Tuberculosis incidence trends and risk factors among people living with human immunodeficiency virus (HIV) in Sichuan, China: a retrospective cohort study (2010–2024)

To retrospectively analyse the tuberculosis (TB) incidence rate and influencing factors among people living with HIV (PLHIV) in Sichuan, China, from 2010 to 2024 and to inform HIV/TB coinfection prevention. A dynamic cohort of PLHIV was established (2010‒2024) to estimate the TB incidence rate. A nested case‒control study was used to identify factors influencing TB incidence via logistic regression. From 2010 to 2024, 1,677,649 person–years (PY) of follow–up were accumulated, with an average follow–up of 5.57 years. The number of HIV/TB coinfections rose from 79 to 1001 (average annual percent change [AAPC] = 19.44%, P < 0.05). Still, in parallel with the growing number of study participants, the annual incidence density (ID) showed no significant trend (AAPC = -1.64%, P > 0.05), yielding a cumulative incidence density (CID) of 5.09 per 1000 PY. The CID varied markedly across regions, ranging from 2.41 to 9.94/1000 PY, with the highest values in the western and southern regions, moderate levels in the northeastern and southeastern peripheries, and the lowest in the central region. Protective factors against TB included older age, female sex, Han ethnicity, higher education, baseline CD4+ T lymphocytes (CD4) ≥ 200 cells/µL, and homosexual transmission. TB risk increased with clinical identification and delay in antiretroviral therapy (ART) initiation (> 90 days) (all P < 0.001). Sichuan PLHIV presented a relatively high TB incidence rate without a significant change trend; marked regional disparities were evident across the province, with distinct temporal trends in incidence rate variation among regions. TB incidence was influenced by multiple factors, including individual characteristics, infection–related, and ART–related factors. Targeted interventions are urgently needed for HIV/TB coinfection control.