Tuberculosis Among Men Who Have Sex With Men Living With HIV in Israel: A Retrospective Nationwide Cohort Study, 2000-2025.

ObjectivesThis study compared men who have sex with men (MSM) who lived with HIV (LWHIV) and tuberculosis to MSM LWHIV without tuberculosis and estimated tuberculosis incidence among MSM-LWHIV over 25-years.MethodsData from the Israeli national tuberculosis and HIV registries between 2000 and 2025 were cross-matched by patients' identifiers to compare MSM LWHIV and tuberculosis to other MSM LWHIV older than 15 years. They were followed up from HIV-diagnosis until they developed TB, died, left Israel or end-2025.ResultsOf 3,018 MSM LWHIV who were followed-up for 30,617 person-years, 16 (0.5%) developed tuberculosis, compared with 244 (6.6%) non-MSM LWHIV, corresponding to 5 and 70 cases per 10,000 person-years, respectively (P<0.01). MSM LWHIV and tuberculosis were more commonly non-Israeli born, had lower CD4-counts and not been treated with antiretroviral therapy than MSM LWHIV without tuberculosis.Tuberculosis in MSM was diagnosed within a median of 2.4 years after HIV (range 0-10), and 8 (50.0%) were diagnosed concomitantly with HIV and tuberculosis. Contact tracing revealed one household exposure, while nine (52.9%) probably acquired tuberculosis while originating/visiting high-tuberculosis settings.ConclusionsTuberculosis incidence among MSM LWHIV is very low. Tuberculosis was probably acquired while originating/visiting endemic countries. Routine HIV-testing of patients with tuberculosis is recommended.