Hemophagocytic lymphohistiocytosis is associated with disseminated tuberculosis in patients with advanced HIV infection

Hemophagocytic lymphohistiocytosis is associated with disseminated tuberculosis in patients with advanced HIV infectionDear editor, We read with great interest the article by Jing Jiang and colleagues, 1 which reported that impaired T cell immunity is associated with disseminated tuberculosis (TB) in HIV-negative patients.In contrast, individuals with HIV infection are more susceptible to disseminated TB (DTB) partly due to CD4 + T-cell depletion, 2,3 yet the factors driving DTB in this population have not been fully investigated.Hemophagocytic lymphohistiocytosis (HLH), a hyperinflammatory syndrome caused by genetic defects or triggered by infections, is commonly seen in adults with HIV.Recent studies suggest HLH shares clinical and pathological features with severe mycobacterial immune reconstitution inflammatory syndrome (IRIS) in advanced HIV infection. 4However, whether HLH is associated with TB susceptibility in HIV-infected patients remains unknown.To address this gap, we conducted an observational cohort study to investigate this potential association in patients with advanced HIV.In this study, we enrolled advanced HIV patients who were suspected of having HLH and TB through the Observation Study on Patients with HIV/AIDS program (OSPWH) (NCT04667026) at Guangzhou Eighth People's Hospital.Participants presented with signs and symptoms that included fever, abnormal chest radiography results, weight loss, pancytopenia, hepatosplenomegaly, lymphadenopathy, and hyperinflammation.After obtaining informed consent, all participants underwent standard evaluations by experienced technicians and specialists for HLH according to the HLH-2004 criteria 5 and TB disease as previously described protocols. 6DTB was defined as infection of the blood stream, bone marrow, brain, or involvement of two or more non-adjacent body sites. 7We then applied univariate logistic regression to assess factors associated with TB susceptibility among patients with advanced HIV, reporting results as crude odds ratio (OR) with 95% confidence intervals (CI).A P value less than 0.05 was considered statistically significant.