Abstract:
Background: Tuberculosis (TB) remains the leading cause of death from a single infectious agent and the foremost killer of people living with HIV. Despite decades of progress, HIV-associated TB continues to exact a disproportionate toll, particularly in low- and middle-income countries. Emerging funding constraints and widening health inequities threaten to reverse gains achieved through integrated HIV and TB programs.
Current Burden: According to the WHO Global Tuberculosis Report 2025, an estimated 10.8 million people developed TB in 2024, resulting in 1.23 million deaths, including approximately 150,000 deaths among people living with HIV. Globally, nearly 41 million people were living with HIV in 2024, with 1.3 million new infections and 630,000 AIDS-related deaths. TB remains the leading opportunistic infection and cause of mortality among people living with HIV despite the availability of effective antiretroviral therapy (ART), tuberculosis preventive treatment (TPT), and rapid molecular diagnostics.
Challenges and Opportunities: Although ART scale-up and integrated HIV-TB services have significantly reduced mortality over the past decade, progress has slowed. Disruptions in prevention and treatment programs, declining international funding, antimicrobial resistance, and persistent gaps in early diagnosis threaten global targets. Modeling by UNAIDS suggests that sustained reductions in HIV financing could lead to millions of additional HIV infections and AIDS-related deaths by 2029. Conversely, innovations including shorter TB preventive regimens, next-generation molecular diagnostics, long-acting antiretrovirals, and differentiated service delivery offer unprecedented opportunities to accelerate progress.
Conclusion: HIV and TB remain a deadly syndemic requiring coordinated, people-centered, and adequately funded responses. Achieving the Sustainable Development Goals and ending both epidemics as public health threats will depend on strengthened integration of HIV and TB services, expanded access to prevention and treatment, investment in innovation, and renewed global solidarity. Failure to act decisively risks reversing decades of progress and perpetuating one of the most devastating infectious disease partnerships of our time.
Keywords: HIV; tuberculosis; HIV-associated tuberculosis; syndemic; antiretroviral therapy; tuberculosis preventive treatment; global health.
Biography:
Dr Edmund L C Ong MBBS MSC FRCP FRCPI DTMH graduated from University of Newcastle Medical School, UK and trained in UK in Infectious Diseases, Tropical Medicine and General Internal Medicine. His research interests are in the field of opportunistic infections, evaluation of anti-infective agents, clinical epidemiology and innovations in healthcare quality improvement and clinical audit. He is a principal investigator and collaborates in numerous research projects including HIV, Tuberculosis, Dengue fever in Nigeria, South Africa and Myanmar. Dr Ong has contributed to numerous text books of infection and has co-authored more than 160 papers in peer reviewed journals. He is an examiner for both undergraduate and postgraduate examinations including MRCP, Dip in HIV Medicine and MMed qualifications. He is an International Global Advisor (Malaysia) for the Royal College of Physicians, London. He is a member and a former Chairperson of the British HIV Association Audit and Standard of Care Committee. He is a trustee of the Charity Health and Hope (UK).
