leave behind lingering inflammation that raises the risk of high blood pressure and other cardiometabolic problems. To explore this question, a team led by corresponding author Sepiso K. Masenga carried out a pilot cross-sectional study comparing PWH who had a history of TB with those who did not. The study looked at basic demographics, cardiovascular measures and a panel of circulating inflammatory biomarkers. Using statistical tools including logistic regression, the researchers tested whether prior TB was linked to clinical differences and to distinct patterns of inflammation, and whether those links differed between men and women.

The study enrolled 318 PWH and identified 31 participants (9.7%) with a prior history of TB. In univariate analyses, prior TB was associated with older age, hypertension, longer ART duration, and higher levels of IL-6 and soluble ST2. The investigators used logistic regression to search for factors tied to a history of TB in the whole group and in men and women separately. They found that hypertension was strongly associated with prior TB among females (OR 4.41, 95% CI: 3.41 (1.57, 7.41) p=0.003) but not among males. In multivariate models that adjusted for clinical variables, longer ART duration remained an independent correlate of prior TB in the full cohort. Sex-stratified multivariate analysis showed sex-specific inflammatory associations: lower IFN-γ was linked with prior TB in males (AOR 0.99, p=0.048), while lower IL-5 was linked with prior TB in females (AOR 0.99, p=0.042).

The findings suggest that a past episode of TB may leave a persistent imprint that relates to higher blood pressure and to different inflammatory patterns in men and women living with HIV. In this pilot study, prior TB was notably associated with hypertension in women and with distinct changes in inflammatory markers by sex, pointing to sex-dimorphic biological pathways. While the study cannot prove cause and effect, it raises the possibility that cured TB contributes to later cardiovascular risk in a way that depends on sex and on specific immune signals such as IL-6, soluble ST2, IFN-γ and IL-5. The authors conclude that further, larger and longitudinal studies are needed to confirm these links, to clarify mechanisms, and to determine whether monitoring or targeting inflammation in PWH with past TB could reduce cardiovascular risk, particularly for women.