Global Burden of Drug-Resistant Tuberculosis and HIV Co-Infection and Its Attributable Risk Factors, 1990 to 2021, with Projections to 2031

Background The continuous spread of HIV and drug-resistant tuberculosis (DR-TB) co-infection is a significant challenge and threatens global tuberculosis (TB) control. The objective of this study was to analyze the global burden of HIV and drug-resistant tuberculosis co-infection across different age groups, genders, and Socio-demographic Index (SDI) regions and attributable risk factors. Methods Data from the GBD 2021 and joinpoint regression analysis were utilized to examine trends from 1990 to 2021 across different genders and SDI regions. The A BAPC model was employed to forecast trends up to 2031. Results Co-infection of HIV with Multidrug-resistant tuberculosis (MDR-TB) shows no gender difference, while extensively drug-resistant tuberculosis (XDR-TB) is more prevalent in men (all P  < 0.01). The burden varies by SDI, with low SDI regions having more MDR-TB and high-middle SDI regions more XDR-TB. Unsafe sex was the primary risk factor for HIV co-infection with DR-TB, with drug use being the second major contributor in men and intimate partner violence in women. Projections of DR-TB by HIV status indicate a gradual decline from 2019 to 2031. Conclusion Despite declining trends, the burden remains substantial, especially in resource-limited areas. To combat co-infections of HIV and XDR-TB, in addition to reducing unsafe sexual practices, it is necessary to implement measures to curb drug abuse among men and protect women from intimate partner violence. Clinical trial number: not applicable.