Global prevalence of HIV and Mycobacterium tuberculosis co-infection: A systematic review and meta-analysis of 371 included articles.

OBJECTIVES

Tuberculosis and Human Immunodeficiency Virus (HIV) are two diseases that have imposed the heaviest burden globally. This study aims to determine the global prevalence of Mycobacterium tuberculosis and HIV (TB-HIV) co-infection through a systematic review and meta-analysis of published articles.

STUDY

DESIGN

Systematic review and meta-analysis.

METHODS

PubMed, Scopus, and Web of Science were searched from their inception to September 2024. We performed a meta-analysis, subgroup analyses, meta-regression, sensitivity analyses, and a time series analysis using R statistical software (V.4.3.3).

RESULTS

A total of 371 articles and 13,265,230 patients were ultimately included, of which 274 articles investigated patients with tuberculosis diagnosed with HIV/AIDS and 115 articles focused on patients with HIV/AIDS diagnosed with tuberculosis. Among these, 18 of the articles determined the incidence of tuberculosis among patients with HIV and the incidence of HIV among patients with tuberculosis. The reported pooled co-infection prevalence based on the random effects model was 14 % (95 % CI: 0.12 to 0.16). We found that TB-HIV co-infection peaked in 1990, then declined and remained relatively stable, reaching its lowest point in 2022. The prevalence of co-infection was 22 % (95 % CI: 0.19 to 0.26) in Africa, 21 % (95 % CI: 0.15 to 0.30) in North America, 16 % (95 % CI: 0.10 to 0.26) in South America, 10 % (95 % CI: 0.08 to 0.12) in Europe, and 7 % (95 % CI: 0.05 to 0.09) in Asia. Meta-regression analyses identified male sex 2.8 % (95 % CI: 1.5 to 4.15), lower educational attainment 0.39 % (95 % CI: 0.31 to 0.47), and drug-resistant tuberculosis 7.0 % (95 % CI: 4.6 to 9.4) as significantly associated with higher co-infection prevalence. Regional variation was also significant, with Africa showing the highest burden. No association was found for research period or poverty level.

CONCLUSIONS

Our results show that the global TB-HIV co-infection rate remains high; however, there are geographical differences. Measures for prevention, early detection, and case management should be further strengthened on a global scale.