Global trends, regional differences and age distribution for the incidence of HIV and tuberculosis co-infection from 1990 to 2019: results from the global burden of disease study 2019

Abstract

Background

People living with human immunodeficiency virus (HIV) are more likely to develop tuberculosis (TB), and their co-infection (HIV-TB) increases the risk of death. We aimed to describe the global trends, regional differences and age distribution of HIV-TB.

Methods

Annual new cases, age-standardized incidence rates (ASRs) and age-specific incidence rates with 95% uncertainty intervals (UIs) of HIV-infected drug-susceptible tuberculosis (HIV-DS-TB), HIV-infected multidrug-resistant tuberculosis without extensive drug resistance (HIV-MDR-TB) and HIV-infected extensively drug-resistant tuberculosis (HIV-XDR-TB) during 1990–2019 were collected from the Global Burden of Disease Study 2019. To reveal the trends of HIV-TB by region and age, the percentage change of new cases and estimated annual percentage change (EAPC) of ASRs were calculated.

Results

The ASR of HIV-XDR-TB increased significantly by an average of 14.77% (95% CI: 11.05%–18.62%) per year during 1990–2019 worldwide, while the ASRs of HIV-DS-TB and HIV-MDR-TB decreased after 2005. HIV-XDR-TB was a great threat to Eastern Europe for the largest number of new cases (792, 95% UI: 487–1167) and the highest ASR (0.34 per 100,000 population, 95% UI: 0.21–0.50). In addition, Oceania had the largest rise in ASRs of HIV-MDR-TB (EAPC = 22.56, 95% CI: 18.62–26.64) and HIV-XDR-TB (EAPC = 32.95, 95% CI: 27.90–38.20) during 1990–2019. Recently, age-specific incidence rates of HIV-XDR-TB increased in all age groups, especially in the 50–69 age groups among high, low-middle and low Socio-Demographic Index regions. Additionally, the proportion of patients aged <15 years was nearly 10% of new cases in sub-Saharan Africa in 2019, which was higher than in other regions.

Conclusions

HIV-infected drug-resistant TB is common in Oceania and Eastern Europe. Moreover, HIV-XDR-TB among elderly people became increasingly prevalent. In the future, the collaboration of management for HIV and TB should be intensified in Oceania and Eastern Europe, and more concerns need to be paid in elderly people.

Keywords:

• HIV/AIDS
• tuberculosis
• co-infection
• trend

Acknowledgements

The authors appreciate the works by the GBD Study 2019 collaborators.

Author contributions

M.L. conceived, designed the manuscript. Y.W. did a literature search, analysis and interpretation, compiled tables and Figures and drafted the manuscript. W.J. and J.L. proofed and interpreted the report. All authors participated in data analysis, interpretation, discussion and writing of the manuscript.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The datasets analysed during the current study are available at http://ghdx.healthdata.org/gbd-results-tool.

Additional information

Funding

This study was supported by a grant from the National Natural Science Foundation of China [No. 71934002] and National Key R&D Program of China [No. 2021ZD0114104 and 2021ZD0114101]. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the article. No payment was received by any of the co-authors for the preparation of this article. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.