Burden of latent tuberculosis infection among people living with HIV in Shanghai, China: a 4-year cohort study

Background Mycobacterium tuberculosis / human immunodeficiency virus (TB/HIV) co-infection remains a significant global public health challenge. In areas with a lower incidence of TB and HIV, how to elevate screening efficiency while maintaining cost-effectiveness worth further exploration. This study aimed to provide a suitable algorism for TB prevention and intervention among people who live with HIV (PLHIV) in Shanghai based on a cohort study. Methods A 4-year cohort study was conducted from May 2019 to December 2024, enrolling PLHIV from two districts in Shanghai. Participants underwent baseline and annual follow-up assessments using interferon-gamma release assays (IGRA) and questionnaires. Demographic, clinical, and laboratory data were collected. Results Among 963 enrolled participants, 857 completed baseline assessments. The baseline TBI prevalence was 6.8% (58/857). Older age and higher CD4 + T-cell count were associated with TBI. During a mean follow-up of 788 days among 615 participants, the IGRA conversion rate was 1.75% per person-year. One case of active TB was diagnosed (incidence rate: 84.33 per 100,000 person-years), occurring in a participant with an indeterminate baseline IGRA result. Participants with indeterminate baseline results had a significantly higher risk of subsequent IGRA conversion or active TB compared to those with negative results. Conclusion Given the low prevalence of latent TB infection and active TB among PLHIV in Shanghai, universal preventive treatment is not optimally efficient. The high rate of indeterminate IGRA results at baseline requires focused clinical assessment. A targeted screening and preventive treatment strategy based on local epidemiology and resources should be developed to enhance TB prevention in this population.