Severe forms of TB, HIV coinfection more likely in women

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Women had a higher risk for both severe forms of tuberculosis (TB) and HIV coinfection than men, suggesting additional research is needed to assess gender disparities in TB.

Although men are at increased risk for tuberculosis (TB) infection, the risk for severe forms of TB and TB and HIV coinfection is higher among women compared with men. These study findings were published in Open Forum Infectious Diseases.

Researchers conducted a time-trend ecologic analysis to assess the incidence of TB infection among individuals in Harare, Zimbabwe between 2008 and 2017. They also assessed the incidence of HIV coinfection among individuals who developed TB infection between 2011 and 2017. Incident TB infection was calculated as the number of new TB diagnoses within a single year per 100,000 individuals. A cross-sectional analysis was performed to assess the effect of gender on the clinical presentation of TB infection, with multinomial logistic regression used to evaluate gender-based disparities.

There were 24,277 new diagnoses of TB infection between 2001 and 2017, of which 58.5% occurred among men. Of all new TB diagnoses, 64.5% occurred in individuals aged between 25 and 44 years and 82.3% were pulmonary TB infection.

The researchers found that men demonstrated a 53% higher risk for TB infection compared with women (risk ratio [RR], 1.53; 95% CI, 1.12-2.09).

In contrast, TB and HIV coinfection was more likely to occur among women compared with men. Men aged between 15 and 24 years (RR, 0.83; 95% CI, 0.74-0.93) and 25 to 44 years (RR, 0.92; 95% CI, 0.88-0.95) demonstrated a 17% and 8% lower risk for TB and HIV coinfection compared with women in the same age groups, respectively. However, as age increased, the risk for TB and HIV coinfection between men and women equalized.

The anatomical location and severity of TB infection also differed by gender. Compared with women, men were less likely to develop TB in the abdomen (adjusted odds ratio [aOR], 0.51; 95% CI, 0.39-0.68), bones, joints, or spine (aOR, 0.63; 95% CI, 0.45-0.90), as well as “other” forms of extrapulmonary TB (aOR, 0.69; 95% CI, 0.59-0.81).

Study limitations include the cross-sectional design, possible missed TB diagnoses, data reporting errors, and potential selection bias.

“Men are well recognized as a high-risk group for TB, but disaggregated gender differences reveal that women are a high-risk group for various forms of EPTB [extrapulmonary tuberculosis] and TB-HIV coinfection,” the researchers noted. “Public health strategies for TB control/prevention must recognize that women are more likely to develop severe forms of TB and TB-HIV coinfection, which may result in worse outcomes for women,” the researchers concluded.

By Maria Arini Lopez


Humayun M, Chirenda J, Ye W, Mukeredzi I, Mujuru HA, Yang Z. Effect of gender on clinical presentation of tuberculosis (TB) and age-specific risk of TB, and TB-human immunodeficiency virus coinfection. Open Forum Infect Dis. 2022;9(10):ofac512. doi:10.1093/ofid/ofac512


For more TB news, check out the latest edition of the TB Online Weekly Newsletter (#39, 23 November 2022).


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