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. 2025 Feb 1;39(2):184-192.
doi: 10.1097/QAD.0000000000004045. Epub 2024 Oct 24.

Sex differences in tuberculosis infection and disease among people with HIV

Lelia H Chaisson  1   2 , Betina Durovni  3 , Nasir Umar  4 , Silvia Cohn  5   6 , Lawrence H Moulton  7 , Eileen Scully  5 , Solange Cavalcante  8 , Jonathan E Golub  5   6 , Richard E Chaisson  5   6 , Valeria Saraceni  3
Affiliations

Sex differences in tuberculosis infection and disease among people with HIV

Lelia H Chaisson et al. AIDS. .

Abstract

Objectives: Worldwide, adult men experience an excess burden of tuberculosis (TB) disease compared with women, but few studies have examined sex differences in TB among people with HIV. In this study, we aimed to investigate sex differences in TB infection and disease among people with HIV in Rio de Janeiro, Brazil.

Design: Analysis of data from a randomized controlled trial and retrospective cohort study.

Methods: We analyzed data from two studies conducted between 2005 and 2017. The THRio Study (2005-2012) evaluated increasing tuberculin skin testing (TST) and TB preventive therapy (TPT), and Universal ART in Rio study (UnivART; 2010-2017) was a virtual cohort study of people with HIV and TB with data from four national electronic registries.

Results: Among 4606 people with HIV in THRio, 2992 (65.0%) had a TST placed and read, of whom 312 of 1865 (17%) males and 203 of 1127 (18%) females ( P = 0.37) had prevalent TB infection. TB disease incidence was higher among males compared with females overall [IRR 1.33, 95% confidence interval (95% CI) 1.04-1.69], among males compared with females who did not receive TPT [incidence rate ratios (IRR) 1.30, 95% CI 1.01-1.67], and among males compared with females on ART (IRR 1.64, 95% CI 1.17-2.29). Among 54 957 people with HIV in UnivART, TB disease incidence rates were higher among males than females overall (IRR 1.28, 95% CI 1.18-1.39), among males compared with females on ART (IRR 1.58, 95% CI 1.40-1.77), and among males compared with females not on ART (IRR 1.11, 95% CI 0.99-1.25).

Conclusion: In this medium TB and HIV burden setting, TB disease incidence was higher among males than females with HIV, despite similar prevalence of TB infection.

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Conflict of interest statement

These studies were supported by the Bill & Melinda Gates Foundation (19790.01 to the Consortium to Respond Effectively to the AIDS-Tuberculosis Epidemic); the Johns Hopkins Center for AIDS Research (P30 AI094189 to REC); the Johns Hopkins Tuberculosis Research Advancement Center (P30 AI168436 to REC) and the Johns Hopkins HIV Epidemiology and Prevention Sciences Training Program (T32 AI102623 to LHC). The funding organizations had no role in the design, collection, analysis, or interpretation of data. Earlier versions of this analysis were presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in 2022 and the Union World Conference on Lung Health in 2023. The authors declare no conflicts of interest.

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