P0533The burden of tuberculosis in an IBD cohort from an African, TB endemic, country

Background African countries are at a confluence of increasing non-communicable diseases such as Inflammatory Bowel Disease (IBD), high rates of infectious diseases such as tuberculosis (TB) while barriers to accessing treatments such as advanced IBD therapies, in particular anti-TNF (anti-tumour necrosis factor) biosimilars, are diminishing.1 In South Africa (SA) anti-TNFs are prescribed, or preferentially funded, first line advanced IBD therapy. In 2024 the TB incidence rate in SA was 389/100,000 and 249 000 people fell ill with TB with 54,000 deaths attributed to TB during this period.2 The 2024 WHO TB Prevention Guideline 3 and ECCO guidelines 4 advise TB infection screening for all patients before initiating anti-TNF therapy. But does this adequately address the broader TB risk faced by African IBD patients during their lifetime living with IBD? To understand the burden of TB in IBD patients in Africa we describe 168 TB cases from an IBD cohort from South Africa. Methods The IBD Africa Registry database was analysed for cases of TB. TB cases were confirmed by a history of diagnosis and treatment supported by a chest X-ray, histology demonstrating caseating granulomata or bacteriologically confirmed TB (positive smear microscopy, culture or rapid diagnostic test). Empiric TB treatment for intestinal TB prior to a diagnosis of IBD was not considered TB. Demographic data, IBD phenotype and immune suppression exposure were analysed Results 4,086 patients were analysed and TB data on 2,504 patients (61.2%) obtained. 168 had a diagnosis of TB (6.7%) In 62/168 patients (36.9%) TB occurred before the diagnosis of IBD (median 13 years) In 89 patients who were diagnosed with TB after an IBD diagnosis compared with 2236 without TB, a positive test for TB infection (p < 0.0001) and exposure to advanced IBD therapies (p = 0.0017) were significantly associated with TB. Demographics, IBD phenotype and neighbourhood typology were not associated with the development of TB. Conclusion With 168 TB cases, this analysis provides a rare, large-scale insight from a TB endemic region and begins to quantify the magnitude of the problem. Over one-third of patients developed TB before their IBD diagnosis illustrating TB rooted in early-life or community exposure, rather than IBD related. Exposure to advanced therapies and a positive test for TB infection are significantly associated with the development of TB. Surprisingly neighbourhood typology, reflecting socio-economic status, strongly associated with TB rates in the City of Cape Town, was not associated with the development of TB. References: 1. Watermeyer G, Katsidzira L,, Setshedi M et al Inflammatory bowel disease in sub-Saharan Africa: epidemiology, risk factors, and challenges in diagnosis. Lancet Gastro Hep 2022, 7:10, 952-961. 2. World Health Organization. Global Tuberculosis Report 2025. Geneva: WHO; 2025 https://www.who.int ‘ Publications 3. 2025WHO Consolidated Guidelines on Tuberculosis: Module 1: Prevention 2nd Edition 2024 https://www.who.int ‘ Publications 4. Kucharzikon T, Ellulon P, Greuteron T et al ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. Journal of Crohn’s and Colitis, 2021, 15:6 2021, 879–913 Conflict of interest: Epstein, David P.: IBD Africa has received educational and research funding from Janssen Pharmaceuticals, Abbvie, Takeda, Equity Pharmaceuticals, Pfizer, Adcock Ingram Dr Epstein has received honorariums from Janssen Pharmaceuticals, Abbvie, Takeda, Aspen, Adcock Ingram Mhlaba, Zozibini: Nil Dolovich, Casandra: No conflict of interest Bernstein, Charles: Grant: Abbvie, Celltrion, Ferring, Pfizer, Takeda, Janssen, Organon, Eli Lilly, Sandoz Personal Fees: Abbvie Janssen, Pfizer, Takeda, Eli Lilly, Ferring, Pendopharm, Sandoz, Amgen, Celltrion, Fresenius-Kabi