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People with HIV are 12–16 times more likely to develop tuberculosis (TB) disease. They also have poorer TB treatment outcomes and have more than two-fold higher mortality during TB treatment compared to people without HIV (1). Despite advances in the prevention, diagnosis and treatment of TB disease, TB remains the leading cause of death among people with HIV worldwide, accounting for 167 000 (27%) of global AIDS-related deaths in 2022 (1).
Close to half of people estimated to have HIV-associated TB are not diagnosed and reported (1). Post-mortem studies have found very high prevalence of undiagnosed TB among people with HIV who have died in healthcare facilities in high TB burden settings (2). Early identification of signs and symptoms of TB followed by diagnosis and prompt initiation of treatment in people living with HIV reduces mortality, improves health-related quality of life and reduces transmission of TB.
To support countries in the introduction and scale-up of collaborative action on TB and comorbidities, including for HIV-associated TB, WHO developed the Framework for collaborative action on tuberculosis and comorbidities (22).
Adolescent: a person aged 10–19 years.
Adult: a person over 19 years of age.
Advanced HIV disease: for adults, adolescents, and children aged 5 years or more, “advanced HIV disease” is defined as a CD4 cell count of less than 200 cells/mm³ or a WHO clinical stage 3 or 4 event at presentation for care. All children with HIV aged under 5 years should be considered as having advanced disease at presentation.
AFB
acid-fast bacilli
AHD
advanced HIV disease
AIDS
acquired immunodeficiency syndrome
ART
antiretroviral therapy
CAD
This document was developed by Annabel Baddeley and Anna Carlqvist (consultant), with inputs from Kerri Viney, Matteo Zignol and Farai Mavhunga, under the overall direction of Tereza Kasaeva, director, all at the World Health Organization (WHO) Global Tuberculosis Programme.
Experts consulted during stakeholder consultation and external review
Globally, tuberculosis (TB) remains a significant cause of ill health and is a leading cause of death due to an infectious agent (1). The TB epidemic is attributable to five main health-related risk factors globally, namely, diabetes mellitus (diabetes), HIV, smoking, undernutrition, and disorders due to alcohol use. The contribution of these risk factors to the global TB burden is reported annually in the WHO global tuberculosis report (1).