Background: Thailand has a high tuberculosis (TB) burden. As a result of effective TB treatment and prevention programs, the number of TB survivors has steadily increased in recent decades. Post-tuberculosis lung disease (PTLD) has emerged as a prominent problem among TB survivors, leading to substantial disability-adjusted life year (DALY) losses. Objective: To determine the prevalence and risk factors of PTLD at Kaeng Khro Hospital, Thailand. Materials and Methods: The present study was a retrospective observational cohort study that included 450 patients with TB, older than 15 years of age, who underwent treatment between October 1, 2016, and September 30, 2024, with chest radiography obtained before and three months after treatment completion. Results: The prevalence rate of PTLD was 83.5%, categorized into lung fibrosis 70.7%, persistent lung cavities 28.7%, bronchiectasis 27.7%, fibrothorax 6.9%, destroyed lung syndrome 6.1%, post-TB chronic obstructive pulmonary disease 3.7%, and post-TB tracheobronchial stenosis and aspergilloma 0.3%. By multivariate analysis, the statistically significant (p<0.05) risk factors were increasing age (adjusted odds ratio AOR 1.03, 95% confidence interval CI 1.00 to 1.06, p=0.021), smoking (AOR 3.81, 95% CI 1.17 to 12.36, p=0.026), lung cavities (AOR 3.00, 95% CI 1.45 to 6.19, p=0.000), and bilateral lung lesions before treatment (AOR 2.75, 95% CI 1.30 to 5.83, p=0.008). HIV infection significantly reduced the risk of PTLD (AOR 0.07, 95% CI 0.02 to 0.31, p<0.001), suggesting a potential protective effect. Conclusion: The prevalence of PTLD was 83.5%. The statistically risk factors before treatment were increased age, smoking, lung cavities, and bilateral lung lesions. HIV infection with low CD4 may attenuate the host inflammatory response, thereby decreasing the risk of PTLD. This highlights the importance of monitoring smoking cessation throughout the course of treatment. Close monitoring for PTLD is warranted in elderly patients and in those with lung cavities among TB survivors.
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