Independent Predictors of Tuberculosis Coinfection among People Living with HIV in Medan, Indonesia: A Case-Control Study
Abstract
Tuberculosis (TB) remains a major cause of morbidity among people living with HIV (PLHIV), particularly in high-burden countries such as Indonesia. This study aimed to identify factors independently associated with TB-HIV coinfection among PLHIV in Medan, Indonesia. An unmatched case-control study with a 1:3 case-to-control ratio was conducted in seven HIV Care, Support, and Treatment facilities in Medan. TB-HIV cases were ascertained from SIHA 2.1 records for January–August 2025, and participant data were collected from September 2025 to January 2026. A total of 144 participants were included, comprising 36 cases and 108 controls. Cases were identified from eligible records, while controls were selected sequentially until three controls were obtained per case. TB-HIV coinfection was confirmed by medical records documenting a positive molecular test (GeneXpert/TCM) and/or chest radiography. Underweight was defined as body mass index (BMI) <18.5 kg/m². Bivariate analyses and multivariable logistic regression were performed. Underweight was strongly associated with TB-HIV coinfection (COR=68.200; 95% CI: 21.268–218.702) and remained independently associated after adjustment (AOR=48.776; 95% CI: 10.394–228.895; p<0.001). Participants who had never received tuberculosis preventive therapy (TPT) had higher odds of coinfection (COR=14.826; 95% CI: 4.282–51.332; AOR=18.895; 95% CI: 3.161–112.965; p=0.001). Non-adherence to antiretroviral therapy (ART) was also associated with coinfection (COR=34.000; 95% CI: 7.731–149.530; AOR=15.820; 95% CI: 2.537–98.637; p=0.003). Large effect estimates and wide confidence intervals warrant cautious interpretation given the small number of cases and sparse data. Underweight, absence of TPT, and non-adherence to ART were independently associated with TB-HIV coinfection. Larger prospective studies are needed to validate these findings and clarify temporality before causal or prospective predictive conclusions are drawn.
Keywords: Tuberculosis Coinfection, HIV, Nutritional Status, Antiretroviral Adherence, Tuberculosis Preventive Therapy
Full Text:
PDFReferences
Adhikari, N., Bhattarai, R. B., Basnet, R., Joshi, L. R., Tinkari, B. S., Thapa, A., & Joshi, B. (2022). Prevalence and associated risk factors for tuberculosis among people living with HIV in Nepal. PLOS One, 17(1), 1–12. https://doi.org/10.1371/journal.pone.0262720
Alebel, A., Demant, D., Petrucka, P., & Sibbritt, D. (2021). Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis. BMC Infectious Diseases, 21(1), 1–20. https://doi.org/10.1186/s12879-020-05706-z
Arismaya, N. I. (2023). Prediktor Kejadian Tuberkulosis pada Pasien HIV (Studi Kasus di Balkesmas Wilayah Semarang). HIGEA (Journal of Public Health Research and Development), 7(Sup). https://doi.org/10.15294/higeia.v7iSup.64820
Azevedo-Pereira, J. M., Pires, D., Calado, M., Mandal, M., Santos-Costa, Q., & Anes, E. (2023). HIV/Mtb Co-Infection: From the Amplification of Disease Pathogenesis to an “Emerging Syndemic.” Microorganisms, 11(4), 1–18. https://doi.org/10.3390/microorganisms11040853
Bell, L. C. K., & Noursadeghi, M. (2018). Pathogenesis of HIV-1 and Mycobacterium tuberculosis co-infection. Nature Reviews Microbiology, 16, 80–90. https://doi.org/10.1038/nrmicro.2017.128
Bizuneh, F. K., Bizuneh, T. K., Masresha, S. A., Kidie, A. A., Arage, M. W., Sirage, N., & Abate, B. B. (2024). Tuberculosis-associated mortality and risk factors for HIV-infected population in Ethiopia : a systematic review and. Frontiers in Public Health, 12(1), 14. https://doi.org/10.3389/fpubh.2024.1386113
Bruchfeld, J., Jansson, M., & Källenius, G. (2026). Tuberculosis and HIV Coinfection: Advances and Remaining Concerns. CSH Perspective, 16(9), 1–18. https://doi.org/10.1101/cshperspect.a041807
Choi, S., Im, J.-J., Yoon, S.-E., Kim, S.-H., Cho, J.-H., Jeong, S.-J., Park, K.-A., & Moon, Y.-S. (2023). Lower socioeconomic status associated with higher tuberculosis rate in South Korea. 23(418), 1–7. https://doi.org/10.1186/s12890-023-02713-z
Cordeiro, S. A., Lopes, T. C. P., Boechat, A. L., & Gonçalves, R. L. (2024). Weight loss and mortality in people living with HIV : a systematic review and meta- analysis. BMC Infectious Diseases, 24(1), 1–11. https://doi.org/10.1186/s12879-023-08889-3
Dauphinais, M. R., Koura, K. G., Narasimhan, P. B., Mehta, S., Finkelstein, J. L., Heysell, S. K., & Sinha, P. (2024). Nutritionally acquired immunodeficiency must be addressed with the same urgency as HIV to end tuberculosis. BMC Global and Public Health, 2(4), 1–9. https://doi.org/10.1186/s44263-023-00035-0
Dinas Kesehatan Provinsi Sumatera Utara. (2025). Laporan Pelaksanaan Kegiatan Program HIV - AIDS dan PIMS Tahun 2024.
