When two deadly infections team up, the result can be devastating. Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) — two of the world’s most serious infectious diseases — form a dangerous alliance that continues to challenge India’s healthcare system. Known as HIV–TB coinfection, this combination is responsible for higher rates of illness and death, especially among people with weakened immunity. Yet, with timely diagnosis, proper treatment, and community awareness, this “double trouble” can be defeated.
When one disease fuels another
HIV weakens the body’s immune system, making it harder to fight off infections. TB bacteria, which may already be present in a dormant state, can then become active. According to the World Health Organization (WHO), people living with HIV are 15 to 18 times more likely to develop active TB
compared to those without HIV¹. In India, this connection is a major public health concern. As per the India TB Report 2024, around 62,000 TB patients were also found to be HIV positive — accounting for about 3.2% of all notified TB cases in the country². The good news? TB services are now being closely linked with HIV programmes to ensure both infections are diagnosed and treated early.
The Indian picture: A double challenge
India has the third-largest population of people living with HIV (PLHIV) in the world, estimated at 2.4 million, as per NACO (National AIDS Control Organisation)³. At the same time, it also bears the world’s highest TB burden, contributing to over 27% of global TB cases⁴. When both infections collide, the risk of death multiplies. In fact, TB remains the leading cause of death among people with HIV, accounting for nearly one-third of all AIDS-related deaths worldwide⁵. However, India’s integrated approach under the National TB Elimination Programme (NTEP) and National AIDS Control Programme (NACP) is steadily changing that story.
How India is fighting the HIV–TB coinfection
The Indian government has made HIV–TB collaborative activities a key priority. Here’s how this strategy is unfolding on the ground:
- Bidirectional Screening
o Every TB patient is screened for HIV, and every HIV-positive person is tested for TB.
o This early detection helps start treatment immediately, saving lives. - One-Stop Centres
o Joint TB–HIV service centres in ART (antiretroviral therapy) clinics ensure both
diseases are treated simultaneously.
o This also reduces stigma and travel burden for patients. - Free Diagnosis and Treatment
o TB diagnosis (using GeneXpert tests) and HIV testing are provided free under
government programmes.
o All TB–HIV coinfected patients receive antiretroviral therapy (ART) and anti-TB
drugs at no cost.
- Nutritional and Social Support
o The Ni-kshay Mitra initiative and community-based care models ensure that
patients get both emotional and nutritional support during recovery. - Preventive TB Therapy for PLHIV
o The ICMR recommends Isoniazid Preventive Therapy (IPT) for HIV-positive
individuals to prevent latent TB from becoming active⁶.
Stigma: The invisible enemy
Beyond the medical challenges, people with HIV–TB coinfection often face double stigma — from society and sometimes even within families. A study by the Journal of Global Health Reports found that more than 40% of PLHIV in India delay TB treatment due to fear of discrimination⁷. Breaking this silence through public awareness, school education, and community counselling is vital. After all, no disease should steal a person’s dignity — especially when both TB and HIV are completely manageable with proper care.
The Road Ahead: Integrating Care and Compassion Eliminating TB and controlling HIV require more than medical solutions. It needs community
ownership, trust, and empathy. Here’s what experts recommend to strengthen India’s fight:
Expand HIV–TB integrated clinics to every district.
Train healthcare workers to recognise coinfection symptoms early.
Promote awareness campaigns that focus on prevention and destigmatisation.
Ensure full nutrition and ART adherence for all coinfected patients.
Empower NGOs and community volunteers to track and support patients at home.
The WHO’s End TB Strategy also stresses that TB–HIV collaboration is essential for reaching the global TB elimination targets by 2030⁸.
Fast facts: HIV–TB coinfection in India
62,000 TB patients in India are also HIV-positive²
TB is the leading cause of death among PLHIV⁵
HIV increases the risk of active TB by 15–18 times¹
Free testing and treatment are available under NTEP & NACP
Integrated care and early screening save lives
Hope on the horizon
India’s progress is encouraging — with over 95% of TB patients screened for HIV and increasing ART coverage among coinfected individuals². The country’s dual response shows that when healthcare systems collaborate instead of working in silos, outcomes improve. Every life saved from HIV–TB coinfection is a victory not just of medicine, but of humanity, compassion, and collective will. As India marches toward its TB Mukt Bharat goal, the message is clear: “No one should die of a curable disease — not from TB, not from HIV, and never from both.”
Key takeaways
TB and HIV are a dangerous but treatable combination.
Early testing and integrated care are the most powerful weapons.
Nutrition, empathy, and adherence support are as vital as medicine.
Stigma and delay in treatment remain major barriers.
Together, India can end both epidemics — one patient, one cure at a time.
This is an educational initiative supported by Mylan Pharmaceuticals Private Limited (a Viatris company).
References:
- World Health Organization (WHO). Global Tuberculosis Report 2023.
https://www.who.int/publications/i/item/9789240078467 - Central TB Division, MoHFW. India TB Report 2024. https://tbcindia.mohfw.gov.in/
- National AIDS Control Organisation (NACO). India HIV Estimates 2023. https://naco.gov.in/
- World Health Organization (WHO). TB Burden by Country.
https://www.who.int/data/gho/data/themes/tuberculosis - UNAIDS. Global AIDS Monitoring 2023. https://www.unaids.org/en
- Indian Council of Medical Research (ICMR). Guidelines for TB Preventive Therapy among
PLHIV. https://main.icmr.nic.in/ - Journal of Global Health Reports. TB–HIV Stigma and Treatment Delay in India.
https://www.joghr.org/ - World Health Organization. End TB Strategy: HIV–TB Collaborative Framework.
https://www.who.int/teams/global-tuberculosis-programme