{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T10:58:23Z","timestamp":1781780303187,"version":"3.54.5"},"reference-count":41,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008374","name":"Center for AIDS Research, Emory University","doi-asserted-by":"publisher","award":["P30AI050409"],"award-info":[{"award-number":["P30AI050409"]}],"id":[{"id":"10.13039\/100008374","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Centers for AIDS Research at the University of Pennsylvania","award":["P30AI045008"],"award-info":[{"award-number":["P30AI045008"]}]},{"name":"Emory Tuberculosis Research Advancement Center","award":["P30AI168386"],"award-info":[{"award-number":["P30AI168386"]}]},{"name":"National Institutes of Health, National Heart, Lung, and Blood Institute","award":["K24HL189236"],"award-info":[{"award-number":["K24HL189236"]}]},{"name":"National Institutes of Health, National Heart, Lung, and Blood Institute","award":["R01HL180294"],"award-info":[{"award-number":["R01HL180294"]}]},{"name":"National Institutes of Health, National Institute of Allergy and Infectious Diseases","award":["R01AI166988-04"],"award-info":[{"award-number":["R01AI166988-04"]}]},{"name":"National Institutes of Health, National Institute of Allergy and Infectious Diseases","award":["T32AI157855-04"],"award-info":[{"award-number":["T32AI157855-04"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,5,28]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterise the patterns and severity of impaired lung function at pulmonary tuberculosis (TB) diagnosis and assess the impact of HIV co-infection on TB-associated lung injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A cross-sectional analysis of adults with and without HIV who presented with newly diagnosed drug-susceptible pulmonary TB in Johannesburg, South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 258 adults who were newly diagnosed with drug-susceptible pulmonary TB underwent comprehensive pulmonary function tests (PFT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Five key PFT manoeuvres were evaluated: forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1\/FVC, total lung capacity (TLC) and haemoglobin-corrected diffusion capacity of the lungs for carbon monoxide (DLCO). Three primary outcomes were modelled: (1) normal versus abnormal lung function, defined as any key PFT manoeuvre z-score &lt; lower limit of normal, (2) continuous z-scores for each PFT and (3) clinical patterns of lung function (normal, restriction, obstruction, mixed disorder and isolated low DLCO). Secondary outcomes included respiratory health-related quality-of-life measures assessed using the St. George\u2019s Respiratory Questionnaire (SGRQ).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HIV\/TB co-infection was associated with lower odds of any abnormal lung function (adjusted OR (aOR) 0.43, 95%\u2009CI 0.24 to 0.74)\u2009and lower odds of restrictive (aOR 0.46, 95%\u2009CI 0.24 to 0.87)\u2009and mixed patterns (aOR 0.22, 95%\u2009CI 0.07 to 0.66) compared with those with TB alone. HIV co-infection was also associated with better FEV1, FVC, FEV1\/FVC and TLC z-scores. While those with HIV had less severe radiographic disease, respiratory symptoms were similar between groups (SGRQ total score: HIV-negative 22 (IQR: 13\u201338)\u2009vs HIV-positive 26 (IQR: 8\u201344), p&gt;0.9).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adults with HIV\/TB co-infection demonstrated a distinct clinical phenotype of TB-associated lung injury at TB diagnosis characterised by less severe radiographic and lung function impairment compared with those without HIV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2026-004248","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T10:45:23Z","timestamp":1781779523000},"page":"e004248","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Lung function impairment at pulmonary TB and HIV\/TB diagnosis: a South African cross-sectional cohort analysis"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9277-7137","authenticated-orcid":false,"given":"Michael","family":"Marll","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tlhago","family":"Ngwanto","sequence":"additional","affiliation":[{"name":"The Aurum Institute, Parktown, GP, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nomsa","family":"Mofokeng","sequence":"additional","affiliation":[{"name":"The Aurum Institute, Parktown, GP, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Mngomezulu","sequence":"additional","affiliation":[{"name":"The Aurum Institute, Parktown, GP, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"El Sammak","sequence":"additional","affiliation":[{"name":"Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anisha","family":"Rajaratnam","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fay","family":"Willis","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Magee","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lungile","family":"Gabuza","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of the Witwatersrand Johannesburg, Johannesburg, GP, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hardy","family":"Kornfeld","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Li","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Philadelphia, Pennsylvania, USA"},{"name":"Department of Biostatistics, Epidemiology, and Informatics, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pholo","family":"Maenetje","sequence":"additional","affiliation":[{"name":"The Aurum Institute, Parktown, GP, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory P.","family":"Bisson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Department of Biostatistics, Epidemiology, and Informatics, Division of Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8972-3736","authenticated-orcid":false,"given":"Sara","family":"Auld","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Georgia, USA"},{"name":"Department of Epidemiology, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"2026061803451638000_13.1.e004248.1","unstructured":"World Health Organization . Global tuberculosis report 2025. Geneva World Health Organization; 2025."},{"key":"2026061803451638000_13.1.e004248.2","unstructured":"WHO . Global tuberculosis report 2024. 2024."},{"key":"2026061803451638000_13.1.e004248.3","doi-asserted-by":"crossref","first-page":"e355","DOI":"10.1016\/S2352-3018(24)00347-3","article-title":"Causes of hospitalisation among people living with HIV worldwide, 2014-23: a systematic review and meta-analysis","volume":"12","author":"Burke","year":"2025","journal-title":"Lancet HIV"},{"key":"2026061803451638000_13.1.e004248.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-087218","article-title":"Impact of HIV coinfection on tuberculosis treatment outcomes in Ethiopia: a systematic review and meta-analysis","volume":"14","author":"Mekonen","year":"2024","journal-title":"BMJ Open"},{"key":"2026061803451638000_13.1.e004248.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-020-05749-2","article-title":"HIV infection and multidrug resistant tuberculosis: a systematic review and meta-analysis","volume":"21","author":"Sultana","year":"2021","journal-title":"BMC Infect Dis"},{"key":"2026061803451638000_13.1.e004248.6","unstructured":"Global tuberculosis report 2023. Geneva World Health Organization; 2023."},{"key":"2026061803451638000_13.1.e004248.7","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1513\/pats.201009-059WR","article-title":"HIV-associated lung infections and complications in the era of combination antiretroviral therapy","volume":"8","author":"Crothers","year":"2011","journal-title":"Proc Am Thorac Soc"},{"key":"2026061803451638000_13.1.e004248.8","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1513\/AnnalsATS.202404-384OC","article-title":"Effect of Human Immunodeficiency Virus on Lung Function and Structure: A Systematic Review and Meta-Analysis","volume":"22","author":"Konstantinidis","year":"2025","journal-title":"Ann Am Thorac Soc"},{"key":"2026061803451638000_13.1.e004248.9","doi-asserted-by":"crossref","DOI":"10.1038\/s41467-025-57668-y","article-title":"Alveolar macrophages from persons with HIV mount impaired TNF signaling networks to M. tuberculosis 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