HIV linked to lower odds of post-TB lung disease; undernutrition raises risk

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BMJ global health Published June 5, 2026 Medically reviewed June 5, 2026 Study authors: Hill Katherine Jane, Mbabazi Irene, Scopazzini Marcello Sergio, Warner Benedict, Sekaggya-Wiltshire … PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Interpret associations between comorbidities and post-TB lung disease cautiously due to very low certainty evidence.

This systematic review and meta-analysis included 41 papers (from 10 321 screened) examining associations between individual comorbidities (HIV, diabetes, undernutrition) and post-tuberculosis lung disease (PTLD) in adults in low- and middle-income countries (LMICs). The primary outcome was spirometry-defined PTLD.

Key findings: People living with HIV had reduced odds of spirometry-defined PTLD (OR 0.68, 95% CI 0.52 to 0.89). In contrast, undernutrition was associated with increased odds of abnormal spirometry (OR 1.99, 95% CI 1.02 to 3.87). For diabetes, a meta-analysis of three papers showed increased odds of PTLD but the association was inconsistent and not statistically significant (OR 1.65, 95% CI 0.96 to 2.84).

The authors note important limitations: no study assessed multimorbidity, PTLD measurement tools varied widely, 58.5% of included studies were at high risk of bias, and the certainty of evidence for all meta-analysed associations was very low. Evidence for other comorbidities was limited and inconclusive.

Practice relevance is restrained: these findings highlight the need for prospective studies evaluating comorbidities in relation to PTLD. Clinicians should interpret the associations with caution given the very low certainty of evidence.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

PMID42225354

View Original Abstract ↓

INTRODUCTION: Post-tuberculosis lung disease (PTLD), a chronic respiratory syndrome affecting approximately half of tuberculosis (TB) survivors, is an emerging public health threat in low- and middle-income countries (LMICs). Multimorbidity, defined as two or more coexisting chronic health conditions, is also rising in LMICs. This systematic review and meta-analysis examines associations between multimorbidity or individual comorbidities and PTLD. METHODS: Medline, EMBASE, Web of Science, Global Health and Scopus databases up to 7 March 2024 were searched and studies in LMICs assessing PTLD and either a single comorbidity or multimorbidity were included. Summary data were extracted independently by two reviewers. Random effects meta-analyses were performed where sufficient comparable data were reported. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies-of Exposure and certainty of evidence for meta-analysable associations was assessed using Grading of Recommendations Assessment, Development and Evaluation. Study protocol was registered with PROSPERO (CRD42024552486). RESULTS: 41 papers, from 10 321 screened, were included. None analysed multimorbidity. PTLD measurement tools varied widely. Meta-analysis of 10 of 24 papers analysing the association between spirometry-defined PTLD and HIV status found reduced odds of PTLD in people living with HIV (OR 0.68, 95% CI 0.52 to 0.89). 15 papers reported on diabetes and showed inconsistent associations; meta-analysis of three papers yielded an OR of 1.65 (95% CI 0.96 to 2.84). Adults with undernutrition had increased odds of abnormal spirometry following TB on meta-analysis of three studies (OR 1.99, 95% CI 1.02 to 3.87). Evidence for other comorbidities was limited and inconclusive. Overall, 24/41 (58.5%) of included studies were at high risk of bias and certainty of evidence for meta-analysed associations was very low. CONCLUSION: PTLD may be more common among adults who are HIV-negative or undernourished, but the evidence is very uncertain. The absence of dedicated multimorbidity studies and inconsistencies in defining PTLD highlight the need for prospective studies evaluating comorbidities in relation to PTLD. PROSPERO REGISTRATION NUMBER: CRD42024552486.