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

Introduction Post-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. Methods We 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. Results Among 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. Conclusion Nearly 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Financial support was provided by unconditional research grants from the Pulmonary Vascular Research Institute (PVRI) [Grant number 422348] and Bayer Healthcare Berlin [Grant number 411278]. The General Medicine & Global Health (GMGH) Research Unit of the University of Cape Town provided institutional support. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: South Africa (University of Cape Town faculty of health science: FWA0000163) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors