High rates of post-tuberculosis lung disease among persons successfully treated for drug-susceptible and resistant tuberculosis

Introduction Tuberculosis (TB) remains a critical global public health challenge, and there is an urgent need to improve the diagnosis and management of post-TB lung disease (PTLD). We aimed to compare end of treatment prevalence of PTLD among participants with and without drug-resistant TB and to evaluate the association between plasma cytokines and matrix metalloproteinases with lung damage. Methods We conducted a prospective cohort study among individuals with microbial cure status for drug-susceptible or multidrug-resistant pulmonary TB in Tbilisi, Georgia during 2020–2021. Eligible participants were ≥16 years without prior TB treatment history, microbiologically confirmed disease at baseline and who had a favourable treatment outcome (cured or completed treatment). The study outcome was the presence of PTLD defined as abnormalities on either chest CT, spirometry or Saint George’s Respiratory Questionnaire. Results Among 123 participants, the prevalence of PTLD was 74% (n=91) with 53 participants meeting one criteria, 27 two criteria and 11 all three criteria. The prevalence of impaired respiratory health (47%) and lung damage on imaging (46%) was higher than abnormal lung function (21%). PTLD was not associated with drug resistance (adjusted OR 0.91, 95% CI 0.42 to 1.99). Persistent cavitary disease at the end of treatment was associated with higher matrix metalloproteinase 8 and lower matrix metalloproteinase 2, interleukin-17A and interleukin-1ß. Conclusion Using comprehensive criteria, we found nearly three in four individuals with microbial cure status for TB disease had prevalent PTLD regardless of drug resistance status. Persistent cavitary disease was associated with serum markers of inflammation and lung tissue remodelling.