Hyperinflammatory Profiles and Early Mortality in HIV-Associated Tuberculosis: A Prospective Cohort Study in Brazil.

Authors

Betânia M F Nogueira, Caian L Vinhaes, Francys A Rangel, Eduardo R Fukutani, Euclimeire S Neves, Cristina S A Damasceno, Emanuelle S O Ferreira, Fernanda S F Oliveira, Gilberto T S Junior, Ronaldo J R Santos, Talita A B Cersosimo, José T T Araujo, Kevan M Akrami, Rebeca Rebouças, Mariana Araujo-Pereira, Ceuci Nunes, Constance Benson, Bruno B Andrade, Artur T L Queiroz

Published in

The Journal of infectious diseases. Sep 07, 2026. Epub Sep 07, 2026.

Abstract

Tuberculosis remains the leading cause of death among people with HIV, yet the immunological mechanisms underlying early mortality are incompletely defined.
In this prospective cohort, 152 adults hospitalized with HIV-associated TB in Bahia, Brazil, had clinical/laboratory data and plasma cytokines measured at admission and day 7. Participants were followed for 100 days; deaths were classified as early (≤14 days) or late (15-100 days). We used clustering, canonical discriminant analysis, bootstrapped correlation networks, and multivariable logistic regression.
Twenty-eight participants (18.4%) died: 13 early and 15 late. Early deaths had poorer functional status, greater organ dysfunction, less frequent early antiretroviral initiation, and biochemical evidence of intense systemic inflammation and coagulopathy. Unsupervised clustering did not clearly segregate outcomes, but early deaths displayed higher innate/chemotactic mediators and persistently dense, hyperconnected cytokine networks at baseline and day 7. Mortality was associated with higher day-7 TNF-α, IL-6 and GM-CSF and lower day-7 IL-2, as well as higher baseline IL-1ra and lower baseline TNF-β and IL-5; baseline International Normalized Ratio (INR) was the only biochemical predictor.
Early mortality in this Brazilian cohort was characterized by a dysregulated, hyperconnected inflammatory state consistent with sepsis-like hyperinflammation, supporting immune-informed risk stratification and carefully designed host-directed studies.

PMID:
42703724
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.