Tuberculosis in People Living With Hiv/AIds: Advances and Challenges in Brazil

Tuberculosis-HIV coinfection represents one of the main causes of morbidity and mortality among people living with HIV (PLHIV), especially in high-burden countries such as Brazil. HIV compromises immunity, favoring tuberculosis reactivation and more severe clinical forms. This study aimed to analyze the temporal evolution, clinical outcomes, and sociodemographic and clinical-epidemiological factors associated with TB-HIV coinfection in Brazil between 2001 and 2024. Observational epidemiological time-series study using SINAN data, involving new TB cases with HIV diagnosis. Proportions, outcomes (cure, treatment abandonment, death), and temporal trends were analyzed using joinpoint regression (AAPC). Analyses considered sex, age group, race/color, clinical form, and social factors. A total of 1,789,775 new TB cases were reported, with 8.97% HIV-positive. HIV testing increased from 25.4% (2021) to 84% (2023) (AAPC=5.5%), while HIV positivity among those tested decreased (AAPC=-3.3%), indicating a possible impact of antiretroviral therapy (ART). Coinfection among PLHIV showed an increasing trend (AAPC=1.9%). Extrapulmonary TB showed greater association with HIV and higher mortality rates. More vulnerable groups, such as drug users and people experiencing homelessness, showed worse outcomes: lower cure rates and higher treatment abandonment. The highest positivity was observed among men and adults aged 20 to 59 years, with an increasing trend among women and older adults. Findings on TB-HIV coinfection reveal both advances and challenges. The high rate of HIV testing among TB cases indicates good integration of programs. The decrease in HIV positivity among those tested may indicate a positive impact of ART and other preventive measures. Vulnerable groups such as drug users and people experiencing homelessness continue to present worse outcomes (lower cure rates and higher abandonment), and the increase in coinfection among women and older adults highlights the need for targeted attention. In summary, despite advances in testing and treatment, TB-HIV coinfection remains a challenge in Brazil, requiring integrated strategies for early diagnosis, active surveillance, and targeted care for vulnerable populations to improve outcomes.