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Global Trends and Burden of HIV Coinfection With Extensively Drug-Resistant Tuberculosis From 1990 to 2021: The Global Burden of Disease Study 2021

Year: 2026

Type: article

Abstract: BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) remain global health threats. Extensively drug-resistant TB with HIV co-infection is associated with substantial mortality worldwide. This study aimed to estimate the global burden and temporal trends of extensively drug-resistant tuberculosis and human immunodeficiency virus co-infection (HIV/XDR-TB) from 1990 to 2021. METHODS: We used the Global Burden of Diseases Study 2021 data to estimate the global burden of HIV/XDR-TB from 1990 to 2021. We employed a Disease Modeling-Meta-Regression model to estimate incidence, prevalence, mortality, and disability-adjusted life years. Mortality was calculated using population attributable fraction methods, accounting for HIV/XDR-TB overlap. Results were stratified by Socio-demographic Index (SDI) and reported with 95% uncertainty intervals (UIs). RESULTS: In 2021, global HIV/XDR-TB incidence was 1,606.42 cases (95% UI, 1,163.94-2,182.83), with an age-standardized incidence rate of 1.94 per 10 million and a -15.59% change (95% UI, -36.38 to +10.26) since 2010. Mortality estimates indicated 840 deaths (95% UI, 385.44-1,491.72) in 2021, with an age-standardized death rate of 1.01 per 10 million (95% UI, 0.47-1.80), representing a 35.85% decline from 2010 (95% UI, -50.45% to -17.75%). The burden was highest among those aged 35-39 and consistently higher in males. Regionally, Eastern Europe and Southern Sub-Saharan Africa showed the highest burden, while Oceania had the greatest increase. Substantial heterogeneity was observed across regions and SDI levels. CONCLUSION: Despite declines in HIV/XDR-TB burden, significant regional and demographic disparities persist, highlighting the need for targeted public health strategies in high-burden regions.

Source: Journal of Korean Medical Science

DOI: 10.3346/jkms.2026.41.e302