Predictors of active tuberculosis among presumptive tuberculosis cases in people living with HIV attending a tertiary hospital in Nigeria

Tuberculosis (TB) remains a major cause of morbidity and mortality among people living with HIV (PLHIV). Although routine symptom-based TB screening is recommended in HIV care settings, data on the diagnostic yield and predictors of confirmed TB among presumptive TB cases in Nigeria remain limited. This study assessed the predictors of active tuberculosis among presumptive tuberculosis cases in people living with HIV attending a tertiary hospital in Nigeria. We conducted a retrospective review of routinely collected data from adult PLHIV documented in the presumptive TB register of a tertiary hospital HIV clinic between October 2022 and December 2025. Sociodemographic and clinical data were extracted and analyzed using SPSS version 26. Associations with TB diagnosis were assessed using Chi-square or Fisher’s exact test and multivariate logistic regression. Statistical significance was set at p < 0.05. A total of 162 presumptive TB cases were included, with a mean age of 43.1 ± 13.6 years; 64.8% were females. Overall, 20.4% of participants were diagnosed with active TB while 53.7% had CD4 counts < 200 cells/mm³. TB diagnosis was significantly associated with male gender (31.6%, p = 0.014), CD4 count < 200 cells/mm³ (27.6%, p = 0.011), and presence of two or more symptoms (25.2%, p = 0.039). In multivariable analysis, male gender (AOR = 2.70, 95% CI: 1.20–6.07) and CD4 count < 200 cells/mm³ (AOR = 2.69, 95% CI: 1.13–6.41) remained independently associated with TB. Approximately one in five presumptive TB cases among PLHIV had active TB. Male gender and advanced immunosuppression were independently associated with TB diagnosis, highlighting the need to strengthen TB surveillance among high-risk patients in HIV care settings.