Tuberculosis and HIV coinfection: Progress and challenges towards reducing incidence and mortality

Bianca Sossen; Mmamapudi Kubjane; Graeme Meintjes

doi:10.1016/j.ijid.2025.107876

Tuberculosis and HIV coinfection: Progress and challenges towards reducing incidence and mortality

Int J Infect Dis. 2025 Jun:155:107876. doi: 10.1016/j.ijid.2025.107876. Epub 2025 Mar 8.

Authors

Bianca Sossen¹, Mmamapudi Kubjane², Graeme Meintjes³

Affiliations

¹ Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town, South Africa. Electronic address: bianca.sossen@uct.ac.za.
² Health Economics and Epidemiology Research Office, Wits Health Consortium, Parktown Johannesburg, South Africa.
³ Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town, South Africa; Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.

PMID: 40064284
DOI: 10.1016/j.ijid.2025.107876

Abstract

HIV-associated tuberculosis (HIV-TB) is associated with disproportionate mortality: approximately 24% of the 660,000 individuals with TB and HIV died, compared to 11% of those without HIV dying from TB in 2023. HIV is a key driver of ongoing high TB incidence in many countries, particularly in the World Health Organization Africa region, and TB is the leading cause of hospitalization in people with HIV (PWH) globally. Significant developments have occurred recently concerning the prevention, screening, diagnosis, and management of HIV-TB. Antiretroviral therapy and novel regimens for TB preventive therapy are now known to decrease TB incidence and improve survival. The use of Xpert Ultra (Cepheid, USA) and urine Determine^TM TB LAM Antigen (Abbott, USA) as diagnostics are associated with improved survival for HIV-TB. However, there are ongoing gaps in our knowledge: regarding the natural history of TB disease in PWH; optimal approaches to diagnosis of TB and TB drug resistance including in non-sputum samples; and post-TB disease in PWH. We discuss recent progress, together with ongoing challenges towards reducing incidence, morbidity, and mortality. We highlight ongoing research that will advance our understanding and management of HIV-TB: including vaccine research, novel treatment strategies, and expanded options for the diagnosis of TB and drug resistance in PWH.

Keywords: Control; Elimination; Global; HIV; Tuberculosis.

Publication types

Review

MeSH terms

AIDS-Related Opportunistic Infections* / diagnosis
AIDS-Related Opportunistic Infections* / drug therapy
AIDS-Related Opportunistic Infections* / mortality
AIDS-Related Opportunistic Infections* / prevention & control
Anti-Retroviral Agents* / therapeutic use
Antitubercular Agents* / pharmacology
Antitubercular Agents* / therapeutic use
Drug Resistance, Bacterial
Global Health
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Hospitalization
Humans
Incidence
Mycobacterium tuberculosis / drug effects
Mycobacterium tuberculosis / isolation & purification
South Africa / epidemiology
Sputum / microbiology
Tuberculosis* / diagnosis
Tuberculosis* / drug therapy
Tuberculosis* / mortality
Tuberculosis* / prevention & control
World Health Organization

Substances

Anti-Retroviral Agents
Antitubercular Agents