Objective To evaluate the status of latent tuberculosis infection (LTBI) with Mycobacterium tuberculosis and the risk of LTBI activation after glucocorticoid therapy in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods Clinical data of AAV patients who visited Xiangya Hospital of Central South University from May 2018 to May 2023 were retrospectively analyzed. According to the results of interferon-γ release assay (IGRA), they were divided into a LTBI group and a non-LTBI group. The LTBI group was subdivided into an active TB group (ATB group) and a non-ATB group according to the presence of ATB. General conditions and biochemical indicator characteristics of the two groups were compared. The COX regression model was used to analyze the risk factors for LTBI activation in AAV patients. Results A total of 302 AAV patients were included in this study, with an age of 64.0 (53.0, 71.0) years old, 169 male cases (55.96%), and an IGRA positive rate of 24.17% (n=73). The proportion of patients with renal insufficiency in the LTBI group was higher than that in the non-LTBI group (79.45% vs 60.70%), with statistically significant difference (P<0.05). In the LTBI group, the age of patients was 62.0 (53.5, 72.0) years old, 44 cases were male (60.27%), out of which 11 cases (15.07%) had ATB. In the non-LTBI group, 4 male cases (1.75%) had ATB. In the LTBI group, there were statistically significant differences between the ATB group and the non-ATB group in terms of daily average glucocorticoid levels, age, renal dysfunction, neutrophils, and blood creatinine (all P<0.05). COX univariate regression analysis showed that statistically significant differences existed among the groups in terms of daily average glucocorticoid levels, daily average glucocorticoid levels >11.75 mg/day, age, age >65 years old, and blood crea-tinine levels ≥150 μmol/L (all P<0.05). COX multivariate regression analysis showed that daily average glucocorticoid levels >11.75 mg/day (OR=0.14, 95%CI: 1.30-79.01) and age >65 years (OR=0.08, 95%CI: 0.01-0.85) were independent influencing factors for LTBI activation. Conclusion AAV patients have a high rate of LTBI, and daily average glucocorticoid levels >11.75 mg/day is an independent risk factor for LTBI activation in AAV patients. Age >65 years may benefit from receiving lower doses of immunosuppressive therapy, but it is necessary to expand sample size for further study.