Tuberculosis–human immunodeficiency virus coinfection and sociodemographic factors in Chihuahua, Mexico: A cross-sectional study

<h2>1. Abstract</h2><h3>Background</h3> Tuberculosis (TB) and HIV coinfection are still major public health issues, particularly in regions marked by social and structural inequities. This study examined sociodemographic, clinical, and behavioral factors associated with TB–HIV coinfection in Chihuahua, Mexico. <h3>Methods</h3> An analytical cross-sectional study used TB and HIV surveillance registries from 2019–2024. All confirmed TB cases with documented HIV status and complete sociodemographic data were included. Variables comprised age, sex, self-identified indigenous status, municipality, clinical form of TB, body mass index (BMI), and non-HIV-related immunosuppression. Descriptive and bivariate analyses were performed, followed by multivariate logistic regression to estimate adjusted odds ratios (aORs) with 95% confidence intervals. Model performance was assessed using the Hosmer–Lemeshow test, ROC curve analysis, and five-fold cross-validation. <h3>Results</h3> Among 5,123 TB cases, 3.9% were coinfected with HIV. Coinfection was more frequent in men and among individuals in the 30-39 years. After adjustment, non-HIV immunosuppression emerged as the strongest predictor (aOR = 14.66; p < 0.001). Female sex (aOR = 0.29; p < 0.001), and indigenous self-identification (aOR = 0.07; p < 0.001) were associated with lower odds of coinfection compared with males and non-indigenous individuals, respectively. In addition, individuals with BMI ≥ 18.5 kg/m2 had lower odds of coinfection compared with underweight status. No significant differences were observed between pulmonary and extrapulmonary TB forms. The model demonstrated strong discrimination (AUC = 0.867). <h3>Conclusions</h3> TB–HIV coinfection in Chihuahua follows identifiable epidemiological patterns, highlighting the importance of systematic HIV screening, timely antiretroviral therapy, and equity-oriented public health strategies.