Independent Predictors of Tuberculosis Coinfection among People Living with HIV in Medan, Indonesia: A Case-Control Study
Abstract
Tuberculosis (TB) remains a major cause of morbidity among people living with HIV (PLHIV), particularly in high-burden countries such as Indonesia. This study aimed to identify factors independently associated with TB-HIV coinfection among PLHIV in Medan, Indonesia. An unmatched case-control study with a 1:3 case-to-control ratio was conducted in seven HIV Care, Support, and Treatment facilities in Medan. TB-HIV cases were ascertained from SIHA 2.1 records for January–August 2025, and participant data were collected from September 2025 to January 2026. A total of 144 participants were included, comprising 36 cases and 108 controls. Cases were identified from eligible records, while controls were selected sequentially until three controls were obtained per case. TB-HIV coinfection was confirmed by medical records documenting a positive molecular test (GeneXpert/TCM) and/or chest radiography. Underweight was defined as body mass index (BMI) <18.5 kg/m². Bivariate analyses and multivariable logistic regression were performed. Underweight was strongly associated with TB-HIV coinfection (COR=68.200; 95% CI: 21.268–218.702) and remained independently associated after adjustment (AOR=48.776; 95% CI: 10.394–228.895; p<0.001). Participants who had never received tuberculosis preventive therapy (TPT) had higher odds of coinfection (COR=14.826; 95% CI: 4.282–51.332; AOR=18.895; 95% CI: 3.161–112.965; p=0.001). Non-adherence to antiretroviral therapy (ART) was also associated with coinfection (COR=34.000; 95% CI: 7.731–149.530; AOR=15.820; 95% CI: 2.537–98.637; p=0.003). Large effect estimates and wide confidence intervals warrant cautious interpretation given the small number of cases and sparse data. Underweight, absence of TPT, and non-adherence to ART were independently associated with TB-HIV coinfection. Larger prospective studies are needed to validate these findings and clarify temporality before causal or prospective predictive conclusions are drawn. Keywords: Tuberculosis Coinfection, HIV, Nutritional Status, Antiretroviral Adherence, Tuberculosis Preventive Therapy