THE CORRELATION OF TUBERCULOSIS IN PATIENTS LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS

Abstract

Tuberculosis-HIV coinfection remains a public health challenge, especially in low- and middle-income countries. HIV-induced immunosuppression increases susceptibility to active TB and produces atypical presentations, requiring timely diagnosis and integrated care. Since sputum microscopy tends to be negative, bacteriological confirmation is recommended, along with the combined use of culture, molecular tests, and clinical-radiological evaluation. Antiretroviral therapy substantially reduces the risk of TB, but dual therapy is complex: interactions with rifampicin require adjustments (e.g., doubled dose of dolutegravir), and the medication burden compromises adherence. Social determinants such as poverty, low education, precarious work, inadequate housing, and stigma delay care and increase abandonment and mortality. In Brazil, coinfection is concentrated in young adults and men; regional series show a low cure rate and significant abandonment. In Manaus, between 2018–2022, 2,322 cases were registered, predominantly among men, with significant abandonment and factors such as smoking and drug use, indicating accumulated vulnerabilities. Population-based studies and hospital analyses point to recurrence associated with low immunity and unfavorable social conditions. It is concluded that, in addition to clinical aspects, the centrality of stigma and gender inequalities in the therapeutic trajectory is crucial. It is recommended to organize TB-HIV care pathways with active screening, contact tracing, initiation of TB and ART treatment, qualified pharmacological management, psychosocial support, and social protection. Analytical models and correlations between TB and HIV series should guide strategies focused on territory, sex, and age group, prioritizing adherence and retention in care to reduce transmission, recurrence, and deaths.