Ebrahim, E. S., Tsegaye, D. A., Biks, G. A., Shiferie, F., Wegayehu, L., Tekeste, A., Seboka, G., Tefera, A., Mekuria, L. A., Hayes, A., Alemayehu, W. A., Melese, E., Odu, J., Mookherji, S., Liddell, E., & Negash, A. (2025). Community-based enhanced adherence counseling among people living with HIV in Ethiopia : outcomes and key predictors of viral suppression. AIDS Research and Therapy, 22(1), 1–11. https://doi.org/10.1186/s12981-025-00815-8
Ganesan, K., Mwesigwa, R., Dear, N., Esber, A. L., Reed, D., Kibuuka, H., Iroezindu, M., Bahemana, E., Owuoth, J., Singoei, V., Maswai, J., Parikh, A. P., Crowell, T. A., Ake, J. A., Polyak, C. S., Shah, N., & Cavanaugh, J. S. (2023). Epidemiology of Tuberculosis Among People Living With HIV in the African Cohort Study From 2013 to 2021. Journal of Acquired Immune Deficiency Syndromes, 92(5), 359–369. https://doi.org/10.1097/QAI.0000000000003152
Getaw, D., & Tigu, F. (2024). TB co-infection and associated factors among HIV patients attending highly active antiretroviral therapy in Saint Peter ’ s TB Specialized Hospital , Ethiopia : a five years retrospective study. African Health Sciences, 24(2), 54–61. https://doi.org/10.4314/ahs.v24i2.7
Getu, A., Wolde, H. F., Animut, Y., & Kibret, A. A. (2022). Incidence and predictors of Tuberculosis among patients enrolled in Anti-Retroviral Therapy after universal test and treat program, Addis Ababa, Ethiopia. A retrospective follow -up study. PLoS ONE, 17(8), 1–13. https://doi.org/10.1371/journal.pone.0272358
Hwang, S. Y., Kim, J. Y., Lee, H. S., Lee, S., Kim, D., Kim, S., Hyun, J. H., Shin, J. Il, Lee, K. H., Han, S. H., & Song, Y. G. (2022). Pulmonary Tuberculosis and Risk of Lung Cancer : A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 11(3), 1–19. https://doi.org/10.3390/jcm11030765
Iftitah, N. M., Adi, S., & Gayatri, R. W. (2020). Faktor yang Mempengaruhi Terjadinya Ko-Infeksi. Preventia: Indonesian Journal of Public Health, 5(1), 27–34. https://dx.doi.org/10.17977/um044v5i1p27-34
Júnior, J. N. de B. S., Leal, G. da C., Ferreira, Q. R., Andrade, L. K. de A., Ballestero, J. G. D. A., Santos, V. S., Pescarini, J. M. ., Trajman, A., Arakaki-sanchez, D., Bartholomay, P., Andrade, R. L. D. P., Pelissari, D., & Palha, P. F. (2025). Effectiveness of tuberculosis preventive treatment on disease incidence among people living with HIV / AIDS : A systematic review and. PLOS One, 20(8), 1–18. https://doi.org/10.1371/journal.pone.0330208
Kementerian Kesehatan RI. (2025). Laporan Kinerja Kementerian Kesehatan 2024. https://repository.badankebijakan.kemkes.go.id/id/eprint/5852/1/LKj Kemenkes 2024.pdf
Ministry of Health of The Republic of Indonesia. (2025). Indonesia Health Profile 2024. https://drive.kemkes.go.id:5001/d/s/16EsO2mOsosXJt21Ye3MPlxFrug4kxNA/NiX5fIVuuVcSzAPJCaTwgPnm5hShiaJP-VbqA1x7k0Qw
Nguenha, D., Ndebele, F., Saavedra, B., Mambuque, E., Acacio, S., Cardenas, V., Chihota, V., Grant, A., Yimer, G., Fielding, K., Cobelens, F., Churchyard, G., & García-Basteiro, A. (2025). BMI as a predictor of progression from TB infection to active TB in PLHIV. The International Journal of Tuberculosis and Lung Disease, 29(2), 54–59. https://doi.org/10.5588/ijtld.24.0287
