Mycobacterium tuberculosis in HIV co-infection: a growing concern in Europe?

In the European region of the WHO, the largest part of tuberculosis (TB)/HIV co-infection is found in parts of Eastern Europe. In other parts of Europe, TB among people with HIV has been declining with migrants at highest risk. This review provides an overview of the epidemiology, determinants, regional differences, diagnostic and therapeutic standards, and future challenges of TB/HIV co-infection in Europe.

Socioeconomic factors, including substance abuse, incarceration and migration as well as persistent gaps in early HIV and TB diagnosis, and lack of antiretroviral therapy (ART) continue to drive TB incidence and poor outcomes; meanwhile, new shorter (all-oral) TB regimens and diagnostic innovations offer major advances, but their impact is uncertain due to unequal access and emerging drug resistance.

Addressing TB/HIV co-infection in the WHO European region requires scaling up early HIV and TB testing, and ART coverage; integration of HIV, TB, and substance-use services within person-centered care models; strengthening laboratory and surveillance systems in Eastern Europe and Central Asia; and addressing social determinants-such as poverty, stigma, and substance use disorders-that drive much of the TB/HIV burden in the region.