
A nested analysis of a multicenter phase IV randomized controlled trial compared 38 pulmonary tuberculosis (PTB) patients receiving anti-tuberculosis therapy with 38 healthy controls following two doses of an inactivated COVID-19 vaccine. Although both groups developed comparable neutralizing antibody titers and seroconversion rates, PTB patients showed distinct baseline immune abnormalities, including reduced proteins involved in vesicle transport and phagocytosis and pro-inflammatory transcriptional changes. After vaccination, healthy controls demonstrated broad proteomic and transcriptomic remodeling, whereas PTB patients showed limited molecular and inferred immune-cell changes, suggesting attenuated systems-level immune activation despite preserved short-term antibody responses.
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