HIV-Associated Tuberculosis Epidemiology and Management

HIV-associated tuberculosis remains a leading cause of morbidity and mortality where the two epidemics overlap. People living with HIV (PLHIV) have a 20–30 times higher risk of progressing from latent to active tuberculosis due to impaired cell-mediated immunity. The global burden is greatest in sub-Saharan Africa and parts of Asia, where co-infection fuels both transmission and poor clinical outcomes. Key drivers include low CD4 T-cell counts, late HIV diagnosis, under-nutrition and gaps in tuberculosis preventive therapy. Diagnosis is complicated by atypical presentations, smear-negative disease and extrapulmonary involvement, requiring integrated use of molecular assays, chest imaging and clinical algorithms. Management hinges on early antiretroviral therapy to restore immune function, isoniazid preventive therapy to reduce incident disease and standard four-drug tuberculosis regimens with careful monitoring for drug–drug interactions. Strengthening infection control, active case finding and adherence support are critical to interrupt transmission and improve survival among PLHIV.

Research from Nature Portfolio

Recent analyses of national laboratory data have revealed inequities in tuberculosis testing across HIV and viral suppression strata. In a large South African cohort, per-capita testing was lowest among people without HIV and among those with suppressed viral load, yet test positivity peaked in unsuppressed PLHIV and in young adult males. Logistic modelling identified viral suppression as a key modifier of testing yield, underscoring the need for targeted screening policies that bridge gaps in both HIV care and tuberculosis case detection.

HIV-Associated Tuberculosis Epidemiology and Management publication trend

The graph below shows the total number of articles in hiv-associated tuberculosis epidemiology and management across all publications each year (not limited to Nature Index journals).

Technical terms

CD4 T-cell count: A laboratory measure of immune competence, with lower counts indicating greater vulnerability to opportunistic infections, including tuberculosis.

Incidence density rate (IDR): The number of new cases of disease per unit of person-time observed, often expressed per 100 person-years.

Isoniazid preventive therapy (IPT): Administration of isoniazid to PLHIV without active tuberculosis to reduce the risk of progression to disease.

Extrapulmonary tuberculosis (EPTB): Tuberculosis manifestations outside the lungs, including lymphatic, pleural, bone or central nervous system involvement, which may present atypically in PLHIV.

References

1. Tuberculosis testing patterns in South Africa to identify groups that would benefit from increased investigation. Scientific Reports (2023).
2. Tuberculosis and its associated risk factors among HIV-positive pregnant women in northwest Ethiopia: A retrospective follow-up study. Heliyon (2023).
3. Incidence and risk factors for HIV-tuberculosis coinfection in the Cologne–Bonn region: a retrospective cohort study. Infection (2024).
4. Dynamics of Matricellular Protein Levels in Blood Predict Recovery in Patients with Human Immunodeficiency Virus-Tuberculosis Coinfection. Viruses (2024).
5. TUBERCULOSIS: EPIDEMIOLOGY AND CONTROL. Mediterranean Journal of Hematology and Infectious Diseases (2014).