Multidrug-resistant tuberculosis (MDR-TB) in people living with HIV: Clinical issues, therapeutic challenges and perspectives in sub-Saharan Africa. A narrative review

HIV coinfection and multidrug-resistant tuberculosis (MDR-TB) pose a major public health challenge in sub-Saharan Africa, where high HIV prevalence promotes tuberculosis progression and complicates its management. In people living with HIV (PLHIV), profound immunosuppression leads to atypical clinical presentations, low bacillary load, and increased diagnostic difficulty. Despite advances such as the introduction of the GeneXpert test and all-oral treatments such as the BPaL regimen, access to these tools remains uneven, exacerbating diagnostic delays and mortality. Drug interactions between antiretrovirals and second-line antituberculosis drugs, as well as the toxicity of prolonged regimens, further complicate clinical management. Mortality among coinfected patients remains high, sometimes exceeding 40%, particularly in the absence of early diagnosis and adequate treatment. Improved early detection, integration of HIV/MDR-TB care and accessibility to innovative treatments are essential to change the trajectory of this dual epidemic in the region.