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Household air pollution and risk of pulmonary tuberculosis in HIV-Infected adults

posted on 2024-05-02, 10:12 authored by Patrick D.M.C. Katoto, Dieudonné Bihehe, Amanda Brand, Raymond Mushi, Aline Kusinza, Brian W. Alwood, Richard N. van Zyl-Smit, Jacques L. Tamuzi, Nadia A. Sam-Agudu, Marcel Yotebieng, John Metcalfe, Grant TheronGrant Theron, Krystal J. Godri Pollitt, Maia LesoskyMaia Lesosky, Jeroen Vanoirbeek, Kevin Mortimer, Tim Nawrot, Benoit Nemery, Jean B. Nachega

In low- and middle-income countries countries, millions of deaths occur annually from household air pollution (HAP), pulmonary tuberculosis (PTB), and HIV-infection. However, it is unknown whether HAP influences PTB risk among people living with HIV-infection.

We conducted a case-control study among 1,277 HIV-infected adults in Bukavu, eastern Democratic Republic of Congo (February 2018 – March 2019). Cases had current or recent (<5y) PTB (positive sputum smear or Xpert MTB/RIF), controls had no PTB. Daily and lifetime HAP exposure were assessed by questionnaire and, in a random sub-sample (n=270), by 24-hour measurements of personal carbon monoxide (CO) at home. We used multivariable logistic regression to examine the associations between HAP and PTB.

We recruited 435 cases and 842 controls (median age 41 years, [IQR] 33-50; 76% female). Cases were more likely to be female than male (63% vs 37%). Participants reporting cooking for >3h/day and ≥2 times/day and ≥5 days/week were more likely to have PTB (aOR 1·36; 95%CI 1·06-1·75) than those spending less time in the kitchen. Time-weighted average 24h personal CO exposure was related dose-dependently with the likelihood of having PTB, with aOR 4·64 (95%CI 1·1-20·7) for the highest quintile [12·3-76·2 ppm] compared to the lowest quintile [0·1-1·9 ppm].

Time spent cooking and personal CO exposure were independently associated with increased risk of PTB among people living with HIV. Considering the high burden of TB-HIV coinfection in the region, effective interventions are required to decrease HAP exposure caused by cooking with biomass among people living with HIV, especially women.


NIHR Global Health Research Unit

American Thoracic Society (ATS) foundation

KU Leuven Faculty of Medicine

Lions Club Brugge

United States National Institutes of Health

National Institutes of Allergy and Infectious Diseases (NIAID)

Stellenbosch University Clinical Trial Unit-CTU- of AIDS Clinical Trial Group-ACTG)

NIH/Fogarty International Center (FIC)



Stellenbosch University


Katoto, Patrick DMC; Bihehe, Dieudonné; Brand, Amanda; Mushi, Raymond; Kusinza, Aline; Alwood, Brian W; van Zyl-Smit, Richard N; Tamuzi, Jacques L; Sam-Agudu, Nadia A; Yotebieng, Marcel; Metcalfe, John; Theron, Grant; Godri Pollitt, Krystal J; Lesosky, Maia; Vanoirbeek, Jeroen; Mortimer, Kevin; Nawrot, Tim; Nemery, Benoit; & Nachega, Jean B.




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Geographical Location

Democratic Republic of Congo, Bukavu

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  • Medicine and Health Sciences

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Recommended Citation

Katoto, PDMC, Bihehe, D, Brand, A, Mushi, R, Kusinza, A, Alwood, BW, van Zyl-Smit, RN, Tamuzi, JL, Sam-Agudu, NA, Yotebieng, M, Metcalfe, J, Theron, G, Godri Pollitt, KJ, Lesosky, M, Vanoirbeek, J, Mortimer, K, Nawrot, T, Nemery, B & Nachega, JB. 2024. Household air pollution and risk of pulmonary tuberculosis in HIV-Infected adults. Stellenbosch University. Dataset. DOI:

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