Global burden of HIV and drug-resistant tuberculosis co-infection and its attributable risk factors, 1990 to 2021, with projections to 2031.

BACKGROUND: The persistent global spread of HIV and drug-resistant tuberculosis (HIV/DR-TB) co-infection poses a significant challenge to international tuberculosis control efforts. This study aimed to analyze the global burden of HIV/DR-TB co-infection across age groups, genders, and Socio-demographic Index (SDI) regions, while identifying attributable risk factors. METHODS: Data from the Global Burden of Disease (GBD) 2021 and joinpoint regression analysis were utilized to examine epidemiological trends from 1990 to 2021 across different genders and SDI regions. The Bayesian Age-Period-Cohort (BAPC) model was employed to forecast trends up to 2031. RESULTS: HIV and multidrug-resistant tuberculosis (HIV/MDR-TB) co-infection exhibited no significant gender differences in prevalence, incidence, mortality, or DALYs (P = 0.053, 0.277, 0.354, 0.212). In contrast, HIV and extensively drug-resistant tuberculosis (HIV/XDR-TB) co-infection showed significantly higher rates in males for all outcomes (P = 0.007, 0.003, 0.003, 0.005). Burden distribution varied by SDI quintile: Low SDI bore a greater HIV/MDR-TB co-infection burden. High-middle SDI had higher HIV/XDR-TB co-infection prevalence. Unsafe sex was the predominant risk factor for HIV/DR-TB co-infections in both genders, followed by drug use in males and intimate partner violence in females. Regional risk patterns revealed that male drug use was more strongly associated with HIV/DR-TB co-infection in high-middle SDI regions, whereas unsafe sex and intimate partner violence (in females) showed greater impact in low SDI regions. Projections indicated a steady decline in HIV/DR-TB co-infection from 2021 to 2031. CONCLUSION: Despite observed declines, HIV/DR-TB co-infection continues to pose a significant public health challenge. Regional SDI-stratified interventions are urgently needed: low-SDI settings should prioritize healthcare system strengthening to address gender-specific vulnerabilities including unsafe sexual practices and intimate partner violence, while high-middle SDI regions require comprehensive drug abuse prevention programs combining public education with enhanced pharmaceutical controls.