A Systematic Review on Human Immunodeficiency Virus Tuberculosis Coinfection in India

There is a rising prevalence of human immunodeficiency virus-tuberculosis (HIV-TB) coinfection. India is one of the largest contributors to TB across Asia. The systematic review aimed to provide comprehensive data on the prevalence of HIV-TB coinfection among adult patients and its geographic variation (distribution) in India over the past 10 years.

PRISMA guidelines for systematic review were followed for this review. The leading search was through Medline/PubMed Central, Web of Science, and Science Direct. Government reports were also assessed for any relevant data on coinfection - the final review comprised 18 articles. Narrative synthesis was done to highlight any emerging patterns in the articles. The data extraction included key factors such as place/site of study, prevalence, TB type, age, gender distribution, religion, socioeconomic status, other risk factors, and the strengths and weaknesses of each study.

Most studies were single-centered, and the sample size ranged from 221 to 20,245. The prevalence of HIV-TB coinfection was as low as 0.4% up to approximately 42%. Maximum studies were from the states of Tamil Nadu and Maharashtra. Higher infection was seen among males. More cases were primary and of pulmonary TB. Studies did not report the prevalence in rural settings or among groups such as third genders, nor did they associate the findings with religion, socioeconomic status, education level, etc. Low CD4 count (<200 cells) was the most common risk factor.

There is a need for more information on the prevalence of HIV-TB coinfection and its association with factors such as population characteristics. Studies are required that highlight the rural and urban differences and prevalence among vulnerable groups such as third genders and from all states of India.