Risk Factors for Pulmonary Tuberculosis in Patients with HIV : A Systematic Literature Review

Abstract

Coinfection of tuberculosis (TB) and human immunodeficiency virus (HIV) is a significant global health problem, especially in developing countries. In 2023, an estimated 10.8 million people fell ill with TB worldwide, about 161 000 people died of HIV-associated TB. The percentage of notified TB patients who had a documented HIV test result in 2023 was 80%. HIV weakens the immune system, increasing susceptibility to TB, which is the leading cause of death in patients with HIV. This study aimed to identify and analyze various risk factors that contribute to the occurrence of pulmonary tuberculosis in HIV patients. This study is a literature review with a systematic approach to fifty journals published between 2020 until 2025, search on various scientific databases such as Google Scholar, PubMed, and Garuda Ristekbrin portals. The main risk factors for pulmonary TB in HIV patients include CD4 levels <200 cells/mm³, advanced clinical stage of HIV, low socioeconomic status, low education levels. In addition, environmental factors such as household air pollution and a history of contact with TB people also increase the risk. Behavioral variables such as substance use and delays in antiretroviral therapy also aggravate the patients condition. In conclusion, patients with HIV have a high risk factor for developing TB, so it is necessary to increase active screening, strengthening patient education, and strengthen social support. Appropriate risk-based interventions will improve treatment success and lower coinfection mortality.