Nkiene, E., Kayembe, H. C., Yambare, A., Yuma, J., Booto, G., Bongenya, B. I., & Kamangu, E. N. (2026). Tuberculosis and HIV co-infection and associated socioeconomic factors among adults in Kinshasa , Democratic Republic of the Congo : a facility-based cross-sectional study. Discover Public Health, 23(1), 1–13. https://doi.org/10.1186/s12982-026-01388-1
Nursalam, N., Sukartini, T., Misutarno, M., & Priyantini, D. (2023). Adherence to antiretroviral therapy , CD4 count , viral load and opportunistic infections in people with HIV / AIDS : a cross-sectional study. Jurnal Ners, 19(1), 88–94. https://doi.org/10.20473/jn.v19i1.49958
Ojo, T., Ruan, C., Hameed, T., Malburg, C., Thunga, S., Smith, J., Vieira, D., Snyder, A., Tampubolon, S. J., Gyamfi, J., Ryan, N., Lim, S., Santacatterina, M., & Peprah, E. (2022). HIV , Tuberculosis , and Food Insecurity in Africa — A Syndemics-Based Scoping Review. International Journal of Environmental Research and Public Health, 19(3), 1–31. https://doi.org/10.3390/ijerph19031101
Ozer, N. T., & Gündoğan, K. (2024). The Vicious Cycle of Malnutrition and Tuberculosis : A Narrative Review. Journal of Clinical Practice & Research, 46(5), 444–448. https://doi.org/10.14744/cpr.2024.60895
Qi, C.-C., Xu, L.-R., Zhao, C.-J., Zhang, H.-Y., Li, Q.-Y., Liu, M.-J., Zhang, Y.-X., Tang, Z., & Ma, X.-X. (2023). Prevalence and risk factors of tuberculosis among people living with HIV/AIDS in China : a systematic review and meta-analysis. BMC Infectious Diseases, 23(1), 1–13. https://doi.org/10.1186/s12879-023-08575-4
Rangaraj, S., Agarwal, A., & Banerjee, S. (2025). Bird’s Eye View on Mycobacterium tuberculosis–HIV Coinfection: Understanding the Molecular Synergism, Challenges, and New Approaches to Therapeutics. ACS Infectious Diseases, 11(5), 1042–1063. https://doi.org/10.1021/acsinfecdis.4c00870
Saunders, M. J., Cegielski, J. P., Clark, R. A., Houben, R. M. G. J., & McQuaid, C. F. (2025). Body mass index and tuberculosis risk: An updated systematic literature review and dose-response meta-analysis. International Journal of Epidemiology, 54(5), 1–16. https://doi.org/10.1093/ije/dyaf154
Schwalb, A., Bergstrom, M., Woodd, S., Rehman, A. M., PrayGod, G., Kasonka, L., Koethe, J. R., Filteau, S., & Houben, R. M. G. J. (2023). Impact of micro- and macronutrient status on the incidence of tuberculosis: An examination of an African cohort initiating antiretroviral therapy. PLOS Global Public Health, 3(7), 1–13. https://doi.org/10.1371/journal.pgph.0002007
Semitala, F. C., Chaisson, L. H., Dowdy, D. W., Armstrong, D. T., Opira, B., Aman, K., Kamya, M., Phillips, P. P. J., & Yoon, C. (2022). Tuberculosis screening improves preventive therapy uptake ( TB SCRIPT ) trial among people living with HIV in Uganda : a study protocol of an individual randomized controlled trial. Trials, 23(1), 1–13. https://doi.org/10.1186/s13063-022-06371-0
Tang, X.-Z., Ma, Y., Ma, Y., Chen, Q., Zou, L.-P., Fu, X.-Y., Huang, T., Tang, S.-J., & Wu, G.-H. (2025). Epidemiology of tuberculosis and HIV coinfection among inpatients in chengdu, china, 2018-2022. BMC Infectious Diseases, 25(2043), 1–13. /https://doi.org/10.1186/s12879-025-11316-4
