Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality among people living with HIV (PLHIV), with a wide spectrum of pulmonary and extrapulmonary manifestations. Data on TB localisations and associated factors among hospitalised PLHIV in Gabon remain limited.

Methods: We conducted a retrospective study in 2024 at the Infectious and Tropical Diseases Department of the Libreville University Hospital Centre. Adult PLHIV hospitalised for bacteriologically confirmed or clinically diagnosed TB were included. Sociodemographic, clinical, and biological data were extracted from medical records.

Results: Among 1,014 hospitalised patients, 76 (7.4%) PLHIV with TB were included. Women accounted for 77.6% of cases, and the mean age was 42±12.2 years. Pulmonary TB predominated (63.2%), while extrapulmonary involvement, isolated or multifocal, was observed in 36.8% of patients. The most frequent extrapulmonary sites were digestive (13.2%), lymph node (9.2%), and pleural (9.2%). Severe immunosuppression (CD4 <200 cells/mm³) was present in 71.4% of patients, with a mean CD4 count of 180.2±178.6 cells/mm³. Opportunistic infections were documented in 19.7% of cases, mainly oral candidiasis and cerebral toxoplasmosis (14.4%). Tobacco use was significantly associated with multifocal TB (p= 0.01). Overall in-hospital mortality was 15.8%, and the mean length of stay was 8.6 ± 4.2 days.

Conclusion: TB among hospitalised PLHIV in Libreville is characterised by advanced immunosuppression, a high burden of extrapulmonary disease, and substantial mortality. Strengthening early HIV and TB diagnosis and addressing behavioural risk factors remain critical.