Beyond HIV: Prevalence and Interaction of Immunosuppressive Conditions in Patients with Tuberculosis

BACKGROUND: Tuberculosis (TB) remains a significant global public health issue. In Tanzania, TB prevalence and incidence rose by 2.1% and 2.3%, respectively, from 2020 to 2021. Current public health strategies focus mainly on HIV/AIDS-related TB, often neglecting other immunosuppressive conditions. This study aimed to assess the prevalence of immunosuppressive conditions beyond HIV in TB patients and explore their interactions. MATERIALS AND METHODS: A retrospective observational study was conducted among TB patients admitted to or attending the TB clinic at Mbeya Zonal Referral Hospital, Mbeya City, southwestern Tanzania, from January 1, 2021, to February 29, 2024. Data were collected through comprehensive medical history reviews. Immunosuppressive factors were assessed in confirmed TB cases, particularly those present before TB diagnosis. Statistical analyses were performed using STATA version 17, with significance set at P ≤ 0.05 and a 95% confidence interval. RESULTS: A total of 322 TB patients with a mean age of 48 ± 20.8 years (range 2-92) were included. Among them, 38.2% were diagnosed with HIV/AIDS, 20.2% had type 2 diabetes (T2D) mellitus, 5% were malnourished, 3.7% had a history of prolonged corticosteroid use (>6 weeks), and 3.1% had cancer or were undergoing chemotherapy before TB diagnosis. HIV infection was significantly associated with T2D (χ 2 = 50.17, P < 0.001), cancer (χ 2 = 6.25, P = 0.01), prolonged corticosteroid use (χ 2 = 3.82, P = 0.05), and malnutrition (χ 2 = 3.73, P = 0.05). A total of 74.2% of TB patients had one or more immunosuppressive conditions prior to TB diagnosis, with 36% having additional factors beyond HIV/AIDS. CONCLUSIONS: HIV/AIDS is still a major immunosuppressive factor associated with TB development. However, other immunosuppressive conditions also contribute significantly to TB risk. Public health strategies should address these factors alongside HIV/AIDS to reduce the TB burden.