TB-HIV coinfection is a public health challenge in Brazil due to the synergy between the diseases and their impact on morbidity and mortality. Analyzing this coinfection is essential to support public policies. To describe the epidemiological profile of TB-HIV coinfection in the municipality of São Paulo from 2018 to 2024. Descriptive, ecological, and retrospective study, using clinical and demographic data from TB-HIV notifications obtained from TABNET of SMS-SP and DATASUS. A total of 7,910 cases were reported in São Paulo, with predominance among males (75.4%; ratio 3:1; incidence of 50.1 per 100,000). The 30–39-year age group accounted for 30.6% of cases (20.4 per 100,000), followed by 40–49 years (18.2 per 100,000) and 20–29 years (13.6 per 100,000). Most individuals had 8–11 years of schooling (45%; n=2,511). The pulmonary form was the most common (53 per 100,000); among extrapulmonary forms: peripheral lymph node (3 per 100,000), miliary (2.2 per 100,000), and pleural (2.0 per 100,000). Regarding diagnosis: 63.3% by spontaneous demand, 30.4% in emergency settings, 2% by active case finding, and 4.3% post-mortem. The pulmonary form was laboratory-confirmed in 68.3% (n=4,362). Sputum smear microscopy was positive in 29.6% (n=1,742) and negative in 44.6% (n=2,627). Sputum culture was positive in 48.3% (n=2,892) and negative in 23.2% (n=1,391). Rapid molecular testing (RMT) was performed in 69% of cases, detecting rifampicin-sensitive M. tuberculosis in 20.5% (n=1,627), rifampicin resistance in 2.1% (n=167), indeterminate results in 3.6% (n=282); not detected in 19.7% (n=1,559); and not performed in 30.7% (n=2,432). Case type: retreatment after abandonment 20.5% (n=1,624), relapse 14.1% (n=1,112), failure 1.4% (n=112), regimen change 2.0% (n=158). Treatment outcomes: cure 40.1% (n=2,793), abandonment 26.9% (n=1,856), death due to TB 0.1% (n=7), death from other causes 18.1% (n=1,262), transfer 1.0% (n=73), DR-TB 1.3% (n=88), regimen change 2.1% (n=147), primary abandonment 0.4% (n=29), unknown/blank 10.1% (n=699). TB–HIV coinfection in São Paulo predominated among young men, with low educational level and pulmonary disease. Most cases were diagnosed by spontaneous demand or emergency services; active case finding was lower than post-mortem diagnosis. The high rates of abandonment and relapse indicate failures in follow-up. Detection of rifampicin resistance (2.1%) may be underestimated due to low RMT coverage, suggesting underreporting of DR-TB. The need for integrated strategies for prevention, early diagnosis, and treatment adherence is reinforced.
Cabral et al. (Sun,) studied this question.