@article{fdi:010093475,
  title = {{COVID}-19, tuberculosis, and {HIV} triad : a prospective observational study in ambulatory patients in {K}enya, {U}ganda, and {S}outh {A}frica},
  author = {{H}uerga, {H}. and {G}ouillou, {M}. and {O}hler, {L}. and {T}aremwa, {I}. {M}. and {A}kinyi, {M}. and {L}ubega, {A}. and {M}uyindike, {W}. {R}. and {B}astard, {M}. and {B}ossard, {C}. and {A}tieno, {M}. and {M}uhindo, {R}. and {C}asas, {E}. {C}. and {N}akiyingi, {L}. and {C}asenghi, {M}. and {G}upta-{W}right, {A}. and {B}onnet, {M}aryline and {N}dlovu, {Z}.},
  editor = {},
  language = {{ENG}},
  abstract = {{P}eople living with {HIV} ({PLHIV}) have an increased risk of tuberculosis ({TB}) and severe {COVID}-19. {TB} and {COVID}-19 present with overlapping symptoms and co-infection can lead to poor outcomes. {W}e assessed the frequency of {SARS}-{C}o{V}-2 positive serology and {SARS}-{C}o{V}-2 infection and the risk of mortality at 6 months in {PLHIV} with {TB} disease and {SARS}-{C}o{V}-2 infection. {T}his multi-country, prospective, observational study, conducted between 7th {S}eptember 2020 and 7th {A}pril 2022, included ambulatory adult {PLHIV} investigated for {TB} (with symptoms of {TB} or advanced {HIV} disease) in {K}enya, {U}ganda, and {S}outh {A}frica. {T}esting included {CD}4 cell count, {X}pert {MTB}/{RIF} {U}ltra assay (sputum), {D}etermine {TB} {LAM} {A}g assay (urine), chest {X}-ray, blood {SARS}-{C}o{V}-2 serology test and {SARS}-{C}o{V}-2 {PCR} (only if {TB} or {COVID}-19 symptoms). {I}ndividuals were followed for 6 months. {A}mong 1254 participants, 1204 participants had {SARS}-{C}o{V}-2 serology (54% women, median {CD}4 344 cells/mu {L} [{IQR} 132-673]), and 487 had {SARS}-{C}o{V}-2 {PCR}. {SARS}-{C}o{V}-2 serology positivity was 27.0% (325/1204), lower in {PLHIV} with {CD}4 counts <200 cells/<mu>{L} (19.9%, 99/497) than in those with {CD}4 counts >= 200 cells/mu {L} (31.6%, 222/703), p<0.001. {SARS}-{C}o{V}-2 {PCR} positivity was 8.6% (42/487) and 27.7% (135/487) had probable or confirmed {SARS}-{C}o{V}-2 infection. {A}mong {PLHIV} with symptoms of {TB} or of {COVID}-19, 6.6% (32/487) had {SARS}-{C}o{V}-2 infection and {TB} disease. {I}n multivariable analyses, the risk of death was higher in {PLHIV} with both {SARS}-{C}o{V}-2 infection and {TB} compared to those with only {SARS}-{C}o{V}-2 infection (adjusted hazard ratio [a{HR}] 8.90, 95%{CI} 1.47-53.96, p=0.017), with only {TB} (a{HR} 3.70, 95%{CI} 1.00-13.72, p=0.050) or with none of them (a{HR} 6.83, 95%{CI} 1.75-26.72, p=0.006). {T}hese findings support {SARS}-{C}o{V}-2 testing in {PLHIV} with symptoms of {TB}, and {SARS}-{C}o{V}-2 vaccination, especially for those with severe immunosuppression. {PLHIV} with {COVID}-19 and {TB} have an increased risk of mortality and would benefit from comprehensive management and close monitoring.},
  keywords = {{KENYA} ; {OUGANDA} ; {AFRIQUE} {DU} {SUD}},
  booktitle = {},
  journal = {{PL}o{S} {G}lobal {P}ublic {H}ealth},
  volume = {5},
  numero = {4},
  pages = {e0004471 [16 p.]},
  year = {2025},
  DOI = {10.1371/journal.pgph.0004471},
  URL = {https://www.documentation.ird.fr/hor/fdi:010093475},
}