Trends and treatment outcomes of TB among people living with HIV: a nationwide cohort study, 2011-2022.

Abstract

BACKGROUNDRecent trends and treatment outcomes of TB among people living with HIV (PLHIV) have been understudied in Korea.METHODSUsing the nationwide K-TB-N cohort, we identified individuals with TB registered between 2011 and 2022. Among 373,812 TB cases, 931 had TB-HIV co-infection. TB treatment outcomes were compared between PLHIV and the general population using propensity score matching. Multivariable Cox proportional hazards models, including stratified and sensitivity analyses, were used to identify factors associated with death during TB treatment among PLHIV.RESULTSMost of TB-HIV patients were males (91.9%), under 60 years old (82.1%), and approximately 90% received antiretroviral therapy (ART). The number of TB-HIV cases declined from 120 in 2011 to 35 in 2022. Lost to follow-up and not evaluated outcomes decreased over time, whereas mortality remained stable at 10%-20%. The overall TB treatment success rate was 76.9% and mortality was higher than general population. Mortality was associated with older age and comorbidity burden, whereas ART showed a protective association only when initiated before TB diagnosis.CONCLUSIONTB incidence among PLHIV in South Korea has declined over the past decade, but mortality during TB treatment remains high, driven largely by host-related factors including age and comorbidities..