HIV and Tuberculosis Coinfection in Brazil: Cohort Profile Monitored by the Unified Health System (2015-2018)

To describe the sociodemographic and clinical profile of individuals with HIV-tuberculosis coinfection followed in services of the Brazilian Unified Health System (SUS), through the integration of data from the Qualiaids-Brazil Cohort and national health information systems.

Nationwide observational study using data from the Qualiaids-BR Cohort, composed of people living with HIV/AIDS (PLWHA) who initiated antiretroviral therapy (ART) between 2015 and 2018 in SUS services participating in the Qualiaids 2016/2017 survey. Individuals with at least one episode of active tuberculosis after ART initiation were included.

A total of 7,747 individuals with HIV-tuberculosis coinfection were identified. The majority were men, young, mixed-race, with low educational levels, and residing in the Southeast region. Social vulnerabilities included alcohol, tobacco, or illicit drug use (> 20%). Half presented an initial viral load > 100,000 copies/mL and 60% had baseline CD4 counts < 200 cells/mm³. Regarding tuberculosis, 80.3% were new cases, 9.5% re-entries, and 5.7% relapses. Treatment duration was concentrated between 6 and 12 months, with a cure rate of 70.9% and abandonment in 10.4% of cases, of which 21.3% also discontinued ART.

Data integration enabled a comprehensive profile of HIV-tuberculosis coinfection, consistent with national findings and marked by social vulnerabilities that impact adherence and outcomes. The high proportion of treatment abandonment, also associated with ART discontinuation, highlights systemic weaknesses and the need for integrated care strategies for individuals with HIV-tuberculosis coinfection. The findings reinforce the importance of promoting comprehensive and continuous care to mitigate the impacts of coinfection.