Past tuberculosis raises diabetes risk for people with HIV

Cardiovascular disease is now the leading cause of death among people living with HIV, but how prior infections such as tuberculosis (TB) change that risk is not well understood. To explore this question, Joseph Baruch Baluku and his team carried out a comparative cross-sectional study at a tertiary hospital in Kampala, Uganda. They enrolled adults aged 18 years and older who were living with HIV and receiving antiretroviral therapy, selecting participants at random and assembling two groups in a one-to-one ratio: people with a history of active TB (TB survivors) and people without such a history. The researchers set out to compare basic measures tied to heart and metabolic health — including anthropometric measurements, blood pressure, fasting blood glucose (FBG), a lipid profile and glycated hemoglobin — to see whether prior TB was associated with a distinct cardiometabolic profile among people with HIV. By measuring these standard clinical markers in both groups, the study aimed to identify whether a history of TB should prompt clinicians to take different screening or prevention steps for cardiometabolic disease in this population.

The study enrolled 396 participants in total: 196 TB survivors and 200 people without prior TB. Key findings showed that TB survivors had a higher median fasting blood glucose — 5.5 versus 5.1 mmol/l (p<0.001) — and a higher prevalence of diabetes mellitus (DM): 17.9% compared with 9.5% (p=0.015). Despite the higher blood glucose, TB survivors were leaner: median body mass index was 23.0 versus 25.1 kg/m2 (p<0.001), and waist circumference was 81.0 versus 84.0 cm (p=0.026). Lipid measurements also differed: TB survivors had higher HDL-c (1.0 versus 0.8 mmol/l, p<0.001), lower LDL-c (2.7 versus 3.1 mmol/l, p<0.001) and a lower prevalence of dyslipidemia (81.7% versus 96.5%, p<0.001). In multivariable analysis, prior TB was independently associated with a greater prevalence of elevated FBG (adjusted prevalence ratio aPR 1.79, 95% CI 1.10-2.92) and DM (aPR 2.34, 95% CI 1.11-4.94), while it was linked to a lower risk of obesity (aPR 0.42, 95% CI 0.20-0.88).

These results show a complex picture: people with HIV who previously had TB appear more likely to have impaired glucose control and diabetes, even though they tend to be slimmer and have more favorable LDL-c and HDL-c levels. The most direct take-away, stated by the authors, is that TB survivors with HIV may benefit from regular blood glucose monitoring because their risk of diabetes is higher. Clinicians caring for people with HIV should be aware that a history of TB can change cardiometabolic risk in ways that are not captured by body weight alone. The lower rates of obesity and dyslipidemia in TB survivors do not negate the increased diabetes risk, so screening strategies may need to be tailored: weight-based assessments alone could miss people at heightened metabolic risk after TB. Overall, the study supports integrating focused glucose testing into follow-up care for TB survivors living with HIV and highlights the need for ongoing research to guide prevention and management strategies in this group.