The burden of multimorbidity in patients with TB-HIV: a retrospective cohort analysis

Multimorbidity (i.e., the co-existence of two or more long-term health conditions [LTCs]) is increasing in high-TB-burden countries. Few studies have estimated the prevalence of multimorbidity in patients with TB, and none in TB-HIV. This retrospective cohort study used HIV clinic data from the Infectious Diseases Institute in Kampala, Uganda, to determine the prevalence and patterns of multimorbidity in patients with TB-HIV at the time of TB diagnosis, and its effect on TB treatment outcomes.

Adults living with HIV and diagnosed with TB between 1 January 2014 and 14 November 2024 were included. Clinical, laboratory, and prescription records were used to categorise LTCs. The prevalence and patterns of multimorbidity were examined and their effect on WHO-defined TB treatment outcomes was assessed using regression models.

Among 993 included patients, 76.1% (95% confidence interval: 73.4%-78.8%) had multimorbidity and 34.3% (31.4%-37.4%) had three or more LTCs. Anaemia (52.1%) and undernutrition (34.3%) were most prevalent. Multimorbidity was associated with a 3.70% (-0.35%-7.74%, P = 0.07) absolute increase in the adjusted risk of an unsuccessful treatment outcome.

Multimorbidity was highly prevalent at TB diagnosis in this cohort of people with TB-HIV, highlighting the complexity of care required alongside prescription of anti-TB therapy.