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9 (95% CI 10.4, 11.4), with hyperglycemia only was 5.2 (95% CI 4.4, 6.3) and with no exposure was 4.6 (95% CI 4.4, 4.9) cases per 100PY. The attributable proportion of incident TB due to synergy between low BMI and hyperglycemia was 0.23 (95% CI 0.06, 0.36). Synergy between low BMI and hyperglycemia was associated with increased excess TB incidence in PLHIV. TB preventive treatment, nutritional support, and hyperglycemia management should be evaluated as interventions to reduce TB risk in PLHIV with joint exposure. Synergy between low