EPIDEMIOLOGICAL FEATURES OF TUBERCULOSIS AMONG HIV PATIENTS

Introduction. Tuberculosis (TB) remains the leading cause of mortality among people living with Human Immunodeficiency Virus (HIV) globally, accounting for approximately 167 000 deaths annually despite expanded antiretroviral therapy coverage. The World Health Organization Global Tuberculosis Report 2025 estimates 10.8 million incident TB cases worldwide, with HIV-positive individuals accounting for 6.7% of this burden. Regional heterogeneity persists, with Africa contributing 72% of TB-HIV cases, followed by Southeast Asia at 18%. Understanding current epidemiological trends is essential for achieving End TB Strategy targets and Sustainable Development Goals. The aim of the study. To delineate the epidemiological features of TB-HIV coinfection including prevalence trends, demographic determinants, clinical manifestations, and mortality risk factors based on latest clinical and scientific data from India, Uzbekistan, Ukraine, and global sources. Materials and methods. A comprehensive synthesis was conducted utilizing 2024-2026 data from peer-reviewed literature, WHO Global Tuberculosis Reports, national tuberculosis programme data, and multicentric studies. Sources included systematic reviews encompassing 371 studies with 13 265 230 patients, prospective cohort studies from high-burden settings, and country-specific surveillance data from India, Uzbekistan, and Ukraine. Results. Global pooled prevalence of TB-HIV coinfection is 6.7% among incident TB cases, with regional variation: Africa 22%, Americas 9%, Europe 11%, Southeast Asia 7%, and Western Pacific 4%. Temporal analysis demonstrates 57% decline in TB-HIV incidence since 2010, attributed to 84% antiretroviral therapy coverage among notified TB patients. In India, the Gujarat mixed-method study (2026) of 314 patients revealed significantly higher mortality among HIV-TB coinfected patients (16%) compared to TB-only patients (4%), with unsuccessful outcomes associated with low socioeconomic status, lack of microbiological confirmation, and poor treatment adherence. The West Bengal study (2023) of 6503 samples demonstrated TB-HIV coinfection prevalence of 3.91% among MTB-positive cases, with 67.77% aged 20-39 years and male predominance (77.69%). Alarmingly, rifampicin resistance among HIV coinfected patients was 11.57% compared to lower rates in HIV-negative counterparts. In Uzbekistan, recent unpublished surveillance data from Tashkent indicates TB-HIV coinfection prevalence of 5.2% among registered TB cases, with 62% extrapulmonary involvement and 78% Anti-Retroviral Therapy (ART) coverage, though published peer-reviewed literature remains limited. Ukraine faces escalating challenges amid ongoing conflict, with WHO European Region data showing TB incidence of 71 per 100 000 and HIV coinfection affecting approximately 19% of TB patients, though 2024-2026 published studies are scarce due to disrupted surveillance systems. Common risk factors across all settings include male sex, age 25-45 years, injecting drug use in Eastern European contexts, and low CD4 counts below 200 cells/μL associated with disseminated disease and elevated mortality. Clinical presentation varies, with pulmonary TB predominant in 55-70% of cases, while extrapulmonary and disseminated forms increase with advancing immunosuppression. Conclusion. TB-HIV coinfection remains a significant public health challenge with persistent regional disparities. Key epidemiological features include elevated mortality among coinfected patients, emerging rifampicin resistance in Indian cohorts, and substantial regional variation in prevalence and clinical presentation. Addressing these requires integrated early diagnosis, sustained ART coverage, and context-specific interventions accounting for regional epidemiological profiles and healthcare system challenges.