Prevalence and related factors of TB/HIV co-infection among hospitalized children with tuberculosis in Southwest China

Objectives: This study aimed to investigate the prevalence of TB/HIV co-infection in pediatric TB patients in southwest China and its associated variables. Methods: Pediatric TB patients were recruited from January 2014 to September 2024 in southwest China, based on etiology or clinical confirmation. Hospitalization records were extracted for each patient. Results: Among 2,607 pediatric TB patients with an average age of 9.58 ± 4.08 years, 39 (1.5%) were HIV-positive. The TB/HIV co-infection group male-to-female ratio was 2:1, higher than the TB-only group 1.19:1. The highest proportion of TB/HIV co-infection was in the 5-9 years age group (43.6%), while the 10-14 years age group accounted for the highest proportion of TB-alone cases (57.5%). In terms of population distribution, the Yi ethnic group had the highest proportion of TB/HIV co-infection cases (43.6%), while the Tibetan group had the highest proportion of TB-alone cases (51.1%). Extrapulmonary TB in the TB/HIV co-infection group primarily involved abdominal and pericardial sites, whereas the TB-alone infection group had more cases of lymphadenitis and pleural TB. The length of hospitalization (>14 days) in the TB/HIV co-infection group (74.4%) was significantly longer than in the TB-alone infection group (51.7%). Over the past 11 years, most pediatric TB/HIV co-infection cases were from the eastern-central and southern-central regions of Sichuan, particularly the southern Liangshan Yi Autonomous Prefecture. The number of children with TB-alone infections increased gradually during this period. No significant difference in the number of pediatric TB/HIV co-infection cases was observed over the 11 years. Conclusion: Pediatric TB/HIV co-infection in southwest China predominantly affects middle-aged and young boys, with a higher co-infection rate than the national average. The central and southern regions of Sichuan have a relatively high proportion of cases. Public health efforts should focus on strengthening awareness, screening, and early diagnosis of TB and HIV in children in high-risk areas to prevent further infections.