Effects of post tuberculosis lung disease on survival in HIV-infected individuals with pulmonary hypertension: Insights from the Pan African Pulmonary Hypertension Cohort (PAPUCO) study

IntroductionPost-tuberculosis lung disease (PTLD) bears high mortality rates, primarily attributed to pulmonary vascular and cardiovascular complications. We investigated the impact of tuberculosis (TB) history on pulmonary hypertension (PH) prognosis within an HIV-burdened region. MethodsWe acquired sociodemographic, clinical, and echocardiographic data on 206 PH adults from the Pan African Pulmonary Hypertension cohort (PAPUCO), a prospective cohort study undertaken in four African countries. Cox-hazard regression models were constructed to assess how TB history interacts with diabetes, HIV-infection, and other chronic lung diseases (CLD), impacting death risks in PH patients. ResultsAmong the participants, a history of TB, diabetes, and other CLD was found in 23%, 8%, and 12% respectively. Of the 47 (35%)/134 participants living with HIV-infection, 62% exhibited HIV/TB coinfection, with 45% experiencing recurrent TB episodes. Individuals with TB history faced a 1.82-fold higher PH-related mortality risk (adjusted Hazard Ratio [aHR]: 1.84; 95%CI: 1.00, 3.39; p=0.049). Concurrent TB and comorbidities amplified death risks for PH patients, significantly affecting CLD (aHR: 3.10; 95%CI: 1.47, 6.53; p=0.003), and showing borderline impact for HIV co-infection (aHR: 2.10; 95%CI: 0.97, 4.54; p=0.059), while not significantly influenced by diabetes history (aHR: 2.39; 95%CI: 0.32, 18.00; p=0.4), although clinically relevant. ConclusionNearly one in every four patients diagnosed with PH in Africa have a history of TB and one in every three have HIV infection, which dramatically reduces their odds of survival. Our findings constitute a call to action to effectively address the neglected burden of PH among millions of patients suffering with TB diseases.