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Peer-reviewedCC BY-NCJournal of Korean medical science

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

  • Eun Hye Lee1,2
  • Yun Seo Kim3
  • Min Seo Kim4
  • Roshan Ravindran5
  • Dong Keon Yon6,7
  • Young Ae Kang8
  • Jae Il Shin2,9
  • Lee Smith10,11
11 affiliations
  1. 1Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea .
  2. 2Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, Korea .
  3. 3Yonsei University College of Medicine, Seoul, Korea .
  4. 4Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA .
  5. 5KLNIK, Wilmslow, UK .
  6. 6Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea .
  7. 7Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea .
  8. 8Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea .
  9. 9Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea .
  10. 10Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK .
  11. 11Department of Public Health, Faculty of Medicine, Biruni University, Istanbul, Turkey .
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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.

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Cite

BibTeXRIS
BibTeX
@article{lee2026global,
  title = {{Global Trends and Burden of HIV Coinfection With Extensively Drug-Resistant Tuberculosis From 1990 to 2021: The Global Burden of Disease Study 2021}},
  author = {Eun Hye Lee and Yun Seo Kim and Min Seo Kim and Roshan Ravindran and Dong Keon Yon and Young Ae Kang and Jae Il Shin and Lee Smith},
  journal = {Journal of Korean medical science},
  year = {2026},
  month = aug,
  doi = {10.3346/jkms.2026.41.e302},
  url = {https://europepmc.org/article/PMC/PMC13730649},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Global Trends and Burden of HIV Coinfection With Extensively Drug-Resistant Tuberculosis From 1990 to 2021: The Global Burden of Disease Study 2021
AU  - Eun Hye Lee
AU  - Yun Seo Kim
AU  - Min Seo Kim
AU  - Roshan Ravindran
AU  - Dong Keon Yon
AU  - Young Ae Kang
AU  - Jae Il Shin
AU  - Lee Smith
PY  - 2026
DA  - 2026/08/06
JO  - Journal of Korean medical science
DO  - 10.3346/jkms.2026.41.e302
UR  - https://europepmc.org/article/PMC/PMC13730649
AB  - 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.
SN  - 1598-6357
SN  - 1011-8934
ER  -