Tegegne, A. S., & Minwagaw, M. T. (2022). Risk Factors for the Development of Tuberculosis Among HIV-Positive Adults Under Highly Active Antiretroviral Therapy at Government Hospitals in Amhara Region , Ethiopia. International Journal of General Medicine, 15(1), 3031—3041. https://doi.org/10.2147/IJGM.S358517
UNAIDS. (2022). Dangerous Inequality: World AIDS Day Report 2022. UNAIDS. https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2022/november/20221129_dangerous-inequalities?utm_
Uppal, A., Rahman, S., Campbell, J. R., Oxlade, O., & Menzies, D. (2021). Economic and modeling evidence for tuberculosis preventive therapy among people living with HIV : A systematic review and meta-analysis. PLOS Medicine, 18(9), 1–24. https://doi.org/10.1371/journal.pmed.1003712
Vanvalkenburg, A., Kaipilyawar, V., Sarkar, S., Lakshminarayanan, S., Cintron, C., Babu, S. P., Knudsen, S., Joseph, N. M., Horsburgh, C. R., Sinha, P., Ellner, J. J., Narasimhan, P. B., Johnson, W. E., Hochberg, N. S., & Salgame, P. (2022). Malnutrition leads to increased in fl ammation and expression of tuberculosis risk signatures in recently exposed household contacts of pulmonary tuberculosis. Frontiers in Immunology, 13(1), 1–12. https://doi.org/10.3389/fimmu.2022.1011166
Vasiliu, A., Abelman, R., Kherabi, Y., Saktiawati, A. M. I., & Kay, A. (2022). Landscape of TB Infection and Prevention among People Living with HIV. Pathogens, 11(12), 1–14. https://doi.org/https://doi.org/10.3390/pathogens11121552
Wondmeneh, T. G., & Mekonnen, A. T. (2023). The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa : a systematic review and meta-analysis. BMC Infectious Diseases, 22(1), 1–24. https://doi.org/10.1186/s12879-023-08533-0
World Health Organization. (2024a). Global Tuberculosis Report 2024. WHO. https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024/tb-disease-burden/1-1-tb-incidence?utm_
World Health Organization. (2024b). Tuberculosis Key Facts. WHO. https://www.who.int/news-room/fact-sheets/detail/tuberculosis?utm_
Yanes-Lane, M., Ortiz-Brizuela, E., Campbell, J. R., Benedetti, A., Churchyard, G., Oxlade, O., & Menzies, D. (2021). Tuberculosis preventive therapy for people living with HIV : A systematic review and network meta-analysis. PLOS Medicine, 18(9), 1–23. https://doi.org/10.1371/journal.pmed.1003738
Yengkhom, D., Montepiedra, G., Masheto, G., Wabwire, D., Stranix-chibanda, L., Matubu, A., Violari, A., Theron, G., Gupta, A., & Weinberg, A. (2026). Tuberculosis preventive therapy in postpartum women with HIV modi fi es M . tuberculosis -speci fi c and nonspeci fi c immune responses. Frontiers in Immunology, 17(March), 1–11. https://doi.org/10.3389/fimmu.2026.1722621
Zeeb, M., Tepekule, B., Kusejko, K., Reiber, C., Kälin, M., Bartl, L., Notter, J., Furrer, H., Hoffmann, M., Hirsch, H. H., Calmy, A., Cavassini, M., Labhardt, N. D., Bernasconi, E., Braun, D. L., Günthard, H. F., Kouyos, R. D., & Nemeth, J. (2023). Understanding the Decline of Incident , Active Tuberculosis in People With Human Immunodeficiency Virus in Switzerland. Clinical Infectious Diseases, 77(9), 1303–1311. https://doi.org/10.1093/cid/ciad330
DOI: http://dx.doi.org/10.30829/contagion.v8i3.30295
Refbacks
- There are currently no refbacks.
Copyright (c) 2026 Silvi Anggraeni M
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
