Lung function impairment at pulmonary TB and HIV/TB diagnosis: a South African cross-sectional cohort analysis.

Authors

Michael Marll, Tlhago Ngwanto, Nomsa Mofokeng, Lydia Mngomezulu, Sally El Sammak, Anisha Rajaratnam, Fay Willis, Matthew Magee, Lungile Gabuza, Hardy Kornfeld, Yun Li, Pholo Maenetje, Gregory P Bisson, Sara Auld

Published in

BMJ open respiratory research. Volume 13. Issue 1. Jun 18, 2026. Epub Jun 18, 2026.

Abstract

To characterise the patterns and severity of impaired lung function at pulmonary tuberculosis (TB) diagnosis and assess the impact of HIV co-infection on TB-associated lung injury.
A cross-sectional analysis of adults with and without HIV who presented with newly diagnosed drug-susceptible pulmonary TB in Johannesburg, South Africa.
A total of 258 adults who were newly diagnosed with drug-susceptible pulmonary TB underwent comprehensive pulmonary function tests (PFT).
Five key PFT manoeuvres were evaluated: forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity (TLC) and haemoglobin-corrected diffusion capacity of the lungs for carbon monoxide (DLCO). Three primary outcomes were modelled: (1) normal versus abnormal lung function, defined as any key PFT manoeuvre z-score < lower limit of normal, (2) continuous z-scores for each PFT and (3) clinical patterns of lung function (normal, restriction, obstruction, mixed disorder and isolated low DLCO). Secondary outcomes included respiratory health-related quality-of-life measures assessed using the St. George's Respiratory Questionnaire (SGRQ).
HIV/TB co-infection was associated with lower odds of any abnormal lung function (adjusted OR (aOR) 0.43, 95% CI 0.24 to 0.74) and lower odds of restrictive (aOR 0.46, 95% CI 0.24 to 0.87) and mixed patterns (aOR 0.22, 95% CI 0.07 to 0.66) compared with those with TB alone. HIV co-infection was also associated with better FEV1, FVC, FEV1/FVC and TLC z-scores. While those with HIV had less severe radiographic disease, respiratory symptoms were similar between groups (SGRQ total score: HIV-negative 22 (IQR: 13-38) vs HIV-positive 26 (IQR: 8-44), p>0.9).
Adults with HIV/TB co-infection demonstrated a distinct clinical phenotype of TB-associated lung injury at TB diagnosis characterised by less severe radiographic and lung function impairment compared with those without HIV.

PMID:
42315259
Bibliographic data and abstract were imported from PubMed on 19 Jun 2026.

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