Tuberculosis incidence trends and risk factors among people living with human immunodeficiency virus (HIV) in Sichuan, China: a retrospective cohort study (2010–2024)

BACKGROUND: To retrospectively analyse the tuberculosis (TB) incidence rate and influencing factors among people living with HIV (PLHIV) in Sichuan, China, from 2010 to 2024 and to inform HIV/TB coinfection prevention. METHODS: A dynamic cohort of PLHIV was established (2010‒2024) to estimate the TB incidence rate. A nested case‒control study was used to identify factors influencing TB incidence via logistic regression. RESULTS: T lymphocytes (CD4) ≥ 200 cells/µL, and homosexual transmission. TB risk increased with clinical identification and delay in antiretroviral therapy (ART) initiation (> 90 days) (all P < 0.001). CONCLUSION: Sichuan PLHIV presented a relatively high TB incidence rate without a significant change trend; marked regional disparities were evident across the province, with distinct temporal trends in incidence rate variation among regions. TB incidence was influenced by multiple factors, including individual characteristics, infection-related, and ART-related factors. Targeted interventions are urgently needed for HIV/TB coinfection control.