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Mycobacterium tuberculosis bloodstream infection (MTB-BSI) is complicated by diagnostic difficulty and severe illness. We assessed whether MTB-BSI continues to be common in the era of widespread antiretroviral therapy and whether it continues to result in increased risk of early mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled inpatients from medical wards irrespective of tuberculosis symptoms and outpatients with tuberculosis symptoms. All participants had HIV and were \u226518 years old, and all were recruited from 7 countries: Malawi, South Africa, Tanzania, Thailand, Uganda, Vietnam, and Zambia. Participants also had &amp;lt;3 doses of antituberculosis treatment in the past 60 days and no isoniazid preventive therapy in the past 6 months. We estimated the prevalence of MTB-BSI. In Bayesian survival models, we estimated the hazards of mortality for inpatients with MTB-BSI vs those without.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 2019 and 2021, 1703 participants were included: 44% were hospitalized, the median CD4 count was 361\u2005cells\/\u03bcL, and 77% reported using antiretroviral therapy. Crude prevalence of MTB-BSI varied by country but was 4.4% (32\/723) among all inpatients, 22.5% (32\/142) among inpatients with microbiologically confirmed TB, and 0.2% (2\/913) among all outpatients. Among all inpatients, those with MTB-BSI had 2.65-times (95% credible interval, 1.06\u20135.01) increased hazard of death by 30 days and 1.79-times (95% credible interval, .81\u20133.11) increased hazard by 70 days. Lower CD4 and older age were strongly associated with mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MTB-BSI is far more common for inpatients than outpatients with HIV. Across multiple settings with high tuberculosis prevalence, MTB-BSI was strongly associated with heightened risk of early mortality in PWH. Novel optimized diagnostic and treatment strategies are still needed for HIV-associated MTB-BSI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag424","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T12:37:51Z","timestamp":1783427871000},"source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and Mortality due to\n                    <i>Mycobacterium tuberculosis<\/i>\n                    Bloodstream Infection in Adults With HIV: A Multicountry Prospective Cohort Study"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6028-3351","authenticated-orcid":false,"given":"Bianca","family":"Sossen","sequence":"first","affiliation":[{"name":"Department of Medicine, Faculty of Health Sciences, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town ,","place":["South 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,","place":["Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung","family":"Van Nguyen","sequence":"additional","affiliation":[{"name":"National Lung Hospital , Ha Noi ,","place":["Viet Nam"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasiwimol","family":"Ubolyam","sequence":"additional","affiliation":[{"name":"HIV-NAT, Thai Red Cross AIDS and Infectious Diseases Research Centre , Bangkok ,","place":["Thailand"]},{"name":"Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University , Bangkok ,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1061-150X","authenticated-orcid":false,"given":"Marcia","family":"Vermeulen","sequence":"additional","affiliation":[{"name":"Wellcome Center for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town ,","place":["South 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